Sacramento girl needed amputations after 5-hour wait at emergency room

[woo me with science]

Source: Sacramento Bee

By Cynthia Hubert
[e-mail]
Published: Friday, Dec. 31, 2010 - 12:00 am | Page 1B
Last Modified: Friday, Dec. 31, 2010 - 11:43 am

.....

The family's ordeal began on a Sunday morning in early December, when the normally rambunctious (2-year-old) Malyia developed a fever and became lethargic, Ryan Jeffers recalled.....When her symptoms persisted the next day, Jeffers and Yang, his fiancé, took their daughter to an urgent care center, where specialists told them to go to the emergency room. By the time they arrived at Methodist, he said, splotches that looked like bruises had developed on Malyia's cheeks, and she was "getting really weak," he said. "After a while, she couldn't even walk," and her fever had jumped to 103 degrees.

Jeffers, 29, said he pushed for immediate care, but was rebuffed. After about five hours, he said, he ambushed a nurse and demanded to see a doctor. The physician took blood samples that suggested Malyia was in liver failure, Jeffers said. She was taken by ambulance to the pediatric intensive care unit at Sutter Memorial Hospital. Doctors there had her flown to Stanford aboard a helicopter.
....

It turned out the girl was in septic shock from a Streptococcus A infection that somehow invaded her blood, muscles and internal organs....The Stanford team put the girl on life support and gave her medicine to boost her blood pressure. They ultimately had to perform operations to amputate her lower legs and her left hand, which had been irreversibly damaged by a lack of oxygen.

.....

While Malyia's parents have medical insurance, many of their daughter's bills will go uncovered, including a $26,000 tab for her helicopter ride from Sacramento to Palo Alto, Jeffers said. The couple are paying just $10 a day to stay at the Ronald McDonald House, but must cover their food and transportation costs.

.....

HOW TO HELP

Friends have established a fund to help cover the family's expenses. To donate, go to http://jeffersfamily.chipin.com/ryan-jeffers-and-family


Read more: http://www.sacbee.com/2010/12/31/3290271/sacramento-girl-needed-amputations.html

---

:(

[elleng]

1. LET the bills go uncovered!

;(

[No Elephants]

20. And don't let the malpractice lawsuit go unfiled.

[elleng]

66. Yes, but, such are SO burdensome,

would like to see voluntary 'mea culpa' from those responsible, and collective 'we'll assume $ responsibilities,' from all those involved, including 26,000 'travel' expense. I realize attenuated, and causation doesn't exist down the chain, but but but...

[Grinchie]

86. What I find amazing is that people actually accept that it costs $26,000

For a helicopter ride from Sacramento, CA to Palo Alto, Ca. At most, a thirty minute flight.

If one were to add up the total cost for all the capital equipment, i.e. Helicopter, gurney, and a moderate amount of life support gear, along with staff, I can assure you that it would not cost $26,000.

If one were to take an example of 100 flights, this would net the Air Ambulance company 2,600,000. Perhaps 2.6 million dollars is not so much money anymore, and we are seeing the Corporations reacting to inflation, while we eat synthefood made by chemists from mountains of subsidized GMO Corn and Soy.

The point is that we are not supposed to pay for the entire system in one flight, and americans are so stupid these days that they just accept the bill without thinking about how they pulled the numbers out of their ass.

[madmax]

103. Agree - seems to me they pull these fees out

of their asses and because they're so-called health costs no one questions anything.

Aside from that helicopter nonsense, this is such a feaking tragedy. Poor child is only 2 years old and now will live without her legs and a hand. I think her situation should be reciprocated on that bastards who cause hers. Ok, that's harsh but, this is beyond words.

[Grinchie]

111. Reminds me of my time at Intel Corp in Folsom

They would fly us to Santa Clara on a private charter every day for free, round trip first class bus ride to the airport included.

And you are correct. The only reason they charge these prices that are so out of line with reality is because it is "Healthcare". More like an offer you can't refuse from the Corlioni Family.

[One_Life_To_Give]

126. How many flights per year?

The expense isn't so much the flight but maintaining a 24/7 immediate launch ability. Like your fire department the cost isn't what it takes for one event. It's maintaining staff/equipment in case it's needed.

Primary Helicopter
Backup Helicopter
4 Pilots in Rotation
4+ Flight Nurses
Supervising Flight Surgeon
2-3 Specialists in Trauma/Airway
Helicopter Mechanic

Salaries and benefits per year in excess of $1Million.
Maintenance etc. $??
Consumables and Perishables $??

If they only do 100 flights per year they might just break even.
Now for what is described above I think 26k is excessive for just a transport. However if a Respiratory Therapist or other specialty was required along with inflight medical procedures then it could easily justify it.

[benEzra]

128. Yup. That is definitely high.

When my son was born in '99 in Pensacola with a severe heart defect, UAB Hospital in Birmingham, AL sent a jet round trip to Pensacola and back to get him. A week later, the same jet flew him to Boston, MA for surgery at Children's Hospital, another round trip for the flight crew. The total for both flights---Cessna Citation 500 jet, pilot and copilot, a doctor and 2 flight nurses busily keeping him alive, ICU-class isolette, fuel (including a refueling stop on the way to Boston) AND critical-care ground transport on both ends of both trips, cost less than $21K. I realize that inflation has bumped fuel prices up since 1999, but I agree, $26K for a 30-minute flight seems very high.

[CanonRay]

30. But, but, we have the best healthcare system in the world!

USA USA USA!

[zbdent]

54. problem is, this is "anecdotal" ... doesn't work when it's for a lefty/liberal/Democratic cause ...

however, "anecdotal" stories without any identifying characteristics, such as a person's name or a location, are "smoking gun, unimpeachable evidence" when it comes to rightie/conservative/Republican issues ... like some unnamed "Communist" donating money to a Democratic politician.

[perdita9]

64. Pardon me while I laugh

I have a friend who works in a hospital. She got a UTI, did the test herself which showed it was E. coli. Unfortunately she was new to the city and didn't have a doctor yet. It took her 3 days to find someone with a MD after their name who would write her a perscription for an antibiotic.

It was too late. She spent 5 days in the hospital being treated for septic shock.

THAT'S what passes for 'health care' in the USA.

[Cronus Protagonist]

96. Takes me about ten seconds with a simple phone book

And I can do that in any city in the western world with similar, perfect results. No one needs three days to find a doctor. No body.

[SharonAnn]

107. If your insurance limits who you can see in their plan, and many aren't accepting

new patients, and you have a job where you can't be on the phone all day calling doctors offices.

It can happen.

[benEzra]

129. Well, if you're wealthy enough to pay all your doctor's visits out of pocket, go for it.

It took me a long time to get in to see a primary-care physician the last time we moved, though. A lot of them don't want to see you for the first time when you're sick, so you have to wait till you're well, then find one in-network with your insurance, make an appointment (generally booked weeks in advance), show up on the appointed day for your baseline visit, and then you have a physician to call on the next time you're sick. If you're new in town, it's not a quick process.

Around here, not even "Urgent Care" places are open all that late, either, and (like the ER's they supplement) they are chronically understaffed.

