6.13.2007

Blaming the 911 dispatcher

Wow. I can't believe they are blaming the 911 dispatchers for not sending an ambulance to the ER waiting room. Should they have? And taken her where?

I'm having trouble blaming them. Afterall, EMS is already stretched thin in the hood...therefore we need to allow the dispatchers to use discretion. And sending a rig to an ER waiting room...kinda doesn't sound like a great use of limited resources. Things are always more clear when we look thru retrospectoscopes, and this is no exception. Why should be blame the 911 dispatchers for not mounting the appropriate response when the triage nurse (who is trained to identify emergencies) and the King police officers were right there with her, and seemingly unimpressed....in a hospital ER!! Maybe they (the boyfriend) should have moved Ms. Edith Isabel Rodriguez out of the ER, to the McDonald's parking lot across the street...then called 911. At least she would have been brought to the back for an MD evaluation.

There are lots of things wrong with our healthcare system. But blaming individuals solves nothing. Maybe it appeases the public, but in reality, it is a very temporary solution at best. They can replace the triage nurse...fire the CEO...and reprimand 911 dispatchers, but this will result in 2 things:

1) a new policy will be written stating that "everyone with abdominal pain should be triaged at top priority."

2) 911 dispatchers will send rigs out to every nut who calls and requests one.

The repercussions of this include
1) a teenager with 'menstrual cramps' will go back, while a 3 year old seizing child will have to wait. Afterall, taking "all abdominal pains right back" comes at a price. Patients don't bring beds, nurses, or doctors with them. And in the ER, with limited resources....triaging based on chief complaint vs illness severity is not a good idea.
2) If things were bad in the hood *before* with EMS response times....imagine the outrage when there are no firefighter/paramedics to respond to a crash on the 105 freeway, and rich people die as a result.

What happened to Ms. Rodriguez is outrageous - and (thankfully) I wasn't there!! I'd be plenty pissed if she were my family member. And I'm not defending the triage nurse (because she was partially at fault), nor the hospital (because it has been completely reactionary and wholly concerned about maintaining "Black" leadership, just for the sake of Black, at the expense of patient care); therefore, I do believe they should shut the hospital down. But, for the media to turn the public focus on the 911 dispatcher (who was perhaps a bit rude, did nothing wrong), seems...off base.

The types of issues being uncovered at King are issues in every major metropolitan hospital in our country. We should focus on solutions...

...and firing a nurse, a CEO, and a 911 dispatcher isn't a solution.

17 comments:

> ScutMonkey said...

Ditto. EMS is stretched thin as it is. Nurses, EMT's, police, fire, good ED docs...all of us are highly needed and hard to find. Making them scapegoats excacerbates the problem. (CEO's on the other hand...)

It would be nice if we could respond to every person that repeatedly yelled "wolf!" in the ED day after day as if it were real, but the large majority are not. If society invents a "bullshit-o-meter" I think the ED is the first place it should be installed. It would save lives, morbidity and many of us a good night's sleep.

The real issue here is that the ED has become the resort of first choice for EVERYONE, not just emergencies, and we are not perfect at sorting out the fakers from the crumpers. We need a place for these other people to get healthcare. Either we take a faker and a baby dies or we take the baby and someone we thought was faking dies. Either way, it sucks for several people until we get a better system.

I would like the people putting the dispatchers on the stand try and sort out the truth with nothing but a phone line and then they can see if they sleep easily at night.

beajerry said...

Good points!

Anonymous said...

And arguably had they taken her from the ER when she was sick they would have been going beyond their training and moving a patient from an area able to offer definitive care to the back of an ambulance.
This ultimately comes down to mis-triaging unfortunately.

Anonymous said...

I think EVERYONE in medicine should be ashamed by this and DO SOMETHING TO CHANGE IT!! All of your profession's continued whiing and complaining only makes it worse.

Blame goes to EVERYONE in this case for allowing the healthcare situation to get so bad......not just the EMS.

TALE OF LAST NINETY MINUTES OF WOMAN'S LIFE
County officials express dismay at the events surrounding the recent controversial death at King-Harbor hospital. One nurse has resigned.
By Charles Ornstein, Times Staff Writer
May 20, 2007


In the emergency room at Martin Luther King Jr.-Harbor Hospital, Edith Isabel Rodriguez was seen as a complainer.

"Thanks a lot, officers," an emergency room nurse told Los Angeles County police who brought in Rodriguez early May 9 after finding her in front of the Willowbrook hospital yelling for help. "This is her third time here."

