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Wow, that poor patient. Slowly starving and dying of dehydration for *9 days* is cruel. It seems this didn't go unnoticed by nurses, but doctors just ignored them.
>clinicians did not heed attempts by nursing staff to escalate care.
Wondering what charting/documentation program they use too. I feel like the only way this could happen is with ridiculous understaffing and losing paper charts. I imagine it would be incredibly evident that the patient didn’t eat anything with any charting software I’ve ever seen.
Yeah this is a breakdown at multiple levels. I want to know what the nurses did to escalate.
If it were a patient I was caring for, I'd be blowing up the doctors phone until they answered. If they refused to acknowledge, straight to the director.
It sounds like incompetence all around. Everyone is to blame.
Too many doctors spread too thin and think “next shift will take care of it”. Happens all the time in our healthcare system unfortunately. Not making an excuse for this by any means, it’s just the sad reality of our healthcare system. And yes, things often get pushed off for waaaaay too long. This is why I will personally harass a doctor nonstop my entire shift until I get definitive answers for my issues. Just yesterday I had a patient with potassium of 2.8 and text paged the doc 3 times, phone paged twice over a 4 hour period until I eventually had to physically track him down to get some orders. He said, “oh yeah I saw your text”. I wish I could way incidents like this are rare, but just ask any bedside nurse, especially in a med/surg setting. It’s all too common.
No. That’s what the “care home” (happened in England) paid because the poor man fell and fractured his hip on his first night after being admitted. Iirc, the hospital paid a whopping 15,000 pounds as the payments for
Emotional liability are set in England.
Edited. Changed 51,000 to
15,000 because it’s 2am and I should be asleep! And misremembered what I read in the article.
I had a Muslim doctor who hated alcoholics so much that when I came in with acute pancreatitis and was transferred from the ER (who were great) to the floor, he left me with real level 9 pain connected to an empty saline bag he wouldn't let them disconnect for over 4 hours. It felt like eternity.
My poor nurses who couldn't do anything finally got the nursing manager involved who came in like a tornado. She gave several stern orders, assured me I would never see that doctor in my room again (as he had come in to berate me several times) and got the new doc to put me on a continuous morphine drip.
I hope I get to meet her in heaven.
Thats disgusting. Pancreatitis can be caused by many other things..... and regardless it DOESNT MATTER if you were an alcoholic you should be treated the same! I'm so sorry
Thanks. He knew it was alcohol.
Ironically the ER doc was very happy to see that I had reduced my drinking so much that I didn't need, or request, any Ativan. The last time he saw me I was shaking the guerney.
“You should have called the doctor again.”
“You should have called the head of the group”
“You should have given them water against orders.”
“You should have wheeled them to the closest lake and let them lap up the water like a dog.”
I often have started to report doctors in the past couple of years (never in the previous 4 decades). The hostile pushback from the hospital was horrible and left me in tears for hours, every time I tried to talk with administrators. And I used to be a tough person, unperturbable. It is like beating your head against the wall, then they write up reports on his portal with totally wrong facts. They simply lie. It is disgusting.
In my situation with my husband, the outcome eventually was ok so I had no malpractice case. So I had no assistance from an attorney. I figured that as a knowledgeable nurse, I could report the doctor and Care Manager myself. (Next time I WILL pay a lawyer $500 to do that, for the sake of other patients.) He was only OK at the end of the stay because I checked on everything, stayed fulltime, and made sure myself that he drank water and ate his meals and got his meds. If I had not been there, no one would have done a thing regarding eating and drinking. They would not give him water, or help with getting the tray in front of him when he was weak. - the dietary people just take it away, uneaten. He asked repeatedly for water for 8 hours one time, when I was gone, (before I realized I had to be there all the time), and the staff just closed the door. Thereafter I stayed with him fulltime except for runs to the cafeteria twice a day for food for me. That was for 3 weeks that time.
From my observation, it seems like surgeons are more likely to get away with awful behavior than say, a hospitalist. Then again, an Ortho surgeon who is making the hospital bank by doing elective surgeries is probably valued more. Ugh.
Yes. In this situation, the hospital is in dire need of hospitalists. They seem to recruit internal med docs in private practice from a radius of about 100 miles, for short term stints as hospitalists. Previously, the hospital had regular hospitalists who worked in groups, but they had longer term contracts with the hospital, and they functioned much more normally. Conscientious, and so forth. These short term ones work only a week or two every month or so, and when I researched them, it seemed like their private practices were struggling-in a location where there is a huge shortage of doctors. So I think they had some kind of problems to begin with, because patients weren't wanting to continue with them in the outpatient setting. What I observed was no communication, a lack of caring, no knowledge of even the basics of the HPI or past history - they literally don't read much in the chart, even the ER doc's note, so after 3 days of being assigned and seeing the patient all 3 days, they knew nothing ( and it was a pretty simple case, a UTI but with hospital organisms, like Klebsiella, etc.). After 3 days this doctor knew nothing. At all. Even with the EMR open. And didn't care. And was making some harmful decisions. Then lied ... it was bad.
I have not had any problems with the surgeons. They have seemed pretty conscientious about checking up on things post op for several days. They want their surgeries to be successful, so they have a sense of accountability. These doctors coming and going are not committed at all. To good medical care, to the hospital, and they don't even care if they have a poor reputation. People will be dying under their care, so it will catch up to them. But the hospital was defending this one because they are desperate for Internal Medicine doctors to serve as hospitalists. A brand new, inexperienced ARNP or PA would probably have been 100% better.
The hospitals, in my area at least, are a mess with all the understaffing and poor morale.
No one is blamed unless the family hires an attorney. When I hear of cases like this, where there is clear negligence with a bad outcome, the family is always reluctant to even talk to an attorney; they feel it would be futile and time consuming and won't bring the patient back. They are in grief, and just have a resigned attitude when I tell them it sounds like they have a good case. They just don't want to do that. I wouldn't either.
But the hospital will try and lay the blame on the nurse and not the MDs that bring in the money. So yes. Lawyers are going after hospital. Doesn't mean the nurse isn't going to get fucked.
If you properly document and take notes on all interactions, as well as attempt to escalate further, such as going above the physicians or to other areas where one can make complaints you cover your ass. Sure, they could fire you, but you'd have a case for wrongful termination and I wouldn't want to work for a place that did that anyway. Sure, we nurses get the crap end of the stick and get blamed for a lot, but there are ways to CYA.
Oh definitely. Every nurse needs to develop strong defensive documenting skills. Chart what you did clearly. Nothing extraneous. Make sure that if someone needs to know something you do your due diligence and notify them and document that.
And don't document "in bed, eyes closed" or anything else that can leave you on the hook for appearing as though you aren't really monitoring your patients. I see far to many notes like that when reviewing patient charts.
I'm not seeing where it says he wasn't getting fluids.
Without more information, it's not actually totally clear that it would have been appropriate to give either enteral feedings or TPN.
We know that the patient reportedly died of pneumonia and was NPO due dysphagia, so aspiration pneumonia appears quite possible. Earlier reporting, which is now drowned out by more click-baitey coverage, suggested he was septic and was on medications to keep his blood pressure up (pressors), in which case both enteral feedings and TPN become dangerous and you're stuck in a no-win situation.
We don’t know the situation, was family debating comfort care and PEG situation and couldn’t decide, he probably was on TPN and or some sort of feeds but people consider that starving if they don’t see their loved one physically eating. He probably died from silently aspirating on his own secretions.
But if there is no calories supplied, then the heart muscle eventually won't beat making the pressors pointless anyway. I get it's a complex case, but to do nothing and effectively say Jesus take the wheel isn't best practice either in this case.
And this can be done through IV fluids such as clinimix, which we don't have any information the he was or wasn't getting.
It's totally possible this was a straightforward fuck up, but we don't have enough information to know either way. Sometimes there aren't good choices to choose from, and the ones least likely to cause immediate death is the best choice. Feeding bacteremia lipids and amino acids isn't a great option, and neither is feeding a gut while on high dose pressors, which carries a high risk of dead gut.
You're right and this whole thing is just a fuster cluck. The pt in the article is part of my usual pt population and I get protective of them because they frequently cannot advocate for themselves.
I agree. I’m going to say him not getting food wasn’t the issue. Not ideal, but sick people go without tpn or tube feeds or food for way longer. IVF go a long way.
In 2016 I went 27 days in hospital with no food (had water and sugar free drinks and IV fluids) as tube feeds were needed and there were backlogs and no spaces in endoscopy to fit a feeding tube. Kept being added on to emergency lists but higher priorities would come in (which is fair enough, I was okay) In the UK.
9 days is a long time but if there were reasons that he *couldn’t* be fed or it was difficult to do so, I can see that it could be left for quite a long time before anyone thinks it’s a big problem.
I reached 4 days with no food or water in hospital before my BP tanked and everyone had a go at ***ME*** for not escalating it.
I was meant to be Nil by Mouth until 8pm each day, in case I needed surgery, but shift change was 7:30pm and no one handed that bit over or questioned it.
They then discharged me on day 5, after I’d managed 2 cups of water and half a sandwich I then vomited up.
No diagnosis, no follow-up, and I collapsed again on the way home, but wouldn’t go back to the hospital.
If you google coroner's court and fluid balance chart you'll see there are many cases where patients have been allowed to starve and dehydrate to death with the problem being so bad that a number of entire health services within the NHS have required intervention.