[elleng]

71. Its a good system (NOT great.). People make mistakes EVERYWHERE.

Difference here is responsibility, for the care and for the mistakes.

[Doctor_J]

90. It's a good system, but every other industrialized country has a better one

:eyes:

[RaleighNCDUer]

92. You call this a 'system'?

There is no system here. Nothing is systematic. It's all a hodge-podge of personal capability, medical availability, insurance availability, access and money.

A system is where a person could go to ANY medical professional, and be promptly and efficiently guided to where they can get the most help, regardless of their income or insurance status. When half the people say "it's not my job" and the other half say "I don't know" - that cannot be called a system.

(edit for typo)

[elleng]

98. A group

of interacting, interrelated, or interdependent elements forming a complex whole.

American Heritage Dictionary

[RaleighNCDUer]

101. Dictionary definitions notwithstanding, a system that is predicated on

its dysfuctionalism cannot truly be called a system, any more than the 'interacting, interrelated and interdependent' gangs in Somalia can be called a government.

[sweetapogee]

124. can you give an example from

personal experience? The OP is a tragedy we all agree but to condemn the medical industry as collectively incompetent I think is a little harsh. The system, even if locally dysfunctional has to operate within protocols. If you are being treated in a manor outside of the protocols then you my friend have a good chance of extracting some serious greenbacks from your health care provider.

If your ER of choice doesn't do well by you, why not consider another ER next time you have a need? Around here there are 14 receiving facilities within an hour drive, only one of them is a nightmare, the rest are top notch, meaning I would send my mother to any one of them. But the decision on which facility is going to depend mainly on the reason for the ER visit. I'm not going to SLB for trauma, that's good for stroke, I'm going to LVCC for level 1 period.

Seriously, next time call your attorney if you are not receiving from the ER the medical care you require.

[dkf]

2. How delayed were they because people who didn't need to be there were seen first?

Is this the consequence of having no insurance and letting our emergency rooms turn into clinic care?

[truedelphi]

13. A good emergency room doesn't operate that way. They don't

Make it a first come, first serve style of operation.

They triange the patients. Everyone gets seen by a nurse practitioner, who takes the patient-to-be's vitals. Those who are deemed to be serious get seen first.

[RSillsbee]

25. Close but not quite

A Nurse practitioner is a licensed health care similar to a Physician's Assistant. They don't waste NPs doing Pt. intake interviews.

Also I've seen 75 people in the waiting room on a Friday night half of them just needing tylenol. Add an ambulance or two (or three) into the mix and and you can end up waiting a while to be seen.

IMO the biggest problem is that the ER has morphed into an Urgent Care clinic

[TheMadMonk]

33. And the solutions are both simple and cost saving.

A house doctor (GP) to deal with the tylenol/prescription cases, and a final year resident with an experienced nurse constantly circling the waiting room with a suture trolley. Treat the lowest teir cases with an absolute minimum of paperwork. Perhaps using a token system to keep records coherent in case some sort of followup is needed.

Devote a small team solely to clearing the five minute cases and do not "poach" from them for anything short of a multiple car pileup or other major incident. Too long in a waiting room and one flu case becomes twenty in a week or two. One gastro case decorating the waiting room floor almost certainly guarantees more gastro cases in the days to follow. And it's just not particularly pleasant for anyone around, whatever the outcome.

My gut feeling is that, if an ER devoted a set proportion of its efforts to clearing the most minor cases with minimal accounting, its clearance rates on the more major would improve significantly at the same time.

Even better, would be to establish some sort of incentive system (tax break or whatever) for clinics of any type to offer such minor services free of charge to all comers and take the load off ERs entirely. Particulary if the patients are smart enough to triage themselves to some degree. A cosmetic surgery clinic could manage a fair number of careless chefs for the price of six inches of 3 oh silk and a local per each.

It would also be a great way to begin a stealth introduction of Single Payer.

[hedgehog]

62. I've been hearing about over-crowded emergency rooms my

entire adult life. Still, the emergency room today is pretty much identical to the emergency room I took my kids to when they were little. Grab a first season clip of ER and compare it to a final season clip - NOTHING HAS CHANGED!

The ideas you present are valid and an excellent starting point. The problem is that if you start tinkering with one part of hospital operations, you might take a hard look at items such as the CEO's salary!

[napi21]

78. Those are GREAT IDEAS! I have a close friend who is a VP

of Finance at the largest hosp. system in Pgh. Pa. I'll b talking to he tomorrow and I will pass your suggestions along. Even though she's not part of the medical side of the hospital system, her words carry a lot of weight. Even though I dont live there anymore and it wouldn't benefit me, I'd be thrilled if she posed the ideas to whoever's in charge of operations there and even one of your ideas sparked interest!

If anything positive happens, I'll let you know.

[sweetapogee]

118. even us lowly

EMT's have to do a full patient assessment on even the most trivial case and transport the patient to the ER unless they sign a refusal. We can treat a symptom but we cannot diagnose a condition. The report we must file is the same in time spent preparing for a paper cut as for an AMI.

I wanted to make a comment on the cost for medivac. I have a few friends that are flight nurses on medivac and even they are not sure of the cost. I keep hearing anything from 12K to 18K from our service area to the nearest class 1 trauma facility. An ALS truck to the same destination costs $900.00 Still a lot of money. Helicopters of that variety are fleet based and manned 24/7 even if they are not in use. They cost a lot to purchase (as in millions of dollars) and even more to maintain. I personally question the usage of them in some cases. I suspect that we will see fewer of them used in the future, it is just too expensive.

When I run QRS calls from my house, I sometimes weigh the nature and other particulars of the call vs. the amount of time I will spend writing up my report before I decide if I will respond. I'm not getting out of bed at 2:30 for a hangnail, because it may eat up 2 hours of my time but I will gladly do so for a real emergency. It's sad to think but many people have no idea just how much the EMS system is abused. Many people think that entering the ER on a cot gets them faster treatment. This is not always true, you will probably be placed on a ER bed faster (to release the ambulance crew) but you will wait just as long, if not longer to be seen if your CC is not a real emergency.

[truedelphi]

95. In the situation you describe - I bet you are talking

About a Big City Hospital. And the problem there is that there simply are not enough Big City Hospitals. Or enough Urgent Care Clinics.

I have been fortunate to live in rather under populated places my last 20 years. The best emergency care I see is here in Lake County at the Sutter-Owned facility. It is a small enough County that the ER workers know who is there for the dose of Tylenol and who is there cuz they need help.

And it is triaged in an excellent fashion. If the person taking my vitals is not a NP, she has me fooled.

The only complaint I have about the facility is the one I have about all ER facilities here in the US - no open pharmacies. Let's say someone brings their spouse there because he needs his insulin. And they don't have it to give him, and there is no pharmacy open until 9 AM or later the following day. In Europe they are smart enough to have pharmacy going 24/7, so that people who need whatever can get it.

