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  1. #1
    HumblyAsksHelp is offline Junior Member
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    Severe Emergency Room Neglect; What Do I Do Next?

    PENNSYLVANIA. Recently, I sought treatment a local trauma center's emergency room after a dramatically worsening two-day depression that escalated to suicidal impulses. Although I have a long history of well-managed depression and anxiety, there have never been any suicidal impulses until a few hours before my trip to the hospital. During my ER triage interview, I explained that I had no outside triggers that were sparking the depressive episode and that I had been taking all of my usual medications on time and that none had changed. Nevertheless, hour-by-hour, my depression was worsening and I was developing plans and heavy suicidal impulses. The triage nurse asked me to describe my plans and I told her that I had developed over a dozen "fail-proof" plans that would ensure that no one would find me and this type of thought was foreign to me and an alert to seek immediate help. As the nurse began asking me personal and demographic questions, I gave her a five-page, typed medical history with all identification, insurance, medication, allergy and previous admissions information that I keep updated and stored in my glove box for emergency situations. The triage nurse strapped an identification bracelet on my left arm and escorted me to an emergency treatment room. Along the escort, she explained to me that I would be on a "one-on-one watch" until I could be seen by an appropriate physician. I replied that I knew that I would be closely and continually watched and that I was seeking emergency room level treatment for that reason.

    When we arrived in my assigned room, the triage nurse introduced me to one of the hospital's security guards. The guard shook my hand and told me his name and explained that he would be sitting at the door of my room for my own safety. He invited me to talk to him if I chose or to remain quiet if I wished. I thanked him and put my head on the bed's pillow. WITHIN FIVE MINUTES, THE SECURITY GUARD LEFT AND DID NOT RETURN.

    As hours passed, my depression and suicidal impulses grew stronger. At one point, a phlebotomist came to draw blood and at another a woman from the business office came to verify insurance information. My partner came to stay with me for less than thirty minutes and then had to leave and return for a longer time later.

    During my wait for treatment, the door was always opened, but given the position of my room, no one could see inside without being directly in front of the door. There were no cameras in my room.

    Shortly after my partner left, two local police officers escorted a man into the room adjacent to mine. The patient was, for whatever reason, violent, verbally abusive and out of control. The man's tirade lasted for several hours as police officers and hospital security officers outside of his room taunted him thinking that the patient's behavior was in some way humorous and entertaining. Nevertheless, the loud, unruly and violent action in the room next to me upset me emotionally as my suicidal determinations worsened. A nurse came into my room to get supplies from the cabinets at the front of the room. When she did, I stood and begged her to move me to a different room as the noise, cursing and screaming in the next room was too much for me to handle in my emotional state. She curtly explained that she WOULD NOT move me to another room and that I would have to deal with the situation like everyone else. I slipped back into my bed and tried to block offending stimulus of my neighbor's actions.

    After having been in the room for six hours, I arose from my bed in a detached mental state. I took a quick tour of my room on foot and stopped at the wall telephone. I gently unclipped the handset cord of the wall telephone and carried it back to the bed with me. Without full understanding of what I was happening, I stretched the cord and wrapped it vigorously four times around my neck ensuring that it was as tight as it could be. I put myself back in the bed and pulled the blanket up to my cheek as usual and felt the blood supply slowly diminish to my brain.

    After the point when my body became icy and I began to feel a calming euphoria from the lack of oxygen in my brain, my partner came back to be with me for the rest of my emergency room stay.

    When he entered the room, he saw that my face was strikingly blue and quickly came to me repeatedly calling my name. He said that I was unresponsive. He pulled the blanket back to determine what could be wrong and immediately saw the telephone cord wrapped around my neck. He unwrapped it as quickly as he could while yelling for help. He said that at first, a security guard entered and threw the untangled phone cord under a gurney in the hall. Next, four medical workers entered the room and began assessment and then resuscitation procedures.

    The next day, I awoke in the intensive care unit intubated.

    My partner told me that he was interrogated by local police as they tried to determine whether he attempted to kill me or whether I truly did make a suicide attempt. One of the detectives that interrogated him spoke with me after all of the life support tubes had been removed and asked me to recount the events that I could remember.

    Clearly, I require long-term psychiatric and psychological treatment to cope with this event. No one has assessed any other long-term effects this situation has had to my body.