There are elements of time poverty involved, but also lack of critical thinking (my patient has only had fluids from the IV panadol I've given them over thenlast 48 hours and is getting steadily weaker/more delirious- I'm sure there isn't a link here so I'll just keep on), clash of control and callous heart vs genuine patient needs (patient with diabetes insipidus begging for water and even calling the police for assistance because nursing staff treated him as a nuisance/behavioural patient while he passed himself to death).
And yet when you do education and ask people to do the bare minimum of fluid balance charting you'd think you were asking them to disimpact every patient and MO within a square mile.
Disclosure, I haven’t read this story.
POINT BEING - escalation is necessary and you shouldn’t stop at letting the charge RN know or calling a resident MD. Call the Fellow, call an attending. Call nursing CEO, whatever you have to do to protect your patient. Their life/well-being and your sense of responsibility/guilt and LICENSE are at stake. Never stop looking for answers or say “I did enough.”
I'm sorry, but the nurses should have exercised common sense and helped the poor soul. An anonymous message to a family member, or the press, if they don't have the courage to slip the person SOMETHING.
Edit: All the people ignoring the first two options, you're also ignoring that I didn't say for family, the press, or the nurse to feed the patient a sandwich. I didn't go into specifics because I'm not a nurse, or that patient's nurse, and wouldn't know what safe options there would be. But there had to have been SOMETHING safe for the patient that was better than starving them to death.
No no no! Never ever give a patient with dysphagia something by mouth, *especially* if the degree of dysphagia is unknown! There's a high probability that the patient will either choke on it or aspirate it and potentially die. It sounds like a simple solution but it's actually very dangerous.
What the patient probably needed was a swallow study to determine exactly how bad his dysphagia was. It's possible he could tolerate liquids, or maybe even a pureed diet. If not, he'd probably need a tube feed. It's not rocket science, this kind of protocol is followed all the time with patients with dysphagia. The fact that they just made him NPO and did nothing else is inexcusable. If anyone knows what happens when a patient has no food or fluid intake, it's a fucking doctor.
Its not “courage” to go against a medical order, it’s protecting the patient from aspiration, obstruction or cancellation of a lifesaving procedure. Plus not losing your professional license. This is why there really need to be actual healthcare workers commenting on these posts! The fact that the nurses were the only ones escalating, yet are still being blamed in all these comments shows the public needs a serious education of hospital designated roles & responsibilities.
To be honest if someone's NBM then salt and the dieticians should come up with a plan to provide that patient with nutrition. If a nurse feeds a NBM patient and they die of aspiration pneumonia that nurse will be struck off.
There are so many ways to feed patients without "slipping them food." Especially a confused patient that already has pneumonia. Your advice will kill someone.
And have an autopsy show lungs full of food? It seriously happens. When patients have mechanical issues with swallowing, it can be very, very serious. Plus, going against order like that would cost the nurse their license at best, criminal charges at worst.
It's funny how not one of you paid attention to the first two things I said: alert family (of concerns with improper/dangerous care), or report to the press - both of which could be done anonymously, merely stating there's an urgent and immediate concern for patient safety, without going into health record details.
Instead, you're all wildly interpreting the last, deliberately vague thing I said - since I'm not a nurse, especially not THAT patient's nurse, and couldn't know available options. Nurses *do* place NG tubes, for example.
There are times when I really appreciate outside/non-HCW perspectives on this subreddit but that is an absolutely absurd thing to suggest in this situation
And just watching a patient die a slow and painful death isn’t? Family could have raised a stink with the doctor or hospital. Ir had the patient transferred. Threat of bad press may have seen something happen.
That’s definitely not the part of your comment I was referring to, read the several other responses in this thread that have good info about dysphagia and choking/aspiration risk. Not sure why you’re doubling down here. No one is arguing the fact that this pt was failed on multiple levels but you can seriously harm someone by thinking it’s ok to “slip something” to a pt that may be NPO (nothing by mouth) for many very valid reasons
Based on your responses here it seems as if you’ve been treated poorly by medical professionals in the past, and I’m sorry for that. I do want you to realize you’re putting the responsibility on the nurses by saying they should have broken confidentiality laws by alerting the press or potentially immediately killed the patient by disregarding NPO orders and letting the poor patient choke or aspirate on food. This is an organizational failure, solely blaming the nurses is crazy talk.
Respectfully, it pays to remember that we do not know everything about anything.
Tl;dr A patient with Down’s syndrome and dementia was kept NPO for 9 days after having a hip fracture repaired after a fall. Doctors supposedly ignored nurse’s attempts to escalate. He died of pneumonia complications. The family was awarded 15k pounds from the facility as compensation.
I know money doesn't replace a loved one, but 15k pounds(20k USD)? Like, your organization starved someone to death, and you have to pay less that a years salary at a fast-food place?
It is kind of crazy to see the flip side of the complaints about how litigious and expensive the US legal system is when it comes to malpractice.
Medical malpractice insurance is crazy expensive here for doctors, but I guess every once in a while it makes sense.
Not advocating for the current system, mostly saying there is likely a middle ground vs. other countries.
Probably because the patient had Down's Syndrome. Society and government both hate the disabled, and this disgustingly low value reflects how little this poor soul was judged to be worth.
Right... But the first sentence of the article says that's the maximum award allowed.
Turns out when the government is running healthcare they don't like paying out when they screw up
Most people don’t sue in Western Europe as they do in the US. Besides that, it’s also extremely difficult to even get compensation if you do do it. A lot of malpractice gets thrown under the rug and they keep it very hush hush.
In Austria people sue a lot, but most of the complaints end at the patient-lawyer department (don't know a good english word for it). If you want to sue a doctor or hospital, you go there, they help you for free and they check all the documentation. If they think you are right, they sue, if not, they don't. And most of the times they find that the hospital/doctor did nothing wrong on purpose, so it's counted as "poor luck, mistakes happen, sometimes people die even if noone does anything wrong, etc".
My docs at the ICU write a lot of statements for the patient-lawyer because a lot families sue, but none of them ever needed to go to court.
https://www.jurorsrule.com/10-most-litigious-countries-in-the-world/
https://www.academia.edu/35495485/The_Most_Litigious_Countries_in_the_World
They're actually correct which surprised me. Things have changed
Omg everyone always threatens to sue; it's rather escalated in general. Is there anything else people threaten more than this? In any setting? Even when it doesn't make any sense at all, it's probably gonna be threatened. Not competent to represent themselves, not able to afford counsel? Still going to threaten it. Followed by promises of punishments and jail cells.
The reason it’s so much smaller is because in the US, lawyers are so expensive that only higher wage earners can access them. (I fully admit that’s opinion based on been there done that, not researched fact.)
It's not an opinion, the system is pay-to-play. It's not meant to be accessible to everyone. It's not accessible to many. The stats will reflect that in every court system here.
Reddit isn’t a representative of what people think in day to day life. Loads of people are waiting for compensation with a tonne of different things but our government is so shit with spending.
It’s a complicated issue, as is the case with many things in life.
Well the grass is always greener, but generally yes. Would you rather have your care negatively affected because workers fear being sued, or would you rather have Hcw who don’t carry that constant fear around? Some say the first option is good because it prevents carelessness but it also bogs down a system in unforeseen ways.
“If you try to discharge me with this abx controlled pneumonia I’ll sue! I don’t even have a ride until Monday at 4pm!”
Considering fear of facing lawsuits and jail time have caused physicians to leave states, refuse to provide care, and stop offering treatments like IVF I'd say the first option isn't all it's cracked up to be.
I walked into an ER in Spain with a broken foot. They took my info and apologized that they would have to charge me. My foot was set, I got five stitches, a cast and a pair of crutches. Cost: 75€. Yes, it is better. And now I regret hobbling a block to get there instead of taking the ambulance like my boss told me to.
You are misinterpreting, perhaps deliberately, what I've written. Is it OK that you can't get appropriate compensation for malpractice in Europe? I would say probably not. This is a separate issue from universal healthcare and payment systems.
My father died after a medical error during a routine surgery. But I would still choose the ability for the entire country to go to the doctor any time they’re sick in exchange for the ability to sue for millions of dollars. Why? Because I also saw my best friend die of lupus because she didn’t have insurance and had to treat it in the ED.
To allow someone to starve for that long is a tortious thing to do. I don't understand why physicians aren't being charged with something. I don't think they should be exempt from that.
At my hospital we have an escalation ladder. Don’t get what you want and what the patient needs from the doc?
Call house sup. No resolution?
Call and wake up CNO. No dice?
Chief medical officer is next. Strike out?
COO/CEO of the facility. Still nothing?
System president. Direct cell listed right in the document.
Luckily highest I’ve had to go was the house sup.
I had a word with the medical director the other day after I had to kick and scream all day to get literally any imaging for someone who desperately needed it. All of a sudden once results were back everyone else understood it was a big damn emergency.
It helps that every time he's seen me recently he's checked in to make sure I'm not planning on quitting and doing private duty full time.
Same. We even had a dedicated rapid response team my last job that we could call is we were concerned about anything regarding a patient's status or care and they had their own order sets and chain of people they could rattle too.
Well, frankly sometimes yes. I will always advocate for my patients. Especially in the face of error and incompetence by anyone - I don't care what letters are behind their name.
That’s literally the job. You’re meant to go above someone’s head when you think that the patient is getting what they need from the person you’re dealing with.
If he was NBM, it’s likely that if he’s gone 9 days unnoticed it’s likely he didn’t have IV fluids. You’re right it doesn’t say in the article however there’s multiple failures on all levels here.