[thecrow]

115. I got sent to a modern, regional ER one night

I had an evolving stroke goin' on.
It was 3 hours before they read the letter from my doctor
and about 6 before I got to get a CAT scan.
Then my insurance provider kept me waiting in a cold operating room
til 5 am so they didn't have to pay for another night.
Ahhhh.... the American health system. Nobody cares for you anymore.

[sweetapogee]

120. how are you feeling now?

Find out which receiving facilities in your area specialize in trauma, cardiac, stroke, pedi and so forth and go to that specific facility when you have that type of CC. For example, our local ER cannot do much for a stroke so you are wasting valuable time going there first.

I'm puzzled as to why a Dr. would write a note to a receiving facility explaining a stroke. Suspected stroke patients, even if they are in their Dr's office are transported via an ALS or flight pronto. There really isn't that much that needs to be done ahead of time other than vitals and pre-hospital CSS exam. If you are failing the CSS, the ER should have you started with treatment immediately. The Golden Hour for a CVA is just that, 1 hour at onset. Around here, anything other than a TIA will probably be a flight.

take care

[Arkansas Granny]

31. And I suppose that explains why my ankle injury was treated before the

older gentleman who came in pale and sweating and complaining of chest pains. I'm not a nurse practitioner, but he certainly looked like he needed to be seen immediately instead of sitting in the waiting room for 4+ hours. He was still waiting when I left after being xrayed and having a cast applied.

[catrose]

49. Wow

When I went in with chest pains, they didn't even let me look for my insurance card. "Name? Problem? Come on back. Now."

[truedelphi]

87. Ew, that is horrid.

Like I said, a "good" emergency room would...

[RSillsbee]

116. I don't know the whole case HX so I can't answer

If you have all the answers why don't you go to school, get your license go to work and show all of us who have spent most of our lives in the field how it's done

[dixiegrrrrl]

65. Emphasis on the "good".

If I had not insisted on Mr. d. being seen at 10 am on a Sat. morning
( our dr, told him he had to go to ER)
his partially collapsed lung might have gotten worse..there was not only NO triage,
the lone admitting clerk could not even see the ER waiting room from her cubicle.
People just walked in, signed a sheet, and sat down, then waited to be called on, like a regular dr. office. There were 20 folks there at least, on an early Sat, am.
Unless you arrived in an ambulance, there was no sense of urgency and no triage.

[blueamy66]

70. Agreed. Something went terribly wrong in that ER that day.

Last Summer, my fiance was vomitting blood. I ran into the ER screaming and they got a wheelchair out to the parking lot and took care of him FIRST.

I just don't get it sometimes.

[No Elephants]

19. Yes, but the hospital's triage policies determine who is seen first.

ETA: Sorry, should have read True Delphis post before I posted.

[dflprincess]

105. It's a consequence of the first doctor telling the parents to take her to ER

rather than calling an ambulance for her or (at least) calling the hospital and telling them he was sending a very sick child over.

I discovered with my mom that arriving in an ambulance gets you seen much faster than if someone drives you in.

[napi21]

3. lack of most people having HC ins. is the reason she has to wait 5 hrs.

while I suspect most of the people in that er were NOT seriously ill enough that an urgent care or GP's office couldn't have cared for them.

I'm NOT a "sue them" type of person, in this case I'd suggest suing the Methodist hospital for failure to respond. The people wh run the er are trained to recognize when a patient's condition can't wait!

[No Elephants]

24. Could have been any one or more of a number of reasons.

I am in an ER more than most folks. World famous hospital, too.

You would not believe the incompetence and indifference I've witnessed. Not terribly surprising when interns and residents who have been on the run for 30 hours straight are pretty much in charge, especially overnight and on major holidays. (On the flip side, you would not believe the competence and caring Ive witnessed.)

Some nights, it seems there's one car crash and fire after another.

Chronic understaffing is a problem00and heaven forbid someone calls in sick at the last minute. I was in this same hospital's affiliated rehab facility one evening when one RN and one nurses aide were the only staff for an entire floor. (3 p.m to 11 p.m. shift, when dinners, meal time meds and bedtime meds have to be given out and fevers often spike and other conditions tend to worsen.)

And so on.

See also Reply 13.

[shireen]

37. yes i agree

I've had to visit the ER many times over the past 7 years, and it's always been an exasperating experience. Here in Baltimore, we have some of the best health care facilities in the country. Given all the problems I've encountered, I shudder to think about other places with fewer major hospitals.

I hope the parents sue the damned hospital that kept the kid waiting for 5 hours. That's inexcusable.

[Enthusiast]

69. I have been the victim of both

incompetence and indifference in the ER. The anger in my heart toward that facility will not fade even though the problem was 24 years ago.

Oddly enough the same facility performed admirably when I was in a life threatening auto accident. So, my post is basically validating what you said.

[TheMadMonk]

123. LACK of people willing to offer a minumum of charity.

Good Christians all, as they are (tripping over their own tongues in their haste) quick to tell me.

Lack of health insurance is the least of your fucking problems when the national attitude is: "Die fucking quickly if you can't afford to live." The best thing the average sick person CAN do for their family in Amurika is "die fucking quickly" whether or not they have health insurance.

You as a NATION create a system in which over 10% of the population litterally cannot afford heathcare, AND then you as a PERSON piss and moan because desperate people overburden a deliberately underfunded service.

You like that system so much, move to the fucking UAE Where you WILL discover what a true arse reaming is all about with your first unpaid phone or power bill.

[flvegan]

4. "While Malyia's parents have medical insurance, many of their daughter's bills will go uncovered"

USA!! USA!!

We hear it over and over..."most powerful country"..."last superpower"...really?

[Frisbee]

5. Give it a break, we have the best health care in the world.

:sarcasm:

edited because I can't spell for shit!

[blackspade]

7. yep.

So good in fact that she had to wait 5 hours and get limbs amputated.
Yea us.

[DBoon]

59. the best health care money can buy!!

The golden rule - those with the gold rule

[eilen]

108. Truly. I had the distinct displeasure of having to listen

to a relative who is a self-described "intrepreneur" (yes, that is how it sounds when he says it) Proclaim to me about how anyone can be treated in the ED.

He also had an unnatural interest and prurient knowledge of Nancy Pelosi's tax returns. I asked if he was quite as knowledgeable about her Republican colleague's tax returns as well or perhaps Michael Steele's expense reports....

[SheilaT]

6. A lot of issues here.

These people did have insurance, and hospitals which take Medicare (most of them) must see all comers. Someone who does not have insurance still must be seen, although the hospital has no obligation beyond stabilizing the person.

Unconscionably long waits do occur in Emergency Rooms. I could be wrong, but I really doubt that others with trivial things were seen ahead of this girl. The reality is that hospitals, like so many businesses in this country, have cut and cut and cut until there aren't enough staff to do the work that needs to be done.

As a mother whose two children are now grown and who never had any kind of medical crisis, my heart goes out to these people.

[Suich]

8. I agree.

:thumbsup: :thumbsup:

[MedicalAdmin]

12. And the new England journal of medicine agrees with you.

They published a study about 3 years ago that compared wait times in the USA to several other industrialized nations health care wait times. While we score in the middle in one or 2'catqgories wenfailed big time in wait times to see specialists and dead last in wait times in the ER.