    Clearly, the hospital mishandled me by not providing me with constant monitoring while in the emergency room. As a result, the hospital's lack of due diligence directly contributed almost wholly to the ensuing suicidal attempt. SHOULD I PURSUE LEGAL ACTION AND, IF SO, FOR WHAT?

    My mind has become tangled by the trauma of the events and I desperately need help sorting where responsibilities lie, what actions should be taken, and whether what happened warrants any action at all.

    I truly appreciate any intelligent guidance given.

    Respectfully,

    HumblyAsksHelp
    Last edited by HumblyAsksHelp; 06-05-2009 at 09:34 PM. Reason: Error at ending.
  2. #2
    JETX is offline Senior Member
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    Quote Originally Posted by HumblyAsksHelp View Post
    Clearly, the hospital mishandled me by not providing me with constant monitoring while in the emergency room. As a result, the hospital's lack of due diligence directly contributed almost wholly to the ensuing suicidal attempt. SHOULD I PURSUE LEGAL ACTION AND, IF SO, FOR WHAT?
    You have NO case.
  3. #3
    Shay-Pari'e is offline Senior Member
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    Ahh, I've missed Jetx. He is right though, you have no case. i would seriously however look into whether this is in fact depression. this could be much more than that. Stay safe,
  4. #4
    Country Living is offline Senior Member
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    Welcome back, Shay. You've been missed!
  5. #5
    Shay-Pari'e is offline Senior Member
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    Quote Originally Posted by Country Living View Post
    Welcome back, Shay. You've been missed!
    Thank you sweetie
  6. #6
    summerpoem is offline Junior Member
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    You DO have a case!

    I'm new here, having just registered after I read the WRONG replies to your question. I'm not an attorney but I am a mental health professional. I'm an RN, charge nurse for thirteen years, on a locked, acute adult in-patient psychiatric unit of a general hospital in a large urban city.

    I can say with NO doubts at all (having been well-versed in this topic by our own hospital legal department) that you most certainly DO have a very strong case of malpractice against this hospital and ER physician.

    Had you wrapped the phone cord around your neck in your own home, you'd have no case of course. However, the minute you walked into that ER and voiced your suicidal ideations, it became that hospital's LEGAL obligation to keep you safe. No ifs, ands, or buts. NO way can they shirk that duty. You stated up front you were feeling suicidal. (You even stated you had formulated plans which indicates a more lethal and imminent threat.) They were ABSOLUTELY on the hook legally, from that point forward.

    You should have been under constant observation in the ER. If that hospital did not have a psychiatric unit, they were legally compelled to keep you safe until they could find a psychiatric unit or safe option to assume your care. They clearly did not meet their legal obligation to you.

    Major depression with suicidal ideation IS a life-threatening illness. Just as dangerous as a heart attack or a head-on collision. It can be induced by chemical imbalances, medications, psychosis, or even physical illnesses, (brain tumor, or other neurological diseases, etc.)

    It is NOT a character flaw or a weakness. It IS an illness. A life-threatening illness that requires urgent intervention to prevent injury or death.

    I would venture to say one of the reasons suicide has become a leading cause of (preventable) death is because of the attitudes of the people who have replied here before me. These replies show such a lack of understanding of mental illness or the treatment of it. Too, they clearly show just how dire the need is for education of mental illness.

    I want to tell you how very sorry I am for all you've gone through already. I hope you're receiving competent and compassionate care for your illness now.

    Please contact an attorney in your area who is well-versed in psychiatric issues. Believe me, you have a HUGE malpractice case!
  7. #7
    Zigner is offline Senior Member
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    Quote Originally Posted by summerpoem View Post
    Please contact an attorney in your area who is well-versed in psychiatric issues. Believe me, you have a HUGE malpractice case!
    While I agree about contacting an attorney, I do think you are seriously over-estimating the case our OP has.
  8. #8
    slwx is offline Member
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    not a legal expert

    i'd just like to say that i hope you're feeling somewhat better and that you have lots of support now -- i think it's a shame they left you in a room for 6 hours like that

    good for you that you went to the ER and explained it that way. so many people would have been too scared or ashamed to do so.

    i have a son that suffers from depression -- it has gotten to both the suicidal level and the psychotic levels before. we've been to the psychiatric unit of the ER twice. a big problem is that there is a lack of beds in the mental health system.

    my husband was recently intubated from an auto accident, that's a serious state to get into. i hope you've recovered physically from everything too.