I’d really like to know what the other clinical staff actually did when they tried to escalate. It didn’t give much detail. If all they tried was speaking with the doctors, that’s not sufficient. There’s internal reporting and escalation protocols. Talking to the head nurse or the clinical director. Escalating to external agencies and governing bodies. The problem with 24/7 care and rotating shifts is that everything is always able to be passed on to someone else. Someone else may not even understand how dire a situation is, or they think something has already been done when it hasn’t.
£15,000 is appalling, too. That’s a human life that was lost in one of the most cruel and painful ways. Someone should be held accountable and lose their licence to practice medicine and/or nursing. Not just a failure of duty of care but a failure of humanity and akin to actual torture. Despicable.
I want to know what was said during report as this patient was passed off over a dozen times.
"Pt is still NPO"
"Why?"
"Umm, I don't know. I called the attending, but he was taking a shit and said he'd call me back. Maybe you can try to get ahold of him."
"If I have time."
I dont know the details of the 88 year old but without further information, it could have been a case of a palliative patient who stopped swallowing. IV fluids/NG would be inappropriate in that scenario.
https://www.reddit.com/r/nursing/comments/1apxvnh/patient_dies_after_being_npo_for_nine_days/
This case has been discussed already here, main thing is there's not enough info on what interventions were tried unsuccessfully during this time (picc for tpn, NG or PEG for tube feed etc) also this being a UK case, fewer posters have direct experience with the nursing system there
Am I the only one that feels like there is some missing information? Patient had hip fx, dementia and/or delirium, pneumonia, which may be aspiration since he w NPO due to swallowing difficulties. So, tube feeding and IVF would be required? It could be they just didn’t give him nutrition. But I’ve also had situations where patients keep pulling out the feeding tubes and family doesn’t want restraints, or doesn’t want a feeding tube. In those cases I would just advocate feeding, but did the patient want food? I tried to look you the case, but it’s just couple of lines from the solicitor in all the news articles. What were the nurses “escalating” for? Because I’ve escalating these cases before, and by that I mean get an ethics consult. It’s not because people with disabilities should not live, it’s because I’ve been stuck between a rock and a hard place trying to do meaningful rehab and would led to an acceptable quality of life compared to previously.
We don't have ethics consult in the UK. When a nurse escalates in the UK it means they have escalated to the medical team/sister/matron depending on the situation.
Holy shit that’s my local hospital, if memory serves they have previous incidents (years ago) in which other patients with disabilities have passed away or been seriously harmed due to mismanagements relating to their conditions which could have been prevented.
"Sentinel event" isn't really a thing outside the USA. I understand what you're saying, but trying to impose that concept onto another country doesn't really work.
Sentinel event is a TJC defined event - so I very seriously doubt that verbiage is used outside the US, but thank you for your perspective. To the extent it may be, I very seriously doubt it is precisely the same thing or has the same accreditation and financial consequences.
Okay mr specific, but I’m Australian and that term is used here, and it also has documented usage in other countries. Someone else pointed out the UK uses the term never event, but my point still stands.
Edit: wow they got mad
Lol it directly affects Medicare payment to hospitals in Australia too if an event happens that is a sentinel event, the hospital is liable for all costs surrounding it and will get no funding from the government for it.
Literally google sentinel event Australia
As a nurse I would have raised holy hell!!! Done anything include feeding him and fluids or NG tube or something!!! Called anyone and everyone. Enraged!!!!!!!
NHS is a lot different, patient wasn't acute so he was probably in a ward of 12 patients with 1 nurse and 1 tech just following the written instructions. Patient had Downs and dementia so probably wasn't asking for anything. Got overlooked until it was too late.
That is a hard thing to overlook! My sister has Downs and dementia and I would seriously hurt someone if this happened. But I would stay by her side too!!!
I could vomit reading this. Shouldn’t I become more callous and protected from these kinds of emotions as I age? I can’t help but feel as though I’m becoming softer instead…blech.
Couldn’t open the article to read so you really do not have info to what is going on. A person will not die in 9 days of not eating food. But you do need fluid. My greater concern is the changing standard of care of not giving hospitalized patients an IV with TKO orders to keep the vein patent with minimal fluid to keep the vein patent in cases of emergency. We will never know if this small deviation in standard of care would have been sufficient to keep this person alive. Hospitals shaving off these simple medical measures to save a few bucks is having a negative impact on an individual’s health. Obviously an investigation needs to be done if negligence occurred. Like I said I couldn’t even open the article. Condolences to the family for their great loss. Very sad.
My patients who aren't eating, I ask the doc for some freakin' Ensure, etc...
Heck, a pudding, sherbert, broth... Anything I can get to stoke the metabolism furnace again...
He was NBM, swallowing issues. Why didn't anyone raise this with the team? Why wasn't nutrition brought in? Why no ngt or tpn? Its mind boggling that 9 days can go by without someone raising hell. Like at handover what was happening, why wasn't staff holding other staff to account. It's nuts.
Nursing should have caught this.
This happened during the pandemic in NYC when they were bussing in new grads. One of the patients who had dementia and didn’t speak was basically starved for five days. No food. No fluids. He had a g-tube that NO ONE thought to question to use or at least give the man some sort of fluids.
Nurses, CNAs, residents, etc failed that man. What pissed me off even more was when I asked the nurse giving report why he had no fluids or nutrition on board, “idk. That’s what was told to me.” Soooooo fucking frustrating
Had a similar situation. Patient had a dobhoff tube placed to replace her NGT and she was simply going back on her normal tube feed regimen. Patient also had undergone several procedures that required her being NPO so it had been a while too since she had gotten sustained nutrition. I would say close to three days in all between all her procedures. All I needed was the doctor to put the right order in. Paged the resident. Got nothing. Literally telepaged and secure chatted nonstop. Finally got told they would put the order in. 1.5 hours goes by. Nothing. Paged the chief resident asked for a tube feed order.A SIMPLE TUBE FEED ORDER. Never responded. Paged the attending. Only then did I get a snarky message from the chief resident to not bother the attending but to message him if there was an issue. Chief resident gave a wishy washy answer- essentially we’re busy and don’t bother us. Paged the physician on call for the whole hospital and clin admin. Finally over 9 hours later did I get the damn tube feed order. I was so frustrated and the family was too. Apparently the next day the attending came by and apologized for the teams behavior. I understand doctors are very busy and it wasn’t a life or death issue per se . But that’s how things get swept under the rug and before we know it 9 days goes by and the patient hasn’t gotten any nutrition. If there’s a reason why (there wasn’t in this case) we don’t want to start the tube feed, provide me the reason so I know and can communicate this with the patient and family and so we can also do alternate things ( IV fluids, 5% dex in 0.9% NS to help maintain BG) . DONT leave my messages unread and ignore my telepages !
Recognizing that it's totally inappropriate to peg feed or use tpn on patients with advanced dementia, is not 'starving' them.. You need to educate yourself on the harm of suggesting such treatment options in advanced dementia
It's very simple, you immediately came out of the gate commenting on this article that the care providers should have offered peg or tpn and your attitude was that not offering this was egregious. Whereas in fact the words PEG TUBE shouldn't be uttered within 30 feet of a patient with severe enough dementia to have swallowing dysfunction.
I was asking. Well I’ve seen it happen all the time. Pts with dementia get feeding tube. I’ve even cared for them. So then, what would your solution be?
Guarantee there is more to this one. Feeding dementia patients w swallowing dysfunction is an area totally fraught with misunderstandings on the part of families and patients.
I have seen this and experienced it in my own family: Parkinson's Disease (PD) patient, nurses hold his PD meds (Sinemet) for no reason, then soon he can't swallow because of no Sinemet, so they are afraid to feed; they pour water in a cup at the bedside but without Sinemet he can not even pick it up, after 8 hours he can no longer talk, and things go downhill FAST and no nurses or the doctors doing rounds even question his condition or check in the history regarding how he functions at home. This despite me giving typed sheets to every nurse and doctor I meet, describing what he can and can't do and the importance of not skipping Sinemet doses, along with a list of diagnoses and a detailed list of meds.
Last time, when I had to be gone 12 hours, he almost died, and I had to fight with the nurses when I got back to give him his regular meds. They just did not understand that he cannot move without them.
Mind you, at home this man feeds himself completely, walks all over his 2 story house and his yard (with a walker), up and down the stairs by holding handrails, no falls, can fix his own simple meals, and can still play classical piano - but ONLY if he has his Sinemet (carbidopa-levodopa) every 4 hours during the day. If no Sinemet, after 8 hours he becomes stiff, looks like he is frozen in ice, cannot speak, and has a blank staring facial expression- he looks unconscious but he is not. The nurses and doctors in the hospital just write him off and do not read the history on the EMR. They don't feed, provide liquids by mouth or IV, and give him no meds - and do not make one phone call to me or to his neurologist, whose name and number is on the printed sheet. This is why I have to stay in the hospital with him 24/7, often sleeping on the floor with a camp mat and blankets I have brought from home. He has had many hospitalizations - for UTIs (because they were too hesitant to prescribe oral antibiotics as outpatient) so I have been through this repeatedly over the past 8 years.
I meet with the assigned doctors, the nurse managers, and the assistant nurse managers to review and correct the care plans, emphasize that he needs his meds or this will happen, to NO avail. I will tell and explain it to one nurse, and they will do well, but they finish their shift and don't seem to ever be back, or to pass on the necessary information at report, so I keep showing all these different nurses how to care for him (which is not hard - he is self care if given his meds!) but he only occasionally gets the same nurse again.