The 43-year-old mother of three had been released from the emergency room hours earlier, her third visit in three days for abdominal pain. She'd been given prescription medication and a doctor's appointment.

Turning to Rodriguez, the nurse said, "You have already been seen, and there is nothing we can do," according to a report by the county office of public safety, which provides security at the hospital.

Parked in the emergency room lobby in a wheelchair after police left, she fell to the floor. She lay on the linoleum, writhing in pain, for 45 minutes, as staffers worked at their desks and numerous patients looked on.

Aside from one patient who briefly checked on her condition, no one helped her. A janitor cleaned the floor around her as if she were a piece of furniture. A closed-circuit camera captured everyone's apparent indifference.

Arriving to find Rodriguez on the floor, her boyfriend unsuccessfully tried to enlist help from the medical staff and county police — even a 911 dispatcher, who balked at sending rescuers to a hospital.

Alerted to the "disturbance" in the lobby, police stepped in — by running Rodriguez's record. They found an outstanding warrant and prepared to take her to jail. She died before she could be put into a squad car.

How Rodriguez came to die at a public hospital, without help from the many people around her, is now the subject of much public hand-wringing. The county chief administrative office has launched an investigation, as has the Sheriff's Department homicide division and state and federal health regulators.

The triage nurse involved has resigned, and the emergency room supervisor has been reassigned. Additional disciplinary actions could come this week.

The incident has brought renewed attention to King-Harbor, a long-troubled hospital formerly known as King/Drew.

The Times reconstructed the last 90 minutes of Rodriguez's life based on accounts by three people who have seen the confidential videotape, a detailed police report, interviews with relatives and an account of the boyfriend's 911 call.

"I am completely dumbfounded," said county Supervisor Zev Yaroslavsky, who has seen the video recording.

"It's an indictment of everybody," he said. "If this woman was in pain, which she appears to be, if she was writhing in pain, which she appears to be, why did nobody bother … to take the most minimal interest in her, in her welfare? It's just shocking. It really is."

The story of Rodriguez's demise began at 12:34 a.m. when two county police officers received a radio call of a "female down" and yelling for help near the front entrance of King-Harbor, according to the police report.

When they approached Rodriguez to ask what was wrong, she responded in a "loud and belligerent voice that her stomach was hurting," the report states. She said she had 10 gallstones and that one of them had burst.

A staff member summoned by the police arrived with a wheelchair and rolled her into the emergency room. Among her belongings, one officer found her latest discharge slip from the hospital, which instructed her to "return to ER if nausea, vomit, more pain or any worse."

When the officers talked to the emergency room nurse, she "did not show any concern" for Rodriguez, the police report said. The report identifies the nurse as Linda Witland, but county officials confirmed that her name is Linda Ruttlen, who began working for the county in July 1992.

Ruttlen could not be reached for comment.

During that initial discussion with Ruttlen, Rodriguez slipped off her wheelchair onto the floor and curled into a fetal position, screaming in pain, the report said.

Ruttlen told her to "get off the floor and onto a chair," the police report said. Two officers and a different nurse helped her back to the wheelchair and brought her close to the reception counter, where a staff member asked her to remain seated.

The officers left and Rodriguez again pitched forward onto the floor, apparently unable to get up, according to people who saw the videotape and spoke on the condition of anonymity.

Because the tape does not have sound, it is not possible to determine whether Rodriguez was screaming or what she was saying, the viewers said. Because of the camera's angle, in most scenes, she is but a grainy blob, sometimes obstructed, moving around on the floor.

When Rodriguez's boyfriend, Jose Prado, returned to the hospital after an errand and saw her on the floor, he alerted nurses and then called 911.

According to Sheriff's Capt. Ray Peavy, the dispatcher said, "Look, sir, it indicates you're already in a hospital setting. We cannot send emergency equipment out there to take you to a hospital you're already at."

Prado then knocked on the door of the county police, near the emergency room, and said, "My girlfriend needs help and they don't want to help her," according to the police report. A sergeant told him to consult the medical staff, the report said. Minutes later, Prado came back to the sergeant and said, "They don't want to help her." Again, he was told to see the medical staff.

Within minutes, police began taking Rodriguez into custody. When they told Prado that there was a warrant for Rodriguez's arrest, he asked if she would get medical care wherever she was taken. They assured him that she would. He then kissed her and left, the police report said.

She was wheeled to the patrol vehicle and the door was opened so that she could get into the back. When officers asked her to get up, she did not respond. An officer tried to revive her with an ammonia inhalant, then checked for a pulse and found none. She died in the emergency room after resuscitation efforts failed.