    no legal advice, just wanted to send you my best wishes for your recovery.
  9. #9
    ecmst12 is offline Senior Member
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    I want to believe there was negligence (if leaving a suicidal patient in the ER alone isn't negligence), I don't know what is!) however the damages due to the negligence itself and not the underlying mental illness are very unclear. Had OP been properly supervised, she might not have made the actual attempt, but she still would have needed the same extensive treatment for her illness. Unless the suicide attempt itself caused some permanent damage, then any case would be (relatively) small. However, since (IMO as a non-expert in the matter) the negligence in this case is so egregious, it may be worth speaking to a lawyer anyway.
  10. #10
    lealea1005 is offline Senior Member
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    After having been in the room for six hours, I arose from my bed in a detached mental state. I took a quick tour of my room on foot and stopped at the wall telephone. I gently unclipped the handset cord of the wall telephone and carried it back to the bed with me. Without full understanding of what I was happening, I stretched the cord and wrapped it vigorously four times around my neck ensuring that it was as tight as it could be. I put myself back in the bed and pulled the blanket up to my cheek as usual and felt the blood supply slowly diminish to my brain.

    After the point when my body became icy and I began to feel a calming euphoria from the lack of oxygen in my brain, my partner came back to be with me for the rest of my emergency room stay.

    When he entered the room, he saw that my face was strikingly blue and quickly came to me repeatedly calling my name. He said that I was unresponsive. He pulled the blanket back to determine what could be wrong and immediately saw the telephone cord wrapped around my neck. He unwrapped it as quickly as he could while yelling for help. He said that at first, a security guard entered and threw the untangled phone cord under a gurney in the hall. Next, four medical workers entered the room and began assessment and then resuscitation procedures.

    The next day, I awoke in the intensive care unit intubated.
    I'm not trying to be snarky, but I do find it interesting that someone with such trauma can have such a detailed recollection of what happened immediately before becoming hypoxic, intubated, and waking up in the ICU. More frequently, because of the hypoxia, there is no memory at all just before the trauma occurs (MVA, head trauma, etc). Just my observation.
  11. #11
    wyett717 is offline Member
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    I'm not trying to be snarky, but I do find it interesting that someone with such trauma can have such a detailed recollection of what happened immediately before becoming hypoxic, intubated, and waking up in the ICU. More frequently, because of the hypoxia, there is no memory at all just before the trauma occurs (MVA, head trauma, etc). Just my observation.
    I was thinking the same thing. Odd.

    Yes, OP should look into this further. People who arrive at the ER with suicidal thoughts should automatically be placed on suicide watch until they receive treatment. It sounds like the hospital intitially did this, but the security guard left, and it may be the security company (if they are contracted out by the hospital) who is on the hook. An attorney will have to examine your case, although it's hard to determine what your permanent damages actually are.
  12. #12
    You Are Guilty is offline Senior Member
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    A few random thoughts.

    1) The style of writing has set off my "watch-out" radar. Ignoring the apparent clarity of recall issue, the writing certainly suggests significant underlying mental issues.

    2) At any point during the admission, was there an assessment made by hospital personnel that the OP was, in fact, a "danger to himself or others" (can't be assumed just because the 1-on-1 was assigned).

    3) Just because the guard was originally assigned to the 1-on-1, that doesn't mean that he is the only one who could perform it. OP has no way of knowing who was watching from outside the room.

    4) I'd be very interested to know more details about what happened with the patient in the next room. Particularly, was there some sort of code called which required all personnel to report?

    5) There is no "strict med mal liability" as the RN poster seems to suggest. There may (MAY) be plenty of defenses for the hospital here. No way to know for certain until their side of the story is told.

    6) And I think someone mentioned this already but if there are enough facts to support a med mal liability finding, what are the damages? Continued mental illness? Not exactly a high-dollar case which means attracting a lawyer who won't just want to settle quick may prove difficult.

    But I'd certainly float this to a few local med mal lawyers to see if any have interest, and let them do the initial investigation to see if there's a case here.
    Quote Originally Posted by Tranquility
    Once you get to crazy land, it is only a guess on how to get out.
  13. #13
    summerpoem is offline Junior Member
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    Non-Random Thoughts

    Don't want to be argumentive but there IS liability for the hospital and staff of any patient they treat. I have sat through too many legal seminars given by our hospital attorneys. Not to mention the countless times I have spoken with them myself. I'm a straight-forward person and I ask my questions in a direct manner. I make sure communication is clear. I know my stuff. I HAVE to in order to keep my patients, my staff, and myself safe. My assertions here have come straight from the attorneys.