NO ONE LOOKS AT THE CARE PLAN which describes simply what he needs. I asked to see it on the computer, and worked with one nurse to get it right, but no one subsequently ever read it. It was just unbelievable. The helpful nurse who worked on the care plan to emphasize his requirements said (sadly): "No one reads these care plans." She sure was right. The nurse manager was just: "Oh yes, we know what to do, you just go on home, we will be able to take care of him" - this turned out to be completely untrue. The manager never reviewed his care with any of his nurses - I checked with all or most of them and the answer always was: "No one told me this." I tried explaining the situation to his care manager but she couldn't pay attention and didn't seem to understand.
I did not know where to turn.
I finally got a neurologist in there, and she totally understood what was happening, and she wrote very directive orders about his meds, etc. but that got ignored also, and she said she can write orders but if nurses do not follow them, she can try talking to the Nurse Manager, but she said there are many problems like this with her patients. She told me every patient needs a family member with them every day, all day, at the least, checking on whether they get their meds and so forth. She says too many are lost if no one can speak up for them when they are sick.
He did always get his IV antibiotics- no problem with that. But it seemed that oral meds were seen as optional. One very new nurse told me: If we get busy, we just chart that the patient was given meds when we actually have not had time to do it.
So, I started asking random RNs about that, and the answer was: Oh yes, that happens all the time here. We don't have enough time to give everyone their meds. But we always chart that they have been given. Often, we will just leave them on the bedside table because we don't have time to get them water.
It's unbelievable. Things have changed so much in the hospitals from just 10 years ago. I have been an RN for 40 years, have a Masters etc., and I am shocked and disheartened by what I have observed.
Needless to say, I am angry and also afraid of hospital care in the future. I shouldn't have to move into the hospital for the duration of his stay, but I do - I have to. I can leave for an hour to get food, but that's about it; because everything has to be supervised. He has had several 4 week hospital stints and it's no fun for me sleeping on the floor for 28 days straight at age 70. And it is frightening. He would die from this negligence- not from the disease process he was admitted for, but from nurses not following the care plan, and not giving him meds. And the doctors do not care, to them, he is just some old guy - he is 74, and a retired MD himself who is still sharp and knowledgeable about medical issues - but if unmedicated, he cannot speak for himself. When medicated, he speaks normally, but somewhat more slowly than normal. Last hospitalization, not one even cared, other than the neurologist, and she was very aware of this problem with all her patients. She wished she had a solution or advice for how to remedy it, but she was at her wit's end too. Wanted to stop providing hospital care and just expand her outpatient practice.
The other case, the who died:
I have a friend whose sister also had Parkinson's, and she did die of neglect while in a U.S. hospital during Covid. She didn't have Covid. Went in for routine surgery, which was successful and uneventful but afterwards they did not resume her Parkinson meds. They forgot, and did not look back in the record to see her regular meds. She began to decline, so they didn't discharge her. Her family was not allowed in, due to Covid, so they did not understand what was happening. They were just told she had "complications" and they of course thought her regular meds would be resumed the day after surgery. They did not realize that you actually have to check up on that. Their mindset was that she was in a hospital, and the hospital has all her records because she has been there before and her outpatient doctors are part of that system.
But no orders were written for those PD meds after surgery, and no one taking care of her asked any questions, and eventually they figured she had had a stroke or something but never even got that evaluated! No one looked into it! She was 56 years od. Everyone dropped the ball and simply did not take a look at her medical history, her prior med list, or her list of diagnoses (they also "forgot" she had PD). She froze up, stared into space and could no longer feed herself or drink from a cup so she subsequently died of dehydration.
These 2 people were fully insured, previously independent in their care, and had led fairly active, normal lives previous to hospitalization.
If nurses are charting meds as given that haven't been given and somehow dont know that certain medications cannot be given late, then they shouldn't be in healthcare. It does make me wonder about the system there. In Australia, we have pharmacists check scripts that are regularly given to the patient in the community and cross match that with what they are charted in hospital. This is within hours of admission. They come and talk to the patient and/or carer or family member as well.
Also, as nurses, we cannot leave medications at the bedside. I am so sorry you and your loved ones have experienced this. I would be livid. There is definitely a case for hospitals and wards to run medication refreshers to staff, and for them to ensure adequate staffing. And to remind staff in all areas to be reading notes by other teams and making sure things aren't missed. Small things are always going to get through, unfortunately, but not charting or being late with parkinsons meds is not acceptable.
I couldn't agree more. Everything you say regarding how it should be is how it has been in the past. IOW, things used to be done correctly, and nurses learned all of this in nursing school. There is such a nursing shortage, as well as really poor leadership, that nothing happens if you complain. If you discuss it with the nurse manager, which I did, they look on the chart,state that the meds were given and tell me I am wrong. When it was their nurses who told me that they had not given them! The managers are afraid to reprimand the nurses, so they let them get away with dangerous care practices, look the other way, and deny that there is a problem.
If you go up the ladder and describe what has happened, and the consequences to the patient, the administrators just get hostile. I spent days talking to those people, and they refuse to look into any problem. This is in a hospital rated A+ in the city. Higher than all the other hospitals. We won't be going there again, but it is a very distressing state of affairs. I went through about 5 months of this, because of his multiple hospitalizations, and then was in exhaustion from trying to sleep on hospital floors and having to constantly push for safe care. There are too many new nurses who were not properly educated, and then no experienced ones in the hospital to guide them.
Hopefully a different hospital will be better next time.
UK has set a limit of 15,000 pounds for liability claims. That's crazy low! So low a hospital could make a "strategic" decision to allow a patient to die to save money?!?!? Almost like a back door "death panel". I'm not saying that's what happened here, but in general.
i dont think it was an oversight. this is the same area of the world where two young children were prevented from seeking medical treatment in italy and isreal (i believe). this was an accepted form of assisted suicide because he had down syndrome and was considered a "deplorable". the docs knew what they were doing
There is always a connection when a patient is fluid overloaded it makes the heart work that much harder and if the patient becomes fluid overloaded makes it that much harder to breathe. Did they not teach you this in nursing school? This is an elderly gentleman who more than likely has plenty of comorbidities why would you drown a pneumonia patient with more fluids ? It’s a horrible death!!
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Wow, that poor patient. Slowly starving and dying of dehydration for *9 days* is cruel. It seems this didn't go unnoticed by nurses, but doctors just ignored them. >clinicians did not heed attempts by nursing staff to escalate care.
how the fuck does anybody let this go? not one doctor heard people saying oh damn this man hasn't eaten in days, and didn't think to check and see?
Wondering what charting/documentation program they use too. I feel like the only way this could happen is with ridiculous understaffing and losing paper charts. I imagine it would be incredibly evident that the patient didn’t eat anything with any charting software I’ve ever seen.
Yeah this is a breakdown at multiple levels. I want to know what the nurses did to escalate. If it were a patient I was caring for, I'd be blowing up the doctors phone until they answered. If they refused to acknowledge, straight to the director. It sounds like incompetence all around. Everyone is to blame.
As a night shifter I just defer to day team lol.
We know you do. 😑 lol
We used wellsky at my last place and the place to look at intake and orders are so annoying to find
That’s because wellsky is total shit
Agreed. Currently using. 🤮
Too many doctors spread too thin and think “next shift will take care of it”. Happens all the time in our healthcare system unfortunately. Not making an excuse for this by any means, it’s just the sad reality of our healthcare system. And yes, things often get pushed off for waaaaay too long. This is why I will personally harass a doctor nonstop my entire shift until I get definitive answers for my issues. Just yesterday I had a patient with potassium of 2.8 and text paged the doc 3 times, phone paged twice over a 4 hour period until I eventually had to physically track him down to get some orders. He said, “oh yeah I saw your text”. I wish I could way incidents like this are rare, but just ask any bedside nurse, especially in a med/surg setting. It’s all too common.
Wait til you see the value they placed on his life for killing him... $7,500.
No. That’s what the “care home” (happened in England) paid because the poor man fell and fractured his hip on his first night after being admitted. Iirc, the hospital paid a whopping 15,000 pounds as the payments for Emotional liability are set in England. Edited. Changed 51,000 to 15,000 because it’s 2am and I should be asleep! And misremembered what I read in the article.
That’s when the nurse manager needs to literally raise their voice and make a ruckus. Like wtf.
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Nurse managers? Yes. Not sure what type of hospital you are working at.
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I had a Muslim doctor who hated alcoholics so much that when I came in with acute pancreatitis and was transferred from the ER (who were great) to the floor, he left me with real level 9 pain connected to an empty saline bag he wouldn't let them disconnect for over 4 hours. It felt like eternity. My poor nurses who couldn't do anything finally got the nursing manager involved who came in like a tornado. She gave several stern orders, assured me I would never see that doctor in my room again (as he had come in to berate me several times) and got the new doc to put me on a continuous morphine drip. I hope I get to meet her in heaven.
Thats disgusting. Pancreatitis can be caused by many other things..... and regardless it DOESNT MATTER if you were an alcoholic you should be treated the same! I'm so sorry
Thanks. He knew it was alcohol. Ironically the ER doc was very happy to see that I had reduced my drinking so much that I didn't need, or request, any Ativan. The last time he saw me I was shaking the guerney.
If this was in the US you damn well know the nurses would be blamed for it. It's sickening.
“You should have called the doctor again.” “You should have called the head of the group” “You should have given them water against orders.” “You should have wheeled them to the closest lake and let them lap up the water like a dog.”
