Medical Disasters and How to Avoid Them (Part 5)

The new documentary by Michael Moore called SICKO has launched nationwide
heralding the cry of health care reform due to the inadequacies of the
health care system. In “Medical Disasters and How to Avoid Them” Dr. Pierce Scranton, an Orthopedic Surgeon, arms us with practical tips on how to take charge of our own experiences while at a hospital and he teaches us how to protect ourselves and prevent any travesty that could occur. In a series of six articles, HealthWorld Online and Dr. Pierce Scranton, will provide actual case by case, behind the scenes scenarios, along with tips on how NOT to have these experiences happen to you. In the fifth installment you will the importance of knowing how to avoid pitfalls when visiting the emergency room.

Case 5 – B.A.’s Emergency Room Nightmare
B.A. was a 17 year old athletic, off-road biker who struck a tree trunk with his leg when he lost control during a Saturday afternoon race. He was brought to his HMO’s emergency room where the diagnosis of a closed mid-shaft tibial fracture was made. He had good pulses distal to the fracture, and good neurologic function. So the emergency doctor put him in a compression splint, told his family to take him home and elevate the leg, and that he could see an HMO orthopedic surgeon on Monday. That evening his mother called to inform the emergency room that B.A. was having severe pain, and she was instructed to elevate the leg even further on several pillows, put a large bag of ice on the limb, and to double up on the pain pills. If necessary he could also take Ibuprofen with the Percocet pills as it would tend to potentiate pain relief. B.A. reported later that night that the ice had made his whole leg feel numb, and he was quite woozy from all the Percocet.

The next morning B.A.’s foot was blue, and he was writhing in agony. His mother called the HMO emergency room again, but a different doctor curtly told her the same instructions and to wait until Monday for the Orthopedist. Knowing her own son’s pain tolerance, she took him to another hospital emergency room. There, an emergency room doctor made a diagnosis of “acute compartment syndrome,” meaning that there was so much swelling in B.A.’s leg that the blood supply to his lower leg had been cut off. They called the HMO who refused to allow them to treat B.A., and they were forced to return to the HMO for an emergency surgical release to open up the compartments and let blood supply into the leg. The operating surgeon found black, necrotic jelly from liquefied dead muscle in B.A.’s entire lower leg. He told the family later that if he’d seen the boy that Saturday night there was a good chance he could have saved his leg. However, now he required an amputation.

Two years later in the discovery portion of the lawsuit they discovered that the emergency room doctors had an incentive to turn away admissions as they were “bonused” on the number of patients they saw that they did not admit. The HMO settled out of court before trial, and with the settlement was a “gag order” prohibiting any discussion of the case by either party. The records were also sealed by the judge.

How to avoid Emergency Room Pitfalls

1. Today with over 50 million Americans uninsured, emergency rooms have become overwhelmed. Under incredible loads emergency room doctors do the best they can. They are not specialists, and they will be the first to admit this. However, in many large HMOs the emergency room doctors are given incentives to not admit patients. The subscribers to that HMO are not told that if they use the emergency room that doctor actually will be looking for ways to cut corners and send them home – saving the plan money.

2. Be engaged. When you take someone from your family to the emergency room, you know that person, their pain tolerance and emotional make-up far better than an emergency room doctor. Be very attuned to your friend or relative’s complaint’s and as they are in distress, be very attentive to the emergency room doctor and the instructions.

3. If your friend or relative is treated and released, ask, “Doctor, what kind of things can go wrong? What do we need to watch for?” In today’s world, most emergency rooms will give you written instructions and written precautions. But most instructions are generated by a computer program, and that program is only as good as the diagnoses put into it.

4. Get a second opinion! You probably will not get another objective opinion from that emergency room. If you have real concern about the appropriateness of the care then it is necessary to go to another doctor or emergency room. The waiting and hassle will be painful, but as politely as possible explain that you just need to be reassured that the correct diagnosis has been made and that the correct treatment has been administered.

Remember, it’s your health and well-being that’s on the line. Be engaged in the process, and stay healthy!

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Written by Pierce Scranton MD

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