That's right folks, the "commies" kicked our asses when it came to ERs and specialist care like surgery. Damn socialists!

[valerief]

72. Michael Moore compared ER wait times in the US, Cuba, and Canada in the movie Sicko.

I think they were the 3 countries, anyway. Of course, the US came in last, if I recall.

[Enthusiast]

73. Well, let's face it,

medical care should not be a for-profit operation. It just shouldn't. Someone is going to lose and it is always going to be the sick/injured one there to receive treatment.

[valerief]

75. Then again, should food be for-profit either? Should shelter? I'm all for the common good

and not-for-profit medical care, but how do we justify one necessity over others? Especially when business doesn't want to invest in Americans anymore. What do they care if we die early? They've got Asians and high-speed trades to make money for them.

[Enthusiast]

82. If tens of thousands of Americans

were dying due to lack of food or because food was substandard it would compare to medical services. The food and shelter issues are bad enough but the medical services situation is at a crisis level.

I am against any medical services being for profit. The motivation to short cut staff and care to boost profit is just too great. If a health care CEO doesn't show an increase in Profit they can not justify their enormous annual bonus.

[valerief]

89. Hey, I know how to share in the sandbox. However, these CEOs and their ilk

don't need to justify a damn thing. They have US soldiers and high tech weaponry protecting them from us. They don't need us now. They don't care. None of OUR necessities (clean food, clean water, clean air, shelter, medical care) affect THEM. They grow their own pure food, process their own pure water, and probably filter their own air so it's clean. They avoid us, fly over us, and don't even think of us, until they're buying a pol or priest or teevee/radio network to keep us in line.

[RaleighNCDUer]

93. For food, we have food stamps. For housing, we have Section 8 and

homeless shelters. For health care, we have private for-profit insurance.

A little bit of socialism is not a bad thing.

[Crunchy Frog]

106. Because the incentive structures that involve the production of food and shelter

operate differently than those that involve health care. It works well for some things. It works really badly for other things.

[txlibdem]

29. Staff have been cut and cut and cut some more in all US industries

That's the sickening truth for the American worker, companies have barely enough staff to cover the ordinary work load and they're being pushed to the limit at that, then when anything out of the ordinary happens or someone calls in sick the other workers get screwed.

Not to mention that companies are sitting on $2 Billion in cash that should rightfully go toward hiring adequate numbers of staff, but they're either just hanging on to the cash or (worse) are using it to buy out other companies (which results in more staff cuts).

[Liberty Belle]

9. What a tragedy. This happened to a young girl here, who lost all 4 limbs

from an infection that started with chicken pox. Thankfully she's adapted amazingly well; I saw an article on her not long ago.

The hospital in likely at fault, though it's hard to be sure without knowing the circumstances. I once had to take my daughter's friend to the ER with a dislocated shoulder. She was screaming in pain and it took hours to get her treated. But the other cases seen ahead truly were even worse: An attempted suicide, a police officer who had been shot, a heart attack patient, a stabbing victim, and someone else who died of a traumatic injury.

[rhett o rick]

10. Only in America. nm

[Zax2me]

15. HARDLY....

Come on.
We suck, for sure.
But come on....
There are people worse off in this world, a greater percentage, every day.
Go without food, health care, basic living requirements.... More than our unfortunate by a WIDE margin.
Relatively speaking of course, just...be realistic. Those suffering tragedies here pale in comparison.
Doesn't excuse us by any means but still...only in America?!
That's a joke - no, a lie.

[Boudica the Lyoness]

43. Why compare America to third world counties

Why not try to become as good if not better than the best countries in the world.

I see this a lot. Some local republican dip shit went on a mission to deepest darkest Africa and when he came back he wrote to the local paper and said he was so grateful for American health care, "The best in the world".

The dumb shit had travelled abroad only once and only to the 'great nation of Africa'.

[rhett o rick]

67. So you are calling me a liar? Whatever man. Do have a happy new year.

And I mean that. No sarcasm intended.

[Enthusiast]

74. Yes, we better get used to it because it is going to

get far worse.



















:hide: :sarcasm:

[Selatius]

11. In 2014, everybody will have health insurance. Except it won't cover everything.

Health insurance you can't afford, and the bonus is it won't even cover all your medical bills!

Yay! Greatest fucking nation on earth! We're Number 1!

[fasttense]

21. The best health care money can buy.

If you don't have the money, you can't buy it.

[Hugabear]

14. THIS is the healthcare that the repukes are trying to preserve

Actually, if they had their druthers, hospitals would operate on a "ability-to-pay" basis. Can't afford treatment, tough shit. Make room for that person with the fat wallet.

[Zax2me]

16. Dead.

On.
And they just got control of congress. How fucked up is that.
Land of the free - RIGHT.

[Selatius]

17. The thing is people didn't know any better than to vote Republican. The news media didn't inform.

But then again, all of the major news outlets are owned in part by shareholders who also own shares in health insurance companies.

[WVRICK13]

28. Even More Amazing

is we passed a joke of a health care bill that was written with input from the insurance industry. Mandates to buy insurance from private carriers is not a national health care bill, it is industry subsidy.

[Enthusiast]

83. Ignorance baby!

Ignorance is wonderful!

[lostnfound]

Well, the free market says they will pick a better hospital next time...?

At least the Koch brothers don't have to live in a socialist country...?

:sarcasm:
:cry:
THe hell that these parents must be feeling right now, the suffering of the child, and that little girl eventually learning that her condition was avoidable...are unimaginable.

[lostnfound]

18. Deleted duplicate n/t

[Vinca]

22. The poor little girl HAD health insurance. Heaven help the rest of us.

The parents need a good lawyer. The ER was negligent and there is no way, after what happened, they should be on the hook for a dime.

[indy legend]

40. And if the right wing fucks get what they want with torte reform

this family and little girl would have no legal recourse either. They won't be happy until all of us are at the complete mercy of the insurance industry and multi-national corporations with no way of redressing our grievances. It's the tea fuckers er baggers utopia. Welcome to the Republican vision for United $tate$ of Amerikkka folks.

[FarPoint]

23. If emergency rooms were used for actual emergencies...then

the 5 hour wait would not occur.....Indeed, she needed seen timely....but an ER these days preforms the duties of Primay Care as well...which backlogs timely care.... Republicans and lazy democrats let this all happen. Started with Reagan and the DRG's....

[No Elephants]

26. Not necessarily. Please see Replies 13, 24 and 6.

[MJJP21]

27. BUT,,,, BUT,,,, BUT

Isn't this what we are supposed to be afraid of with single payer otherwise known as European health care? How did this happen here with our supposedly greater than theirs health care system?

[grilled onions]

32. Bit IF You Were Somebody "Important"

You would not be waiting. If you were well known,had clout,money,a politician,any big shot-hot shot or any of those INFAMOUS radio hate mongers you would be waltzed in so quickly with a bevy of medical staff at your side and they could,on cue,write about how grand the service is here in HOSPITAL USA.