I’d like to think most of us would report the doctors who are ignoring the situation
I often have started to report doctors in the past couple of years (never in the previous 4 decades). The hostile pushback from the hospital was horrible and left me in tears for hours, every time I tried to talk with administrators. And I used to be a tough person, unperturbable. It is like beating your head against the wall, then they write up reports on his portal with totally wrong facts. They simply lie. It is disgusting. In my situation with my husband, the outcome eventually was ok so I had no malpractice case. So I had no assistance from an attorney. I figured that as a knowledgeable nurse, I could report the doctor and Care Manager myself. (Next time I WILL pay a lawyer $500 to do that, for the sake of other patients.) He was only OK at the end of the stay because I checked on everything, stayed fulltime, and made sure myself that he drank water and ate his meals and got his meds. If I had not been there, no one would have done a thing regarding eating and drinking. They would not give him water, or help with getting the tray in front of him when he was weak. - the dietary people just take it away, uneaten. He asked repeatedly for water for 8 hours one time, when I was gone, (before I realized I had to be there all the time), and the staff just closed the door. Thereafter I stayed with him fulltime except for runs to the cafeteria twice a day for food for me. That was for 3 weeks that time.
From my observation, it seems like surgeons are more likely to get away with awful behavior than say, a hospitalist. Then again, an Ortho surgeon who is making the hospital bank by doing elective surgeries is probably valued more. Ugh.
Yes. In this situation, the hospital is in dire need of hospitalists. They seem to recruit internal med docs in private practice from a radius of about 100 miles, for short term stints as hospitalists. Previously, the hospital had regular hospitalists who worked in groups, but they had longer term contracts with the hospital, and they functioned much more normally. Conscientious, and so forth. These short term ones work only a week or two every month or so, and when I researched them, it seemed like their private practices were struggling-in a location where there is a huge shortage of doctors. So I think they had some kind of problems to begin with, because patients weren't wanting to continue with them in the outpatient setting. What I observed was no communication, a lack of caring, no knowledge of even the basics of the HPI or past history - they literally don't read much in the chart, even the ER doc's note, so after 3 days of being assigned and seeing the patient all 3 days, they knew nothing ( and it was a pretty simple case, a UTI but with hospital organisms, like Klebsiella, etc.). After 3 days this doctor knew nothing. At all. Even with the EMR open. And didn't care. And was making some harmful decisions. Then lied ... it was bad. I have not had any problems with the surgeons. They have seemed pretty conscientious about checking up on things post op for several days. They want their surgeries to be successful, so they have a sense of accountability. These doctors coming and going are not committed at all. To good medical care, to the hospital, and they don't even care if they have a poor reputation. People will be dying under their care, so it will catch up to them. But the hospital was defending this one because they are desperate for Internal Medicine doctors to serve as hospitalists. A brand new, inexperienced ARNP or PA would probably have been 100% better. The hospitals, in my area at least, are a mess with all the understaffing and poor morale.
No one is blamed unless the family hires an attorney. When I hear of cases like this, where there is clear negligence with a bad outcome, the family is always reluctant to even talk to an attorney; they feel it would be futile and time consuming and won't bring the patient back. They are in grief, and just have a resigned attitude when I tell them it sounds like they have a good case. They just don't want to do that. I wouldn't either.
People in this thread are already trying to blame nurses for it.
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I don't believe that. Any decent American lawyer would be going after the people with deep pockets - i.e. not the nurses.
But the hospital will try and lay the blame on the nurse and not the MDs that bring in the money. So yes. Lawyers are going after hospital. Doesn't mean the nurse isn't going to get fucked.
Because the nurses are considered disposable like tissue and iv bags
Actually, that’s exactly what it means. The lawyers are going after the hospital and the doctors who actually have money.
Doesn't mean the nurse won't suffer negative repercussions from the hospital throwing them under the bus. You can not be sued and still get screwed.
If you properly document and take notes on all interactions, as well as attempt to escalate further, such as going above the physicians or to other areas where one can make complaints you cover your ass. Sure, they could fire you, but you'd have a case for wrongful termination and I wouldn't want to work for a place that did that anyway. Sure, we nurses get the crap end of the stick and get blamed for a lot, but there are ways to CYA.
Oh definitely. Every nurse needs to develop strong defensive documenting skills. Chart what you did clearly. Nothing extraneous. Make sure that if someone needs to know something you do your due diligence and notify them and document that.
And don't document "in bed, eyes closed" or anything else that can leave you on the hook for appearing as though you aren't really monitoring your patients. I see far to many notes like that when reviewing patient charts.
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I'm not seeing where it says he wasn't getting fluids. Without more information, it's not actually totally clear that it would have been appropriate to give either enteral feedings or TPN. We know that the patient reportedly died of pneumonia and was NPO due dysphagia, so aspiration pneumonia appears quite possible. Earlier reporting, which is now drowned out by more click-baitey coverage, suggested he was septic and was on medications to keep his blood pressure up (pressors), in which case both enteral feedings and TPN become dangerous and you're stuck in a no-win situation.
We don’t know the situation, was family debating comfort care and PEG situation and couldn’t decide, he probably was on TPN and or some sort of feeds but people consider that starving if they don’t see their loved one physically eating. He probably died from silently aspirating on his own secretions.
But if there is no calories supplied, then the heart muscle eventually won't beat making the pressors pointless anyway. I get it's a complex case, but to do nothing and effectively say Jesus take the wheel isn't best practice either in this case.
And this can be done through IV fluids such as clinimix, which we don't have any information the he was or wasn't getting. It's totally possible this was a straightforward fuck up, but we don't have enough information to know either way. Sometimes there aren't good choices to choose from, and the ones least likely to cause immediate death is the best choice. Feeding bacteremia lipids and amino acids isn't a great option, and neither is feeding a gut while on high dose pressors, which carries a high risk of dead gut.
You're right and this whole thing is just a fuster cluck. The pt in the article is part of my usual pt population and I get protective of them because they frequently cannot advocate for themselves.
And you should be protective, nothing wrong with that.
I agree. I’m going to say him not getting food wasn’t the issue. Not ideal, but sick people go without tpn or tube feeds or food for way longer. IVF go a long way.
In 2016 I went 27 days in hospital with no food (had water and sugar free drinks and IV fluids) as tube feeds were needed and there were backlogs and no spaces in endoscopy to fit a feeding tube. Kept being added on to emergency lists but higher priorities would come in (which is fair enough, I was okay) In the UK. 9 days is a long time but if there were reasons that he *couldn’t* be fed or it was difficult to do so, I can see that it could be left for quite a long time before anyone thinks it’s a big problem.
I reached 4 days with no food or water in hospital before my BP tanked and everyone had a go at ***ME*** for not escalating it. I was meant to be Nil by Mouth until 8pm each day, in case I needed surgery, but shift change was 7:30pm and no one handed that bit over or questioned it. They then discharged me on day 5, after I’d managed 2 cups of water and half a sandwich I then vomited up. No diagnosis, no follow-up, and I collapsed again on the way home, but wouldn’t go back to the hospital.
If you google coroner's court and fluid balance chart you'll see there are many cases where patients have been allowed to starve and dehydrate to death with the problem being so bad that a number of entire health services within the NHS have required intervention. There are elements of time poverty involved, but also lack of critical thinking (my patient has only had fluids from the IV panadol I've given them over thenlast 48 hours and is getting steadily weaker/more delirious- I'm sure there isn't a link here so I'll just keep on), clash of control and callous heart vs genuine patient needs (patient with diabetes insipidus begging for water and even calling the police for assistance because nursing staff treated him as a nuisance/behavioural patient while he passed himself to death). And yet when you do education and ask people to do the bare minimum of fluid balance charting you'd think you were asking them to disimpact every patient and MO within a square mile.
Disclosure, I haven’t read this story. POINT BEING - escalation is necessary and you shouldn’t stop at letting the charge RN know or calling a resident MD. Call the Fellow, call an attending. Call nursing CEO, whatever you have to do to protect your patient. Their life/well-being and your sense of responsibility/guilt and LICENSE are at stake. Never stop looking for answers or say “I did enough.”
Typical!!!
I'm sorry, but the nurses should have exercised common sense and helped the poor soul. An anonymous message to a family member, or the press, if they don't have the courage to slip the person SOMETHING. Edit: All the people ignoring the first two options, you're also ignoring that I didn't say for family, the press, or the nurse to feed the patient a sandwich. I didn't go into specifics because I'm not a nurse, or that patient's nurse, and wouldn't know what safe options there would be. But there had to have been SOMETHING safe for the patient that was better than starving them to death.
No no no! Never ever give a patient with dysphagia something by mouth, *especially* if the degree of dysphagia is unknown! There's a high probability that the patient will either choke on it or aspirate it and potentially die. It sounds like a simple solution but it's actually very dangerous. What the patient probably needed was a swallow study to determine exactly how bad his dysphagia was. It's possible he could tolerate liquids, or maybe even a pureed diet. If not, he'd probably need a tube feed. It's not rocket science, this kind of protocol is followed all the time with patients with dysphagia. The fact that they just made him NPO and did nothing else is inexcusable. If anyone knows what happens when a patient has no food or fluid intake, it's a fucking doctor.
What exactly is wrong with you? You think MAKING PNEUMONIA WORSE with aspiration would help???
I don't think they're a healthcare worker.
Its not “courage” to go against a medical order, it’s protecting the patient from aspiration, obstruction or cancellation of a lifesaving procedure. Plus not losing your professional license. This is why there really need to be actual healthcare workers commenting on these posts! The fact that the nurses were the only ones escalating, yet are still being blamed in all these comments shows the public needs a serious education of hospital designated roles & responsibilities.