According to preliminary coroner's findings, the cause was a perforated large bowel, which caused an infection. Experts say the condition can bring about death fairly suddenly.

Hours after her death, county Department of Health Services spokesman Michael Wilson sent a note informing county supervisors' offices about the incident but saying that that police had been called because Rodriguez's boyfriend became disruptive.

Health services Director Dr. Bruce Chernof said Friday that subsequent information showed Prado was not, in fact, disruptive. Chernof otherwise refused to comment, citing the open investigation, patient privacy and "other issues."

Peavy, who supervises the sheriff's homicide unit, said that although his investigation is not complete, "the county police did absolutely, absolutely nothing wrong as far as we're concerned."

The coroner's office may relay its final findings to the district attorney's office for consideration of criminal charges against hospital staff members, Peavy said.

"I can't speak for the coroner and I can't speak for the D.A., but that is certainly a possibility," he added.

Marcela Sanchez, Rodriguez's sister, said she has been making tamales and selling them to raise money for her sister's funeral and burial. Her family has been called by attorneys seeking to represent them, but they do not know whom to trust.

She said the latest revelations, which she learned from The Times, are very troubling.

"Wow," she said. "If she was on the floor for that long, how in the heck did nobody help her then?

"Where was their heart? Where was their humanity? … When Jose came in, everybody was just sitting, looking. Where were they?"

Sanchez said her sister was a giving person who always took an interest in people in need, unlike those who watched her suffer. "She would have taken her shoes to give to somebody with no shoes," she said. Rodriguez, a California native, performed odd jobs and lived alternately with different relatives.

David Janssen, the county's chief administrative officer, said the incident is being taken very seriously. In a rare move, his office took over control of the inquiry from the county health department and the office of public safety.

"There's no excuse — and I don't think anybody believes that there is," Janssen said.

Over the last 3 1/2 years, King-Harbor has reeled from crisis to crisis.

Based on serious patient-care lapses, it has lost its national accreditation and federal funding. Hundreds of staff members have been disciplined and services cut.

Janssen said he was concerned that the incident would divert attention from preparing the hospital for a crucial review in six weeks that is to determine whether it can regain federal funding.

If the hospital fails, it could be forced to close.

"It certainly isn't going to help," Janssen said.

At the same time, he said, the preliminary investigation suggests that the fault primarily rests with the nurse who resigned. "I think it's a tragic, tragic incident, but it's not a systemic one."

Supervisor Gloria Molina, who hadn't seen the videotape, said she wasn't sure the hospital had reformed.

"What's so discouraging and disappointing for me is that it seems that this hospital at this point in time hasn't really transformed itself — and I'm worried about it," she said.

Supervisor Mike Antonovich said he believed care had improved at the hospital overall, but added, "It's unconscionable that anyone would ignore a patient in obvious distress."

Rodriguez's son, Edmundo, 25, said he still couldn't understand why his mother died. "It's more than negligence. I can't even think of the word."

His 24-year-old sister, Christina, said, "It just makes it so much harder to grieve. It's so painful."

*


--------------------------------------------------------------------------------
charles.ornstein@latimes.com

Times staff writers Stuart Pfeifer and Susannah Rosenblatt contributed to this report.


LINK
[url]http://www.latimes.com/news/local/la-me-king20may20,0,1577522,full.story[/url]

Anonymous said...

I think EVERYONE in medicine should be ashamed by this and DO SOMETHING TO CHANGE IT!! All of your profession's continued whiing and complaining only makes it worse.

Blame goes to EVERYONE in this case for allowing the healthcare situation to get so bad......not just the EMS.

[b]TALE OF LAST NINETY MINUTES OF WOMAN'S LIFE[/b]
County officials express dismay at the events surrounding the recent controversial death at King-Harbor hospital. One nurse has resigned.
By Charles Ornstein, Times Staff Writer
May 20, 2007


In the emergency room at Martin Luther King Jr.-Harbor Hospital, Edith Isabel Rodriguez was seen as a complainer.

"Thanks a lot, officers," an emergency room nurse told Los Angeles County police who brought in Rodriguez early May 9 after finding her in front of the Willowbrook hospital yelling for help. "This is her third time here."

The 43-year-old mother of three had been released from the emergency room hours earlier, her third visit in three days for abdominal pain. She'd been given prescription medication and a doctor's appointment.

Turning to Rodriguez, the nurse said, "You have already been seen, and there is nothing we can do," according to a report by the county office of public safety, which provides security at the hospital.