[janet118]

36. Cheney doesn't have to wait . . . neither do our "representatives"

There are 2 Americas: the rich and powerful and us. That health care bill is a joke. It was supposed to be a "first step." Maybe if there were a public option, it might have been. As it is now, it will result in less people being insured. I live in Massachusetts and it is NOT working. On top of that, the Republicans plan to make sure it is not funded at all. Heck of a job, DINOs.

[LibDemAlways]

44. I guarantee that if Angelina Jolie and Brad Pitt had shown up at the ER

with a sick child, that kid would have been seen immediately. The rich and powerful always get preferential treatment in the USA. It's how the place works.

[Puzzledtraveller]

63. money talks, regardless how of one leans

[sendero]

34. "The best health care system in the world"..

... one wonders how often such debacles happen in those "socialized medicine" countries.

[PatSeg]

35. Damn, I've been in that ER many times

They had had a major renovation not long ago and things had improved dramatically. Evidently, not as much as I thought. I have mixed feelings about Methodist Hospital. I have had the best and the worst care there and a very perceptive doctor in the ER did save my life a year ago. What is described in the article reminds me of the way their ER was several years ago. What a terrible and unnecessary tragedy.

[Evasporque]

38. The girl is lucky to be alive. Good thing the parents took her to the doctor.

First off to figure out that the girl actually had a septic bacterial infection is not easy...the only way to know BEFORE liver failure begins is to culture a blood sample. That can take multiple hours....even then they would of likely started her on a course of antibiotics....

To think that five hours in a emergency room caused her liver failure and amputations is presumptive. The aggressive strep caused that.

I've seen how nasty infections like this can be and how they can so rapidly take over...they are not easy to diagnose and the the tools to do so are still basic cultures and identification.

There are resistant strains of strep that are very nasty floating around low income people...

[northernlights]

45. actually I'm an MLT student and I recognized immediately that she likely had bacterial infection

with toxic shock. The red splotches on her skin coupled with the high fever. And a strep A test is a low-cost, five minute test. Culturing a blood sample takes more than a few hours, but you can run other tests that do take a few hours. And while Strep is nearly always responsive to penicillan and beta-lactams, you do need to have a good idea of what you are treating before you treat it. Unfortunately, there are some very virulent strains out there, especially those that produce the SPE toxin.

It sounds more like a staffing issue than anything else to me. Go read the health care forum and see what nurses are put through: too many patients, no break even to pee, joking about wearing depends to get through a shift.

My clinical microbiology instructor is a shift manager and made a big point of telling us repeatedly that a big part of her job was ensuring a minimum staff level. I was left with the impression "as few people as she can get away with" as opposed to "as many as needed in the real world of breakable humans that get tired."

Like very other field of work, health care staffing has long since cut past the fat through the muscle and right to the bone, even while the insurance parasites suck greater and greater chunks of the pie.

The difference from most other fields of work is that people's lives are literally at stake. Welcome to health care in America. It only gets worse from here.

[Horse with no Name]

58. I've been a Pediatric nurse for the better part of two decades

I would have recognized it in an instant. Symptoms were classic and she exhibited enough "red flags" that after triage, she should have been straight back with a doc at her bedside in less than a minute.

[sweetapogee]

125. thats why

it will be interesting to find out all of the details on this sad story.

[Lydia Leftcoast]

39. If we had public urgent care clinics, this would take a lot of pressure off

the hospital ERs. The minor broken bones and sprains, household burns, strep throats, dislocated shoulders, and other painful but non-life threatening conditions could be seen in the urgent care clinic, while the ERs could be reserved for life threatening conditions.

If I were in charge of health care policy, that would be the first step.

[enlightenment]

41. I lived in a smaller city in Colorado a number of years ago and

discovered an unpleasant fact about urgent care clinics and hospitals. There were two hospitals in the town; an Ostopathic hospital and a Catholic hospital, which was the only hospital in the entire region qualified to handle major emergencies.

Some of the doctors in the town tried to set up an urgent care facility to take the load off the ERs (and make some money, of course). Everyone I knew thought it was a fantastic idea, as the OD hospital did not have a substantive emergency facility, leaving a town of over 50,000 with one real ER.

The Catholic hospital successfully lobbied the city to disallow permission for the urgent care facility - because they didn't want to have the revenue siphoned off.

I had to take my kid to their ER twice - for a broken arm (uncomplicated) and a severe knee laceration (very nasty, but nothing that required surgery or extended treatment). The wait to be seen for both was over three hours each time. Total treatment time, after admission to a treatment room, was seven hours for the arm and almost nine hours for the knee - an injury that was complicated because it sat and festered with dirt and debris for such a long period before treatment

The urgent care facility could have handled both and that space in the ER could have been freed up for those truly in need - that it wasn't available was purely on the heads of the hospital execs.

For profit hospitals should be banned.

[Bette Noir]

48. I totally agree. The profit motive has no business in health care.

Quick anecdote, though: a friend of mine has the same name as a big-time right-wing radio guy. When he had a medical emergency, he got seen right away. The staff was disappointed that he wasn't the celebrity they thought he was, but, once he was in the room, they didn't send him away.

[RaleighNCDUer]

94. And note, it was DOCTORS who wanted the clinic, and it was

HOSPITAL ADMINISTRATORS who fought against it. Most hospital administrators are not medical personnel - they are fucking MBAs, and their only concern is the bottom line. They may have degrees in Hospital Administration, but they are not doctors and they never will be. They might as well be managing a hotel, or an airport, for all the medical knowledge required.

[elias7]

42. Why blame the 5 hour wait for her amputations?

Many factors played a role, but the Sacramento Bee has decided what the story is--- the 5 hour ED wait.

The child was developing sepsis the previous day, when she developed fever and lethargy. While no one would dare blame the parents' judgment, the following considerations are relevant:
There was a time delay in seeking medical help....24 hours
There was a time delay going to an urgent care center, an inappropriate first step for a seriously ill child.
There was no report of a call to the child's PCP, a move that may have expedited matters.

Also relevant is that:
Invasive group A strep sepsis kills 20% of the 10,000 people it affects annually, so even under optimal circumstances, there can be high morbidity or mortality. If this child was born 75 years she would have died, as mortality would be 100% from this and other serious bacterial infections in the pre-antibiotic era.

Methodist sees 120 patients/day average, many of whom are kids with fevers that are 99% of the time benign processes. The failure here was in triage, where the triage nurse should have differentiated a well kid from a sick kid. Sometimes it is not that easy or straightforward, however. Many kids look like crap with a 103 fever, then look like a rose after getting some tylenol or ibuprofen to bring that fever down. Many parents don't give their kid tylenol prior to going to the ER because they think they won't be believed by the doctor if their kid doesn't look sick or have that fever.

Maybe in this case the kid got sicker and started to show signs of sepsis after triage...the child was evaluated again once the father "ambushed the nurse and demanded to see the doctor". That's his side of the story, and he sounds quite heroic, another journalistic game that may or not be true, but generates anger and sympathy. Maybe the child now appeared critically ill whereas before she didn't, and that's what got the kid in the door for workup, we just don't know. The tone of the article makes it sound like the hospital had to be coerced to treat a sick child, and this is likely not a fair representation of the sequence of events.