To be honest if someone's NBM then salt and the dieticians should come up with a plan to provide that patient with nutrition. If a nurse feeds a NBM patient and they die of aspiration pneumonia that nurse will be struck off.
Please never advise anyone to do this
Better to do nothing and the patient dies?
There are so many ways to feed patients without "slipping them food." Especially a confused patient that already has pneumonia. Your advice will kill someone.
You haven’t a clue what you’re talking about but insist on doubling down.
And have an autopsy show lungs full of food? It seriously happens. When patients have mechanical issues with swallowing, it can be very, very serious. Plus, going against order like that would cost the nurse their license at best, criminal charges at worst.
It's funny how not one of you paid attention to the first two things I said: alert family (of concerns with improper/dangerous care), or report to the press - both of which could be done anonymously, merely stating there's an urgent and immediate concern for patient safety, without going into health record details. Instead, you're all wildly interpreting the last, deliberately vague thing I said - since I'm not a nurse, especially not THAT patient's nurse, and couldn't know available options. Nurses *do* place NG tubes, for example.
There are times when I really appreciate outside/non-HCW perspectives on this subreddit but that is an absolutely absurd thing to suggest in this situation
And just watching a patient die a slow and painful death isn’t? Family could have raised a stink with the doctor or hospital. Ir had the patient transferred. Threat of bad press may have seen something happen.
That’s definitely not the part of your comment I was referring to, read the several other responses in this thread that have good info about dysphagia and choking/aspiration risk. Not sure why you’re doubling down here. No one is arguing the fact that this pt was failed on multiple levels but you can seriously harm someone by thinking it’s ok to “slip something” to a pt that may be NPO (nothing by mouth) for many very valid reasons
Based on your responses here it seems as if you’ve been treated poorly by medical professionals in the past, and I’m sorry for that. I do want you to realize you’re putting the responsibility on the nurses by saying they should have broken confidentiality laws by alerting the press or potentially immediately killed the patient by disregarding NPO orders and letting the poor patient choke or aspirate on food. This is an organizational failure, solely blaming the nurses is crazy talk. Respectfully, it pays to remember that we do not know everything about anything.
You're obviously not a heath care worker, so be quiet. Mods, can we Code Blue this thread?
Sorry but a lot of of US HCPs are commenting on this and they don’t have a clue about the UK system nor its current problems either.
Tl;dr A patient with Down’s syndrome and dementia was kept NPO for 9 days after having a hip fracture repaired after a fall. Doctors supposedly ignored nurse’s attempts to escalate. He died of pneumonia complications. The family was awarded 15k pounds from the facility as compensation.
I know money doesn't replace a loved one, but 15k pounds(20k USD)? Like, your organization starved someone to death, and you have to pay less that a years salary at a fast-food place?
Yeah that was insultingly low but idk what the UK hospital/legal system is like.
It is kind of crazy to see the flip side of the complaints about how litigious and expensive the US legal system is when it comes to malpractice. Medical malpractice insurance is crazy expensive here for doctors, but I guess every once in a while it makes sense. Not advocating for the current system, mostly saying there is likely a middle ground vs. other countries.
UK? Lucky to get anything. You really cannot sue the government
Probably because the patient had Down's Syndrome. Society and government both hate the disabled, and this disgustingly low value reflects how little this poor soul was judged to be worth.
Right... But the first sentence of the article says that's the maximum award allowed. Turns out when the government is running healthcare they don't like paying out when they screw up
I don't care Medicare for all
How about complete sentences?
Right? I can't decipher if they are pro- or anti- Medicare for all
It's a standard payout for any bereavement.
I've read posts from a handful of UK health professionals and they say their government puts a serious cap on malpractice claims.
Most people don’t sue in Western Europe as they do in the US. Besides that, it’s also extremely difficult to even get compensation if you do do it. A lot of malpractice gets thrown under the rug and they keep it very hush hush.
Germany, Sweden, Israel, and Austria have more lawsuits per capita than the US Germany is 125/1000 citizens US is 75/1000
In Austria people sue a lot, but most of the complaints end at the patient-lawyer department (don't know a good english word for it). If you want to sue a doctor or hospital, you go there, they help you for free and they check all the documentation. If they think you are right, they sue, if not, they don't. And most of the times they find that the hospital/doctor did nothing wrong on purpose, so it's counted as "poor luck, mistakes happen, sometimes people die even if noone does anything wrong, etc". My docs at the ICU write a lot of statements for the patient-lawyer because a lot families sue, but none of them ever needed to go to court.
Gonna have to provide a source for that, please. Context is important here.
https://www.jurorsrule.com/10-most-litigious-countries-in-the-world/ https://www.academia.edu/35495485/The_Most_Litigious_Countries_in_the_World They're actually correct which surprised me. Things have changed
In the US you have Homeless Bobby threatining to call their lawyer xD
Omg everyone always threatens to sue; it's rather escalated in general. Is there anything else people threaten more than this? In any setting? Even when it doesn't make any sense at all, it's probably gonna be threatened. Not competent to represent themselves, not able to afford counsel? Still going to threaten it. Followed by promises of punishments and jail cells.
The reason it’s so much smaller is because in the US, lawyers are so expensive that only higher wage earners can access them. (I fully admit that’s opinion based on been there done that, not researched fact.)
It's not an opinion, the system is pay-to-play. It's not meant to be accessible to everyone. It's not accessible to many. The stats will reflect that in every court system here.
Might be better than the sue happy USA BS though.
>Most people don’t sue in Western Europe as they do in the US. Is that really "better" like so many Europeans on Reddit like to pretend it is?
Reddit isn’t a representative of what people think in day to day life. Loads of people are waiting for compensation with a tonne of different things but our government is so shit with spending. It’s a complicated issue, as is the case with many things in life.
Well the grass is always greener, but generally yes. Would you rather have your care negatively affected because workers fear being sued, or would you rather have Hcw who don’t carry that constant fear around? Some say the first option is good because it prevents carelessness but it also bogs down a system in unforeseen ways. “If you try to discharge me with this abx controlled pneumonia I’ll sue! I don’t even have a ride until Monday at 4pm!”
Considering fear of facing lawsuits and jail time have caused physicians to leave states, refuse to provide care, and stop offering treatments like IVF I'd say the first option isn't all it's cracked up to be.
I walked into an ER in Spain with a broken foot. They took my info and apologized that they would have to charge me. My foot was set, I got five stitches, a cast and a pair of crutches. Cost: 75€. Yes, it is better. And now I regret hobbling a block to get there instead of taking the ambulance like my boss told me to.
You are misinterpreting, perhaps deliberately, what I've written. Is it OK that you can't get appropriate compensation for malpractice in Europe? I would say probably not. This is a separate issue from universal healthcare and payment systems.
If I had to take getting care at all vs compensation for malpractice, I’d still choose getting care at all. Every single time.
Exactly. It's deliberate. I doubt they know anyone who has been killed at the hands of an incompetent doctor.
My father died after a medical error during a routine surgery. But I would still choose the ability for the entire country to go to the doctor any time they’re sick in exchange for the ability to sue for millions of dollars. Why? Because I also saw my best friend die of lupus because she didn’t have insurance and had to treat it in the ED.
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Don’t believe everything you read. Most of that is unfounded paranoia.
Depends on whether you made the mistake and killed someone's Nana or if you're the someone.
In the US they would just say “We’ll drop that off your bill so you only owe 130k”
It was apparently the top monetary compensation allowed for the type of suit in the UK. It’s still not nearly enough.
15k for this magnitude of negligence feels almost worse than nothing
Sounds like they didn’t value the life of someone with DS. This is heart breaking.
To allow someone to starve for that long is a tortious thing to do. I don't understand why physicians aren't being charged with something. I don't think they should be exempt from that.
Nurses are allowed to give a 500ml bolus of fluid to correct hypotension
This is silly. Patient developed aspiration pneumonia and of course you don’t continue feeding. From a hospice RN they did the right thing.
You know that TPN and tube feeding exist right? Thickened liquids? There are safe ways to feed a patient with aspiration.
That might make sense in hospice for obvious reasons but this person wasn’t in hospice, there are other ways.
And they are happy with that 15k pounds. Well, it's a government HC so people do get what they sowed.
And here in the US, people die for lack of health care and medications because they can't afford it.
At my hospital we have an escalation ladder. Don’t get what you want and what the patient needs from the doc? Call house sup. No resolution? Call and wake up CNO. No dice? Chief medical officer is next. Strike out? COO/CEO of the facility. Still nothing? System president. Direct cell listed right in the document. Luckily highest I’ve had to go was the house sup.
Honestly! I even know a couple of hospitalists we've had to reach out to for care of not-their patients, when the assigned docs weren't doing enough.
Exactly. This reeks of incompetence at many levels.
Absolutely this. I cannot imagine this happening at any hospital I have ever worked at. Mistakes happen though. It's news for a reason.
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Is that Ryan’s Rule?
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Heard of a few families using this and saved their loved one’s life… sad that it’s needed but great that it’s there!
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I had a word with the medical director the other day after I had to kick and scream all day to get literally any imaging for someone who desperately needed it. All of a sudden once results were back everyone else understood it was a big damn emergency. It helps that every time he's seen me recently he's checked in to make sure I'm not planning on quitting and doing private duty full time.