Parked in the emergency room lobby in a wheelchair after police left, she fell to the floor. She lay on the linoleum, writhing in pain, for 45 minutes, as staffers worked at their desks and numerous patients looked on.

Aside from one patient who briefly checked on her condition, no one helped her. A janitor cleaned the floor around her as if she were a piece of furniture. A closed-circuit camera captured everyone's apparent indifference.

Arriving to find Rodriguez on the floor, her boyfriend unsuccessfully tried to enlist help from the medical staff and county police — even a 911 dispatcher, who balked at sending rescuers to a hospital.

Alerted to the "disturbance" in the lobby, police stepped in — by running Rodriguez's record. They found an outstanding warrant and prepared to take her to jail. She died before she could be put into a squad car.

How Rodriguez came to die at a public hospital, without help from the many people around her, is now the subject of much public hand-wringing. The county chief administrative office has launched an investigation, as has the Sheriff's Department homicide division and state and federal health regulators.

The triage nurse involved has resigned, and the emergency room supervisor has been reassigned. Additional disciplinary actions could come this week.

The incident has brought renewed attention to King-Harbor, a long-troubled hospital formerly known as King/Drew.

The Times reconstructed the last 90 minutes of Rodriguez's life based on accounts by three people who have seen the confidential videotape, a detailed police report, interviews with relatives and an account of the boyfriend's 911 call.

"I am completely dumbfounded," said county Supervisor Zev Yaroslavsky, who has seen the video recording.

"It's an indictment of everybody," he said. "If this woman was in pain, which she appears to be, if she was writhing in pain, which she appears to be, why did nobody bother … to take the most minimal interest in her, in her welfare? It's just shocking. It really is."

The story of Rodriguez's demise began at 12:34 a.m. when two county police officers received a radio call of a "female down" and yelling for help near the front entrance of King-Harbor, according to the police report.

When they approached Rodriguez to ask what was wrong, she responded in a "loud and belligerent voice that her stomach was hurting," the report states. She said she had 10 gallstones and that one of them had burst.

A staff member summoned by the police arrived with a wheelchair and rolled her into the emergency room. Among her belongings, one officer found her latest discharge slip from the hospital, which instructed her to "return to ER if nausea, vomit, more pain or any worse."

When the officers talked to the emergency room nurse, she "did not show any concern" for Rodriguez, the police report said. The report identifies the nurse as Linda Witland, but county officials confirmed that her name is Linda Ruttlen, who began working for the county in July 1992.

Ruttlen could not be reached for comment.

During that initial discussion with Ruttlen, Rodriguez slipped off her wheelchair onto the floor and curled into a fetal position, screaming in pain, the report said.

Ruttlen told her to "get off the floor and onto a chair," the police report said. Two officers and a different nurse helped her back to the wheelchair and brought her close to the reception counter, where a staff member asked her to remain seated.

The officers left and Rodriguez again pitched forward onto the floor, apparently unable to get up, according to people who saw the videotape and spoke on the condition of anonymity.

Because the tape does not have sound, it is not possible to determine whether Rodriguez was screaming or what she was saying, the viewers said. Because of the camera's angle, in most scenes, she is but a grainy blob, sometimes obstructed, moving around on the floor.

When Rodriguez's boyfriend, Jose Prado, returned to the hospital after an errand and saw her on the floor, he alerted nurses and then called 911.

According to Sheriff's Capt. Ray Peavy, the dispatcher said, "Look, sir, it indicates you're already in a hospital setting. We cannot send emergency equipment out there to take you to a hospital you're already at."

Prado then knocked on the door of the county police, near the emergency room, and said, "My girlfriend needs help and they don't want to help her," according to the police report. A sergeant told him to consult the medical staff, the report said. Minutes later, Prado came back to the sergeant and said, "They don't want to help her." Again, he was told to see the medical staff.

Within minutes, police began taking Rodriguez into custody. When they told Prado that there was a warrant for Rodriguez's arrest, he asked if she would get medical care wherever she was taken. They assured him that she would. He then kissed her and left, the police report said.

She was wheeled to the patrol vehicle and the door was opened so that she could get into the back. When officers asked her to get up, she did not respond. An officer tried to revive her with an ammonia inhalant, then checked for a pulse and found none. She died in the emergency room after resuscitation efforts failed.

According to preliminary coroner's findings, the cause was a perforated large bowel, which caused an infection. Experts say the condition can bring about death fairly suddenly.