I work in an ER and I am providing a viewpoint from the other side of the waiting room. There is plenty of blame to go around, but pointing fingers is useless if it only reinforces negative stereotypes, but it does seem to sell papers...

[slackmaster]

81. I made a medical problem worse by delaying treatment, followed by a long ER wait

I got an index finger deeply bitten by one of my pet cats one Sunday evening. I was trying to bathe him for some stupid reason, and he bit me hard, all four canine teeth to the bone.

I thought about going to the ER immediately but didn't. I figured I'd go to my primary care doctor on the way to work Monday morning, expecting a shot in the ass and a round of oral antibiotics.

By the time I got to my doctor's office, the finger was severely swollen. Doc told me to go to the ER at one of our major hospitals immediately - A hospital with a long-standing good reputation.

The emergency department was very busy, mostly with sick babies and young children. I didn't get to see a doctor for more than four hours. When I did get to see the doctor who was in charge of the ER, she flipped out and had me put on IV antibiotics immediately. She had a nurse give me a big shot of morphine in my IV drip, because I was in agony and driving everyone crazy.

At about hour 10 an orthopedic surgeon saw me, still in the ER. He told me he was checking me in. They put me on a orthopedic wing that was populated mostly with elderly people with broken bones. They gave me a room by myself so I wouldn't spread bacteria to as many people.

The surgeon saw me three more times, at 12-hour intervals. Finally I was released after more than 48 hours as an inpatient, eating Vicodin, watching TV, and taking an occasional beer smuggled in by friends. After being released I had to carry an infusion pump delivering about 12 grams of antibiotics per day for the next 10 days.

Things can snowball out of control quickly. If I had done the smart thing and driven myself to one of the prime hospital emergency rooms immediately, I might have been spared a lot of agony. Or not.

[elias7]

88. It's hard to always know what's a big problem and what's a little problem

Although one would have hoped that the triage system in that girl's case would have picked up a toxic child and brought her in immediately, it's not really that straightforward, even for those with medical backgrounds. And perhaps the child was not showing overt signs of toxicity and sepsis at triage time, only to have the process unfold while waiting those 5 hours. It's tough for everybody-- the patients, the nurses, the doctors-- you do the best you can, and hope no one slips through those cracks as this unfortunate girl did.

You should get a buddy in the ER field who you could call, or barring that, call your on-call PCP's service or the local ER for advice. Some things, like cat bites, are pretty straightforward and there's no way you could know that. For what it's worth, cat bites are notorious for rapid onset <24 hours infection with Pasteurella Multocida, and infection will require several days of IV antibiotics, which can sometimes be done as a recurring ER every 12-24 hour visit for meds. But now you can tell everyone you know, and the knowledge base grows. A cat bite, especially a deep one, should be seen immediately to be cleaned and have antibiotics started, lest your experience be theirs. Glad your doing better.

[slackmaster]

113. My solution is not to try to bathe cats any more

If I ever have a cat that really needs to be bathed, I'll pay a professional to do it.

[Nikia]

46. Maybe I'm lucky to live in a rural area.

Our hospital has a walk in clinic in the hospital late morning until early evening in addition to a 24/7 ER. If someone at the walk in clinic has some more serious problem, they are wheeled to the ER. While the walk in clinic wait time has varied for us (Seen right away to 2 hours), we have been seen instantly the few times we needed the ER. Severe cases do often end up getting transferred by ambulance or helicopter, but at least they have been evaluated and receiving some care.
Regardless if hospitals also have a walk in clinic, no one should have to wait 5 hours in an ER regardless of the severity of their illness. Customers in regular businesses would never tolerate 5 hour wait times. If this was a grocery store, they would hire more cashiers. It seems that the free market doesn't work so well for hospitals.

[johncoby2]

47. If they are republicans then they dont need any help from me.

Let them go bankrupt and get their treatment at the local county hospital.

[somone]

50. How about taking a TINY fraction of the war budget

and spending it on nurse training and neighborhood clinics?

[Enthusiast]

77. What an America hating attitude!

How about just accepting we have the best health care in the world. Quit denying it!



















:hide: :sarcasm:

[lonestarnot]

51. Horrible!

[Bozvotros]

52. Profit / Not for Profit

Not much difference except one pays taxes. Not for profit hospital is a misnomer, because they can and do make profits, they just hand it to the directors and managers rather than stockholders. Around here both kinds of hospital are buying up every group practice and small hospital they can and convert them to "state of the art" cost cutting to increase their margins. This means you replace RNs with LPNs, LPNs with CMAs and CNAs and base staffing ratio on the number of patients more than the acuity of patients.

Both types around here are not afraid to aggressively purge staff and unprofitable cost centers. ER's don't make much profit so they are not that interested in improving services there. Cosmetic surgery and orthopedics? That's different.

Both kinds know exactly how to legally game Medicare too. The trend towards building new suburban hospitals is a way for hospitals to increase their Medicare reimbursement which is based on costs for the first few years. New hospitals cost more than old ones and if you drive your initial costs up, you can cut costs later when you have your new rate. Our large not for profit hospital just built a large suburban hospital and outpatient clinic and spent 3 million having their name put on a baseball field downtown. They are making money. People are raving about what great service they are getting out there compared to the old hospital. I tell them to wait until their Medicare reimbursement rate is set and then talk to me.

[jwirr]

53. Is this a private hospital? Owned by a company?

[slackmaster]

56. Non-profit. Methodist is owned by Catholic Healthcare West.

http://www.chwhealth.org/stellent/groups/public/@xinternet_con_sys/documents/webcontent/131805.pdf

[givemebackmycountry]

55. A $26,000 tab for her helicopter ride from Sacramento to Palo Alto

26 grand for a helicopter ride?
Jesus Christ, that's borderline obscene.

[Horse with no Name]

60. Well it IS more than a firing up a helicopter

There are generally at least 3, sometimes 4 highly qualified staff on that helicopter.
At least one pediatric nurse, respiratory therapist, paramedic and sometimes--depending how unstable the child is--a doctor will go along for the ride too.

[Enthusiast]

79. Same cost as here in Ohio. nt

[Horse with no Name]

57. Wow. These symptoms were classic Strep A and ANYONE

who had been through a PALS certification class should have been able to pick up on it (it is one of the major test questions) AND in an ER, the triage nurse SHOULD be PALS certified. The splotches should have been her tell-tale sign.
Poor baby girl.

[elias7]

76. Respectfully, I disagree

Classic Strep A is strep throat. If accompanied by the classic rash--a fine, almost sandpaper-like diffuse maculopapular eruption-- it would be called scarlet fever. These don't usually make you too sick, but high fever is a hallmark. Another classic group A strep infection is erysipelas, which is a facial cellulitis, hard to miss, requires IV antibiotics to start, and doesn't sound like this case.