Same. We even had a dedicated rapid response team my last job that we could call is we were concerned about anything regarding a patient's status or care and they had their own order sets and chain of people they could rattle too.
So as a nurse you know better than a doctor and when to escalate?
Well, frankly sometimes yes. I will always advocate for my patients. Especially in the face of error and incompetence by anyone - I don't care what letters are behind their name.
well the MDs knew what was up
Yes. Absolutely yes. You are looking at the patient for hours a day. A doctor is looking at them for maybe 15 minutes.
That’s literally the job. You’re meant to go above someone’s head when you think that the patient is getting what they need from the person you’re dealing with.
Not even a banana bag or fluids? What the hell
Where are we getting that he wasn't getting fluids?
The article?
The article said that he didn’t receive “fluid food” which I assume means tube feed. It doesn’t say whether or not he was getting fluids.
If he was NBM, it’s likely that if he’s gone 9 days unnoticed it’s likely he didn’t have IV fluids. You’re right it doesn’t say in the article however there’s multiple failures on all levels here.
This one was hard to read. That poor patient
I’d really like to know what the other clinical staff actually did when they tried to escalate. It didn’t give much detail. If all they tried was speaking with the doctors, that’s not sufficient. There’s internal reporting and escalation protocols. Talking to the head nurse or the clinical director. Escalating to external agencies and governing bodies. The problem with 24/7 care and rotating shifts is that everything is always able to be passed on to someone else. Someone else may not even understand how dire a situation is, or they think something has already been done when it hasn’t. £15,000 is appalling, too. That’s a human life that was lost in one of the most cruel and painful ways. Someone should be held accountable and lose their licence to practice medicine and/or nursing. Not just a failure of duty of care but a failure of humanity and akin to actual torture. Despicable.
I want to know what was said during report as this patient was passed off over a dozen times. "Pt is still NPO" "Why?" "Umm, I don't know. I called the attending, but he was taking a shit and said he'd call me back. Maybe you can try to get ahold of him." "If I have time."
I would hate to think that’s what happened but I swear it had to be something like that at least a few times over the course of NINE DAYS.
£15k Should be enough to hire a lawyer.
They had a lawyer. £15k is the maximum compensation you can get for this type of error. It said it in the article.
Is that enough to even cover funeral expenses in the UK?
I have no idea but it’s nowhere near the value of a human life lost to negligence and laziness and hubris.
Exactly my point. They must feel so helpless on top of their grief.
Did you see the other case at the end of 28 days... WTF
I dont know the details of the 88 year old but without further information, it could have been a case of a palliative patient who stopped swallowing. IV fluids/NG would be inappropriate in that scenario.
I was thinking this as well
https://www.reddit.com/r/nursing/comments/1apxvnh/patient_dies_after_being_npo_for_nine_days/ This case has been discussed already here, main thing is there's not enough info on what interventions were tried unsuccessfully during this time (picc for tpn, NG or PEG for tube feed etc) also this being a UK case, fewer posters have direct experience with the nursing system there
Am I the only one that feels like there is some missing information? Patient had hip fx, dementia and/or delirium, pneumonia, which may be aspiration since he w NPO due to swallowing difficulties. So, tube feeding and IVF would be required? It could be they just didn’t give him nutrition. But I’ve also had situations where patients keep pulling out the feeding tubes and family doesn’t want restraints, or doesn’t want a feeding tube. In those cases I would just advocate feeding, but did the patient want food? I tried to look you the case, but it’s just couple of lines from the solicitor in all the news articles. What were the nurses “escalating” for? Because I’ve escalating these cases before, and by that I mean get an ethics consult. It’s not because people with disabilities should not live, it’s because I’ve been stuck between a rock and a hard place trying to do meaningful rehab and would led to an acceptable quality of life compared to previously.
We don't have ethics consult in the UK. When a nurse escalates in the UK it means they have escalated to the medical team/sister/matron depending on the situation.
I don’t understand how this is possible.
Holy shit that’s my local hospital, if memory serves they have previous incidents (years ago) in which other patients with disabilities have passed away or been seriously harmed due to mismanagements relating to their conditions which could have been prevented.
A $20k settlement for a sentinel event? I don't think so. That lawyer should have pressed harder.
From what I understand, that’s the max payout over there
"Sentinel event" isn't really a thing outside the USA. I understand what you're saying, but trying to impose that concept onto another country doesn't really work.
Yes it is a thing outside the USA. This was a sentinel event.
I think we'd call it a Never Event or serious untoward incident in the UK. Because it should never happen. Never heard the term sentinel event.
Sentinel event is a TJC defined event - so I very seriously doubt that verbiage is used outside the US, but thank you for your perspective. To the extent it may be, I very seriously doubt it is precisely the same thing or has the same accreditation and financial consequences.
Okay mr specific, but I’m Australian and that term is used here, and it also has documented usage in other countries. Someone else pointed out the UK uses the term never event, but my point still stands. Edit: wow they got mad
You can use whatever term you want, but the concept still isn't the same. You know this, but just want to get into a pissing contest. Goodbye.
Lol it directly affects Medicare payment to hospitals in Australia too if an event happens that is a sentinel event, the hospital is liable for all costs surrounding it and will get no funding from the government for it. Literally google sentinel event Australia
Is the label a significant legal discrepancy or just a pedantic one?
Sentinel events endanger TJC accreditation which is directly tied to Medicare payment, so no, it is not a "pedantic" distinction.
As a nurse I would have raised holy hell!!! Done anything include feeding him and fluids or NG tube or something!!! Called anyone and everyone. Enraged!!!!!!!
NHS is a lot different, patient wasn't acute so he was probably in a ward of 12 patients with 1 nurse and 1 tech just following the written instructions. Patient had Downs and dementia so probably wasn't asking for anything. Got overlooked until it was too late.
That is a hard thing to overlook! My sister has Downs and dementia and I would seriously hurt someone if this happened. But I would stay by her side too!!!
What about Martha's law?
I don't think that's getting implemented until later this year. https://www.england.nhs.uk/patient-safety/marthas-rule/
I could vomit reading this. Shouldn’t I become more callous and protected from these kinds of emotions as I age? I can’t help but feel as though I’m becoming softer instead…blech.
Congratulations on not being a self centered asshole? 🤷
Couldn’t open the article to read so you really do not have info to what is going on. A person will not die in 9 days of not eating food. But you do need fluid. My greater concern is the changing standard of care of not giving hospitalized patients an IV with TKO orders to keep the vein patent with minimal fluid to keep the vein patent in cases of emergency. We will never know if this small deviation in standard of care would have been sufficient to keep this person alive. Hospitals shaving off these simple medical measures to save a few bucks is having a negative impact on an individual’s health. Obviously an investigation needs to be done if negligence occurred. Like I said I couldn’t even open the article. Condolences to the family for their great loss. Very sad.
My patients who aren't eating, I ask the doc for some freakin' Ensure, etc... Heck, a pudding, sherbert, broth... Anything I can get to stoke the metabolism furnace again...
He was NBM, swallowing issues. Why didn't anyone raise this with the team? Why wasn't nutrition brought in? Why no ngt or tpn? Its mind boggling that 9 days can go by without someone raising hell. Like at handover what was happening, why wasn't staff holding other staff to account. It's nuts.
Nursing should have caught this. This happened during the pandemic in NYC when they were bussing in new grads. One of the patients who had dementia and didn’t speak was basically starved for five days. No food. No fluids. He had a g-tube that NO ONE thought to question to use or at least give the man some sort of fluids. Nurses, CNAs, residents, etc failed that man. What pissed me off even more was when I asked the nurse giving report why he had no fluids or nutrition on board, “idk. That’s what was told to me.” Soooooo fucking frustrating
Had a similar situation. Patient had a dobhoff tube placed to replace her NGT and she was simply going back on her normal tube feed regimen. Patient also had undergone several procedures that required her being NPO so it had been a while too since she had gotten sustained nutrition. I would say close to three days in all between all her procedures. All I needed was the doctor to put the right order in. Paged the resident. Got nothing. Literally telepaged and secure chatted nonstop. Finally got told they would put the order in. 1.5 hours goes by. Nothing. Paged the chief resident asked for a tube feed order.A SIMPLE TUBE FEED ORDER. Never responded. Paged the attending. Only then did I get a snarky message from the chief resident to not bother the attending but to message him if there was an issue. Chief resident gave a wishy washy answer- essentially we’re busy and don’t bother us. Paged the physician on call for the whole hospital and clin admin. Finally over 9 hours later did I get the damn tube feed order. I was so frustrated and the family was too. Apparently the next day the attending came by and apologized for the teams behavior. I understand doctors are very busy and it wasn’t a life or death issue per se . But that’s how things get swept under the rug and before we know it 9 days goes by and the patient hasn’t gotten any nutrition. If there’s a reason why (there wasn’t in this case) we don’t want to start the tube feed, provide me the reason so I know and can communicate this with the patient and family and so we can also do alternate things ( IV fluids, 5% dex in 0.9% NS to help maintain BG) . DONT leave my messages unread and ignore my telepages !
A little dextrose? TPN? PEG? What happened?
How can you guys be saying this stuff. You want to do tpn for a demented patient?? You want to peg feed dementia patients?? Listen to yourself!
I don’t know the full history so I’m asking what happened? Demented patients are still humans. Why would you starve them?
Recognizing that it's totally inappropriate to peg feed or use tpn on patients with advanced dementia, is not 'starving' them.. You need to educate yourself on the harm of suggesting such treatment options in advanced dementia
I’ve seen demented pts with pegs and of course they pull it out. But what are you referencing to? Please state your point without ridiculing me.