Hours after her death, county Department of Health Services spokesman Michael Wilson sent a note informing county supervisors' offices about the incident but saying that that police had been called because Rodriguez's boyfriend became disruptive.

Health services Director Dr. Bruce Chernof said Friday that subsequent information showed Prado was not, in fact, disruptive. Chernof otherwise refused to comment, citing the open investigation, patient privacy and "other issues."

Peavy, who supervises the sheriff's homicide unit, said that although his investigation is not complete, "the county police did absolutely, absolutely nothing wrong as far as we're concerned."

The coroner's office may relay its final findings to the district attorney's office for consideration of criminal charges against hospital staff members, Peavy said.

"I can't speak for the coroner and I can't speak for the D.A., but that is certainly a possibility," he added.

Marcela Sanchez, Rodriguez's sister, said she has been making tamales and selling them to raise money for her sister's funeral and burial. Her family has been called by attorneys seeking to represent them, but they do not know whom to trust.

She said the latest revelations, which she learned from The Times, are very troubling.

"Wow," she said. "If she was on the floor for that long, how in the heck did nobody help her then?

"Where was their heart? Where was their humanity? … When Jose came in, everybody was just sitting, looking. Where were they?"

Sanchez said her sister was a giving person who always took an interest in people in need, unlike those who watched her suffer. "She would have taken her shoes to give to somebody with no shoes," she said. Rodriguez, a California native, performed odd jobs and lived alternately with different relatives.

David Janssen, the county's chief administrative officer, said the incident is being taken very seriously. In a rare move, his office took over control of the inquiry from the county health department and the office of public safety.

"There's no excuse — and I don't think anybody believes that there is," Janssen said.

Over the last 3 1/2 years, King-Harbor has reeled from crisis to crisis.

Based on serious patient-care lapses, it has lost its national accreditation and federal funding. Hundreds of staff members have been disciplined and services cut.

Janssen said he was concerned that the incident would divert attention from preparing the hospital for a crucial review in six weeks that is to determine whether it can regain federal funding.

If the hospital fails, it could be forced to close.

"It certainly isn't going to help," Janssen said.

At the same time, he said, the preliminary investigation suggests that the fault primarily rests with the nurse who resigned. "I think it's a tragic, tragic incident, but it's not a systemic one."

Supervisor Gloria Molina, who hadn't seen the videotape, said she wasn't sure the hospital had reformed.

"What's so discouraging and disappointing for me is that it seems that this hospital at this point in time hasn't really transformed itself — and I'm worried about it," she said.

Supervisor Mike Antonovich said he believed care had improved at the hospital overall, but added, "It's unconscionable that anyone would ignore a patient in obvious distress."

Rodriguez's son, Edmundo, 25, said he still couldn't understand why his mother died. "It's more than negligence. I can't even think of the word."

His 24-year-old sister, Christina, said, "It just makes it so much harder to grieve. It's so painful."

*


--------------------------------------------------------------------------------
charles.ornstein@latimes.com

Times staff writers Stuart Pfeifer and Susannah Rosenblatt contributed to this report.


LINK
[url]http://www.latimes.com/news/local/la-me-king20may20,0,1577522,full.story[/url]

Atilla RN said...

Anonymous said: "I think EVERYONE in medicine should be ashamed by this and DO SOMETHING TO CHANGE IT!! All of your profession's continued whiing and complaining only makes it worse.


Whining and complaining IS doing something to change it. If enough people hear the frustrations from those in medicine (through blogs, websites, etc), perhaps things and attitudes will slowly change as they become more aware of the problems.

.

Blame goes to society, in general, for allowing this to happen.

Blame goes to the drug addicted, illegal immigrant, homeless, prostitute who cried wolf one too many times. Blame goes to the overextended system run by for profit insurance companies and mulimillion dollar CEOs. Blame goes to our inability to care for all of the poor Mexicans who come here with their medical problems. Blame goes to the malpractice lawyers (and the malpractice system in general), for causing health care costs to sky-rocket.

There is plenty of blame to go around. Unfortunately no one element working alone can really make a difference. The attitude of society has to change, as a whole, and a new emphasis placed on health care, poverty, malpractice, and for profit insurance middle-men and CEOs.

In reality, the doctors, nurses, etc. have way less power over this than the patients (regular people in society who are sufficienty fed up, and willing to support changing the status quo are actually the power-holders).

This, includes you Mr. Anonymous.

Anonymous said...

it's too sensational a story to report without checking facts like emtala violations if medics actually responded to the ED, etc.

stupid media as usual.

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