The "splotches" on the girl's face are not a tell-tale sign of strep in any PALS course I have taken. A splotch that looks like a bruise in this setting sounds like purpura- a hemorrhagic phenomenon that is a common endpoint for sepsis/DIC. Purpura fulminans (fulminant purpura)is ominous, and is most commonly associated with N. Meningitidis or "Meningococcus", the type of meningitis that the college kids get one day and are dead or getting limbs amputated the next day if not treated quickly. Vascular rashes (petechiae/purpura) can be manifestations of all sorts of things, not just a rapidly fatal infectious process, but their presence should raise a red flag in the setting of fever and and unwell child.

Kids get flushing of the cheeks with fevers quite frequently. Rashes of all sorts come with many viruses (viral exanthems). Peri-orbital petechial rashes occur with vomiting. But hemorrhagic rashes in a toxic-appearing child usually means sepsis with multi-system organ failure developing and a potentially fatal process if not quickly addressed. This could be from any number of bacteria, including staph, strep, meningococcus, gram negative bacteria (E.Coli, Pseudomonas, etc.), and not pathognomonic for any one bacteria.

But, as someone with a lot of experience with sick kids, I have to say that picking out the sick ones is not always so straightforward as you seem to imply. And much could have changed from time=0 hours and time=5 hours. Without more info, it is premature to point fingers.

[Horse with no Name]

99. Well, I guess I will say likewise

And as someone who ALSO has extensive pediatric experience (I know I mentioned TWO decades of it)...I have NEVER let a sick kid slip through my fingers.
Never. Even when they only exhibited the slightest of symptoms.
Oh, I probably should mention that I have worked PICU as well. I just prefer taking care of patients more than I do tending machines.
I've worked at some of the largest CHILDREN'S hospitals in the country as a staff RN as well as a traveler...and may I reiterate, I have NEVER let one slip through.
I just recertified PALS for the umpteenth time (as well as being ACLS, STABLE and NRP certified)...and the question is there.
It is there because it is important!
I can also tell the difference between red splotchy cheeks due to fevers and rashes (I can even differentiate the types of rashes for you and what their appearance means).
If it is a problem for other caregivers, then I suggest some remedial courses because if you know what you are doing--then in 20 years you can say the same thing that I can say...I have NEVER let a sick one slip through. Even when I had to argue the doctor down and demand that they come to the hospital to see the patient.
There is a "red flags" video out there. If you haven't seen it, it might help you to pick out the sick ones. Because in MY practical experience, it is NOT hard to pick out the truly sick ones. For the nurses that have a hard time doing that...then they should update their skills--otherwise we will see more and more stories like this one.
I refuse to be an apologist for those "new nurses" who have come into nursing and went straight into specialty without paying their dues and think they know EVERYTHING. Problem is, they are solely focused on a very narrow scope and seem not to be able to visualize the entire picture of what is going on. Those are the ones that I have seen KILL patients or severely mangle and maim them. In fact, seasoned LVN's are always more valued than these "Rambo nurses".
Those are the ones that ALWAYS seem to miss things and whose patients ALWAYS seem to have difficult outcomes.
I came up the ranks working Med-Surg and can almost literally say that I HAVE seen just about everything in my practice.
I've worked at 14-bed hospitals and I have worked at hospitals that have over 1000 beds and everything in between.
I, too, can sit and spout all the fancy words that you think make you sound like you know what you are talking about...but that would be quite presumptuous of me. So I won't do that.

[OhioBlue]

112. wow... thank you HWNN for your absolute

dedication. We need more nurses like you... no... not only nurses but people in every field. I'm so glad to see your commitment to excellence as demonstrated in this post/thread.

I've been in the ER several times for myself or family and truly wish I/we had a nurse like you. Some personnel were very good... some not so much.. but I can honestly say that I don't think I've ever encountered someone with your commitment and integrity. Thank you again.

[Horse with no Name]

114. I have always treated EVERY patient like they were my own

family and have always been very vigilant and taken every complaint or concern seriously. No matter how trivial it might have seemed. That method has never failed me. The only patients I have ever lost on my watch were ones who were already in the process of dying. I don't have a "Doctor is a God" complex and it doesn't bother me in the least to call one at 3 am with a patient concern. That's their job.
I have also been a fiercely staunch advocate for the families of the patients I have taken care of.
I've never been one of "those nurses" that felt that I was the gatekeeper of the pain meds. If someone tells me they hurt, I believe them and medicate them. The nurses who feel that they need to belittle the patient and accuse them of drug-seeking behaviors literally make me ill.
I can't tell you how many families have "apologized" because they felt they were being overbearing.
I always tell them that I don't mind. EVERY patient needs someone to make sure their needs are taken care of--don't apologize. Ask questions. Assert yourself.
You'd be amazed at how surprised people act when I say that.
Not to say that ALL patients aren't special, but there is an AWESOME responsibility that we as caregivers take when we are entrusted to the care of someone's child. The day that I can't give that child that special attention they require is the day I will walk away from this profession for good.
Trust me also when I say--there are MANY nurses out there who are just as committed with high ethics and integrity.
I've worked with many along the way. In fact, many of them were my mentors.
Problem is, as with everything, they get chewed up and spit out by the hospital corporations and their gifts to our profession are lost forever.
Hospitals don't CARE if their nurses are compassionate or skilled.
They only care that they are 1)As cheap as you can get 2)Young (older nurses tend to have health problems, so hospitals have started gravitating towards new graduate nurses).
At one of the Top 5 Children's Hospitals in the country that I worked at, when I first got there, the median level of experience on my shift was 35 years. NOTHING slipped through the cracks. I worked with some of the best nurses in the country. Eight years later when I left, the median level of experience was THREE years. Children were dying, doctors were refusing to admit their highly acute patients to that floor and things were happening that should have never happened. It was ridiculous. I think they ended up with one nurse with more than a year of experience.
Thank you again for your kind words--but like every other industry, profit is the motive and the rot starts at the top.
Good nurses are expendable. Cheap, young nurses are all the rage!
Patients don't count any more because their commitments to the hospital for ones with insurance are negotiated by insurance companies to the facilities that offer the lowest rates and the uninsured have to basically just take what they can get.
It is a sad, sick system and my fear is that we haven't seen the worst yet.

[elias7]

117. You sound very experienced, talented and dedicated.

I agree, it is not very hard to pick out the sick ones, and as I said in earlier posts, this may have been a failure at the triage level, or perhaps the child did not look toxic at the time of triage.

I still do not agree, however, that this presentation was classic group A strep. Fever, lethargy and a splotchy rash on the face resembling bruises is not specific for a particular bug, but is specific for septicemia ?early DIC/MSOF. If you don't believe me, consider asking one of your pedi-intensivists.

I apologize for sounding like I was spouting fancy words that I think make me sound like I know what I'm talking about. I was trying to communicate on a professional level with someone who clearly had experience. Didn't mean to insult you.

For what its worth, I am an ED physician with 15 years experience as an attending, and I am boarded in Emergency Medicine and Internal Medicine.