    I was an ER nurse too for ten years, prior to going into psychiatric nursing. For a fact, once a patient is triaged into the ER for treatment, the hospital has assumed liability. The only way that would cease to exist is if the patient voluntarily leaves on their own, (and has not indicated suicidal ideation.)

    However, if a patient says they are suicidal, the hospital can NOT wash their hands of responsibility of keeping that patient safe. It does not matter whether I as a nurse "believe" their story or not. If the patient voices suicidal ideation, they ARE considered a danger to self. We are not allowed to make the determination of whether it's genuine or not. If the patient does not want to stay for treatment after voicing suicidal ideation, that patient is put on a 72 hour hold by the ER doctor to be evaluated by a psychiatrist.

    Also it doesn't matter what havoc is going on in the rest of the department. That patient requires 1:1 staffing. Chaos in the department is no legal excuse for abandoning a patient. If necessary, the charge nurse would call the nursing supervisor for needed help. That's how it works. It happens frequently on my unit. Believe me, I know the drill here. And yes, anyone can do 1:1 staffing. Doesn't have to be a guard.

    As for her clarity of recall, I don't find that odd at all. Many of our patients remember in striking detail all that happened prior to the massive overdose, or slashing of their wrists. Emotional trauma makes memories stand out. Don't you remember vividly where you were on Sept. 11, 2001? True, some patients are foggy with little recall and that is very common when associated with alcohol and drugs.

    What are the damages? I'll be right back to summarize my thoughts about them...
    Last edited by summerpoem; 06-10-2009 at 07:27 PM. Reason: Edited for typos
  14. #14
    summerpoem is offline Junior Member
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    Damages?

    Well, let's just run through a few of them. Specifically, what the OP does NOT remember. She remembers wrapping the cord around her neck. Her partner told her she was unresponsive and the medical team came in to resuscitate her. Her next memory was waking up in the ICU, intubated.

    That means she was near death and was coded. You only intubate a patient in an emergency who is NOT breathing. (Intubation is putting a tube down the throat into the lungs and hooking that person up to a ventilator to breathe for them.) Codes are very traumatic. Fractured ribs, lacerated livers, and internal injuries are very common. Too, emergency intubation means the ER doctor selected the size of the ET tube based on a quick decision of that person's throat and trachea. A wrong decision could mean damaged vocal cords and inability to swallow properly after it's removed.

    She woke up the next day in ICU. Unconscious for at least a day. IV fluids, and tubes everywhere. This is not a benign event to minimize in any way. Plain and simple, she almost died...

    But she didn't, so what's the big deal, huh? Well, besides the physical turmoil they put her through, they also inflicted a major setback to her emotional recovery. She came to them for help! This is NOT standard of care for suicidal crisis!

    Another thing. Her life was saved by many skilled (and expensive) professionals. They used (expensive) life-saving equipment and technology on her. Those ventilators in the ICU are NOT cheap. Nothing in the hospital is cheap. Wonder what her bill looks like...

    At least she's alive. Bottom line, they dropped the ball. They owe her big time. The OP was very ill and went to the hospital for help. She was treated like a rebellious child. It makes me so sad to see how profound is the lack of understanding of mental illness.

    We all want to think we're too smart, too sharp, or just too "together" to ever end up on a psychiatric unit. But keep in mind, we're all just one head injury away (a fall, or an mva, etc.) from chronic, ongoing, mental health care. Be thankful if your brain works half way right today. It just might not tomorrow...

    She needs to get an attorney to review all of her medical records for documentation, or lack thereof. I hope her attorney wins her a handsome settlement. Some hospitals have to learn the hard way how to treat the mentally ill.
  15. #15
    Proserpina is offline Senior Member
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    OP needs still needs tangible damages.

    None of us were there at the hospital; we only have OP's report of what happened and at the very least the hospital records are needed before anyone can make a judgment as to whether any malpractice occurred.

    And we don't have those records.

    I truly don't mean to be argumentative, but there's simply not enough information to conclude that OP deserves a "handsome settlement"; frankly to state that so definitively without knowing the full story is doing the OP a disservice.

    OP, please call around a few medmal attorneys in your area and have them review your records.

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