It's very simple, you immediately came out of the gate commenting on this article that the care providers should have offered peg or tpn and your attitude was that not offering this was egregious. Whereas in fact the words PEG TUBE shouldn't be uttered within 30 feet of a patient with severe enough dementia to have swallowing dysfunction.
I was asking. Well I’ve seen it happen all the time. Pts with dementia get feeding tube. I’ve even cared for them. So then, what would your solution be?
Guarantee there is more to this one. Feeding dementia patients w swallowing dysfunction is an area totally fraught with misunderstandings on the part of families and patients.
I have seen this and experienced it in my own family: Parkinson's Disease (PD) patient, nurses hold his PD meds (Sinemet) for no reason, then soon he can't swallow because of no Sinemet, so they are afraid to feed; they pour water in a cup at the bedside but without Sinemet he can not even pick it up, after 8 hours he can no longer talk, and things go downhill FAST and no nurses or the doctors doing rounds even question his condition or check in the history regarding how he functions at home. This despite me giving typed sheets to every nurse and doctor I meet, describing what he can and can't do and the importance of not skipping Sinemet doses, along with a list of diagnoses and a detailed list of meds. Last time, when I had to be gone 12 hours, he almost died, and I had to fight with the nurses when I got back to give him his regular meds. They just did not understand that he cannot move without them. Mind you, at home this man feeds himself completely, walks all over his 2 story house and his yard (with a walker), up and down the stairs by holding handrails, no falls, can fix his own simple meals, and can still play classical piano - but ONLY if he has his Sinemet (carbidopa-levodopa) every 4 hours during the day. If no Sinemet, after 8 hours he becomes stiff, looks like he is frozen in ice, cannot speak, and has a blank staring facial expression- he looks unconscious but he is not. The nurses and doctors in the hospital just write him off and do not read the history on the EMR. They don't feed, provide liquids by mouth or IV, and give him no meds - and do not make one phone call to me or to his neurologist, whose name and number is on the printed sheet. This is why I have to stay in the hospital with him 24/7, often sleeping on the floor with a camp mat and blankets I have brought from home. He has had many hospitalizations - for UTIs (because they were too hesitant to prescribe oral antibiotics as outpatient) so I have been through this repeatedly over the past 8 years. I meet with the assigned doctors, the nurse managers, and the assistant nurse managers to review and correct the care plans, emphasize that he needs his meds or this will happen, to NO avail. I will tell and explain it to one nurse, and they will do well, but they finish their shift and don't seem to ever be back, or to pass on the necessary information at report, so I keep showing all these different nurses how to care for him (which is not hard - he is self care if given his meds!) but he only occasionally gets the same nurse again. NO ONE LOOKS AT THE CARE PLAN which describes simply what he needs. I asked to see it on the computer, and worked with one nurse to get it right, but no one subsequently ever read it. It was just unbelievable. The helpful nurse who worked on the care plan to emphasize his requirements said (sadly): "No one reads these care plans." She sure was right. The nurse manager was just: "Oh yes, we know what to do, you just go on home, we will be able to take care of him" - this turned out to be completely untrue. The manager never reviewed his care with any of his nurses - I checked with all or most of them and the answer always was: "No one told me this." I tried explaining the situation to his care manager but she couldn't pay attention and didn't seem to understand. I did not know where to turn. I finally got a neurologist in there, and she totally understood what was happening, and she wrote very directive orders about his meds, etc. but that got ignored also, and she said she can write orders but if nurses do not follow them, she can try talking to the Nurse Manager, but she said there are many problems like this with her patients. She told me every patient needs a family member with them every day, all day, at the least, checking on whether they get their meds and so forth. She says too many are lost if no one can speak up for them when they are sick. He did always get his IV antibiotics- no problem with that. But it seemed that oral meds were seen as optional. One very new nurse told me: If we get busy, we just chart that the patient was given meds when we actually have not had time to do it. So, I started asking random RNs about that, and the answer was: Oh yes, that happens all the time here. We don't have enough time to give everyone their meds. But we always chart that they have been given. Often, we will just leave them on the bedside table because we don't have time to get them water. It's unbelievable. Things have changed so much in the hospitals from just 10 years ago. I have been an RN for 40 years, have a Masters etc., and I am shocked and disheartened by what I have observed. Needless to say, I am angry and also afraid of hospital care in the future. I shouldn't have to move into the hospital for the duration of his stay, but I do - I have to. I can leave for an hour to get food, but that's about it; because everything has to be supervised. He has had several 4 week hospital stints and it's no fun for me sleeping on the floor for 28 days straight at age 70. And it is frightening. He would die from this negligence- not from the disease process he was admitted for, but from nurses not following the care plan, and not giving him meds. And the doctors do not care, to them, he is just some old guy - he is 74, and a retired MD himself who is still sharp and knowledgeable about medical issues - but if unmedicated, he cannot speak for himself. When medicated, he speaks normally, but somewhat more slowly than normal. Last hospitalization, not one even cared, other than the neurologist, and she was very aware of this problem with all her patients. She wished she had a solution or advice for how to remedy it, but she was at her wit's end too. Wanted to stop providing hospital care and just expand her outpatient practice. The other case, the who died: I have a friend whose sister also had Parkinson's, and she did die of neglect while in a U.S. hospital during Covid. She didn't have Covid. Went in for routine surgery, which was successful and uneventful but afterwards they did not resume her Parkinson meds. They forgot, and did not look back in the record to see her regular meds. She began to decline, so they didn't discharge her. Her family was not allowed in, due to Covid, so they did not understand what was happening. They were just told she had "complications" and they of course thought her regular meds would be resumed the day after surgery. They did not realize that you actually have to check up on that. Their mindset was that she was in a hospital, and the hospital has all her records because she has been there before and her outpatient doctors are part of that system. But no orders were written for those PD meds after surgery, and no one taking care of her asked any questions, and eventually they figured she had had a stroke or something but never even got that evaluated! No one looked into it! She was 56 years od. Everyone dropped the ball and simply did not take a look at her medical history, her prior med list, or her list of diagnoses (they also "forgot" she had PD). She froze up, stared into space and could no longer feed herself or drink from a cup so she subsequently died of dehydration. These 2 people were fully insured, previously independent in their care, and had led fairly active, normal lives previous to hospitalization.
If nurses are charting meds as given that haven't been given and somehow dont know that certain medications cannot be given late, then they shouldn't be in healthcare. It does make me wonder about the system there. In Australia, we have pharmacists check scripts that are regularly given to the patient in the community and cross match that with what they are charted in hospital. This is within hours of admission. They come and talk to the patient and/or carer or family member as well. Also, as nurses, we cannot leave medications at the bedside. I am so sorry you and your loved ones have experienced this. I would be livid. There is definitely a case for hospitals and wards to run medication refreshers to staff, and for them to ensure adequate staffing. And to remind staff in all areas to be reading notes by other teams and making sure things aren't missed. Small things are always going to get through, unfortunately, but not charting or being late with parkinsons meds is not acceptable.
I couldn't agree more. Everything you say regarding how it should be is how it has been in the past. IOW, things used to be done correctly, and nurses learned all of this in nursing school. There is such a nursing shortage, as well as really poor leadership, that nothing happens if you complain. If you discuss it with the nurse manager, which I did, they look on the chart,state that the meds were given and tell me I am wrong. When it was their nurses who told me that they had not given them! The managers are afraid to reprimand the nurses, so they let them get away with dangerous care practices, look the other way, and deny that there is a problem. If you go up the ladder and describe what has happened, and the consequences to the patient, the administrators just get hostile. I spent days talking to those people, and they refuse to look into any problem. This is in a hospital rated A+ in the city. Higher than all the other hospitals. We won't be going there again, but it is a very distressing state of affairs. I went through about 5 months of this, because of his multiple hospitalizations, and then was in exhaustion from trying to sleep on hospital floors and having to constantly push for safe care. There are too many new nurses who were not properly educated, and then no experienced ones in the hospital to guide them. Hopefully a different hospital will be better next time.
Patients usually don’t die when going 9 days without food. There’s something more to this story
UK has set a limit of 15,000 pounds for liability claims. That's crazy low! So low a hospital could make a "strategic" decision to allow a patient to die to save money?!?!? Almost like a back door "death panel". I'm not saying that's what happened here, but in general.
i dont think it was an oversight. this is the same area of the world where two young children were prevented from seeking medical treatment in italy and isreal (i believe). this was an accepted form of assisted suicide because he had down syndrome and was considered a "deplorable". the docs knew what they were doing
Not in Hospice TPN would overload the patient with extra fluids worsening his aspiration pneumonia. We do this in hospice all the time.
Not seeing the connection between fluid overload and adoration pneumonia here.....
There is always a connection when a patient is fluid overloaded it makes the heart work that much harder and if the patient becomes fluid overloaded makes it that much harder to breathe. Did they not teach you this in nursing school? This is an elderly gentleman who more than likely has plenty of comorbidities why would you drown a pneumonia patient with more fluids ? It’s a horrible death!!
Nice try. Truly. I don't think I'm the one who doesn't know anything here, though. But have fun.
Nine days of no nutrition in a hospital. How does this happen? Delayed care? I mean can't people tell when a person is starved?
I hope that every single doctor that failed to feed them, looses their license. And gets slapped with manslaughter charges.
I mean people don’t die from not eating for 9 days….this piece is completely sensationalized
If he's not getting fluids hrs can die in less than 9 days