[Horse with no Name]

119. Well, I am very sorry I let you get under my skin

For whatever reason. I do apologize.
Perhaps the person teaching our PALS stressed this as one of the scenarios because of personal experience, I can't be sure. But I do know it was one of those that he drilled me on.:)
This child was ill--perhaps the major fault lay with the parents waiting 24 hours to seek help. But then the system failed. In kids you barely have room for one failure--but very rarely two.
I know in one facility that I worked in, they allowed an inexperienced LVN to do the Triage and an RN signed her paperwork.
There are lots of shortcuts being taken out there--and they are generally detrimental to the patient.
I spoke in another post of some of the more experienced nurses I have worked with over the years and I believe that any of them would clued in to how sick this child was--whether or not they would have been able to nail a diagnosis, I can't be sure of that. But they would have known the child was sick.
As a physician, you don't have the opportunity (in general) to be the gatekeeper so the physician isn't at fault in this situation. It is a failure of MY profession and that makes me angry. Things like this make us all look bad.
The ONE question that I do have that I haven't seen addressed...IF the child was seen at a Minor ER clinic and told to go the ER...it has been my experience that for them to send a patient from their facility, that a transfer has to be done--otherwise it can be considered patient dumping.
Had that been done--the child would have been transferred in and never had to sit in the ER.
There are many unanswered questions.
Again--sorry for my earlier attitude.
I have no excuse.

[elias7]

121. I got stuck doing a few urgent care center shifts a couple of years ago

There was a loose affiliation with the ED I worked in, and folks who were needing a more appropriate level of care but not grossly emergent were instructed to go to the ER, those with emergent problems were transferred by ambulance. Either way, the ED got a call from the urgent care center to give a heads up.

It would be unconscionable for a truly sick kid to have been sent without communication, let alone by private car. There are a few potential breakdown points in the reading of this single article, including a dropped ball by the urgent care doc, which I would, like you, consider an unacceptable performance of duty.

No need to apologize about a pitched tone. These issues are emotionally charged for both professional and personal reasons, forums are anonymous and any little thing can be misinterpreted or misconstrued when you can't see the face of the person you're talking to. I'm sure I pushed a button somewhere and that colored the tone of the rest of my post for you. It's nice when people can take the time to get back on the same page, as it would seem you and I are. :toast:

[McCamy Taylor]

85. Minor point. They are classic symptoms of sepsis.

Could have been any one of a number of bacteria---but all of them can lead to organ shutdown.

[sulphurdunn]

61. The ER staff

in this hospital know exactly what needs to be done to mitigate this kind of tragedy. Did anyone from the press ask them? Hell, does anyone in the hospital administration ever ask them?

[blueamy66]

68. I have no words.

holy crap

[chervilant]

80. Sigh...

Not a single solitary observation that our planet--and our nation--is seriously overpopulated. This fact alone makes wait times in virtually ANY venue a given, except in very rural areas (although, the rural areas are filling up fast, and cheap, remote land now sells at a premium).

We hummans have compounded our overpopulation issues with a rampant materialistic hedonism that supports and sustains radical income inequity.

In short, we're currently a mess, as a species. Time to get over our most ubiquitous cranial rectal inversions, and do something collectively to step off this path of self-destruction.

If it's not too late...

[McCamy Taylor]

84. Try to take kids to pediatric hospitals when possible. Adult hospitals often do not recognize

the signs of severe illness in children, number one of which is they just sit there and do not make a fuss the way that a healthy child would.

[Horse with no Name]

102. Absolutely. But Children's Hospitals miss stuff too

My strong advice to ANY parent is that if you think something is seriously wrong with your child...INSIST that your child be seen immediately. Even if you have to make an ass out of yourself.
I could tell you horror stories that I have seen over the years...but the golden rule is that NOBODY knows your child better than you do and until someone else takes over as their advocate--then you should do what it takes. (I only say this in emergent situations).
I have to also say...that if your child becomes lethargic, I would consider that a medical emergency until it is ruled out.
Certainly waiting 24 hours to have them seen can have catastrophic results.
Many years ago when I was very young and before I finished nursing school--my then toddler (all grown up now) was sick.
I KNEW there was something really wrong...but without the knowledge I have now, all I could do is force the issue.
I went to the ER of the hospital I worked at. The response was inadequate. Nobody listened to me. My "intuition" was not appreciated. In fact, they felt I was nothing more than a hyper vigilant nursing student, lol. I left that ER and drove 40 miles to the next town to a larger hospital (there wasn't a children's hospital closeby).
By the time I got there, my child was limp--but would arouse.
I was standing at the check-in desk when the Triage Nurse walked by and did a double-take.
She snatched my child out of my arms and told me to check her in.
By the time I got back there, there were 20 people surrounding my child.
They were sticking her and drawing blood, getting IV's, doing neck X-rays. There was an open trach tray on the table.
As a parent who ONLY knew something "wasn't right" and who didn't back down when the first ER told me nothing was wrong with my child--I saved my child's life. She had epiglotitis.
Her throat was nearly swollen shut.
They were able to get enough steroids in her to get the swelling down and the trach wasn't necessary.
We got lucky that day--because even sitting in the waiting room would have been disastrous for my child. She was already lethargic--I doubt there would have been much of a change in her status.
This is a story I have shared with parents over the years who KNEW something was wrong with their child but let themselves be bullied by caregivers who were "know-it-alls" and backed down to them.
It can happen to anyone.
Just because someone is a doctor or a nurse...it doesn't mean they are qualified to know what is "normal" for your child.

[madmax]

104. You said it all. Great advice. +10 nt

[Liberty Belle]

110. So true! My daughter had a heart problem when she was young--

I couldn't get the doctor's receptionist to take things seriously. Finally I demanded that her vital signs be taken; at first the receptionist refused so I turned to the other people in the waiting room and loudly announced that my daughter's heart was racing out of control and can you believe they won't take her vital signs? The other parents started getting on the receptionists' case. Finally she gave in and had us see a nurse, who took my daughter's pulse and ran to get the doctor, who immediately ordered her hospitalized and called in a cardiologist.

Thankfully after a couple more such spells she had a surgical procedure done that totally cured her. But I shudder to think what could have happened if I hadn't been very aggressive, even obnoxious, to get her treated.

[LisaL]

122. Squeaky will gets the grease.

[bobburgster]

91. That is so sad!

Something so treatable, parents do the right thing, and they crappy emergency room people drop the ball. What a crying shame!

[Name removed]

97. Deleted message

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[davidwparker]

100. Sad.

No wonder this nation has come under judgement.

on edit: No justice. No peace.

[DeadEyeDyck]

109. heartbreaker

[harun]

127. Insurance != Health Care.

[Devil_Fish]

130. This if Fucking disgusting. I hope they sue. How Fucking horible. NT

[Liberal_in_LA]

131. why in the heck should a helicopter ride cost $26,000?

Highway robbery.

[pxlfreq]

132. sad sad sad

And look! We get to see much more of this!

http://www.csmonitor.com/USA/Politics/The-Vote/2011/0104/House-GOP-health-care-repeal-What-will-that-bill-do-exactly

It's amazing to me how any sane person can't look at this and KNOW...ABSOLUTELY KNOW that this is a pure money-grabbing scheme by big insurance. They were butt-hurt when they feared losing money and made damn sure they got the repubs back in there to get their money back for them...amazing