September 15, 2005

UNC and Duke Hospitals - First Do No Extra

I just read through a story in the News & Observer concerning UNC Hospital and the loss of a child's fingertip. There are two sides to each story, but in this one, it appears that bureaucracy trumped care.

I will follow that system of regimen which, according to my ability and judgement, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. The Original Hippocratic Oath

One afternoon in March, Claudine Lee rushed her 20-month-old son to the only hospital in rural Bladen County, the tip of his right pinkie hanging by a flap of skin. The emergency physician, Dr. Vicki Lanier, told her the boy, whose finger had been crushed in a door, needed a larger hospital with surgeons who could repair it.

Lanier tried UNC Hospitals, but a doctor there refused to see the child. She tried Duke, where a doctor agreed to treat Marcus, but only after arguing that UNC should have.

It is probably an hour and a half drive between UNC and Bladen County Hospital in an ambulance, tops.

More than seven hours after the accident, a Duke surgeon stitched Marcus's finger back together. But the tissue died; his fingertip eventually was amputated...

The UNC physician who took Lanier's call, whose full name is not given, told her "it was not appropriate to send the patient" to Chapel Hill, the reports say. He also told her that Bladen County Hospital should have an orthopedic surgeon on call who could evaluate and treat Marcus, according to the report. "They are getting paid to do it," Lanier said the UNC physician told her. UNC, he told her, typically accepts orthopedic transfers only after a local orthopedist has seen the patient and determined that care at UNC is needed. But Bladen County Hospital, which has just 25 beds, does not have a full-time orthopedics department, just visiting orthopedists who come in from outside the county once or twice a week. Lanier explained this to the UNC physician repeatedly, the reports say.

In the future, McCall said, UNC will accept transfer requests even if there is debate about whether UNC is the best place for the patient to receive care. "We don't want anything like this to happen again," she said.

Really? How interesting. Go figure.

When UNC refused Marcus, Lanier paged a Duke orthopedic surgeon, who agreed that Marcus needed to be seen...

Thank goodness, way to go Duke, let's save this little boy's finger

But before starting the transfer, the surgeon asked Lanier to call UNC back and demand to know why the boy's injury wasn't worthy of its attention.

Uhmm, maybe you could find that out AFTER you save his finger?

He waited to hear back from Lanier, who told him that UNC repeated that the transfer was inappropriate and again refused to treat the child, according to the reports.

So, okay, UNC f**ked up, let's save the 20-month old boy's finger...

The Duke surgeon then called Duke's hospital transfer center.

Really? How interesting. Idiot.

According to the investigation reports, which quote a transcript of the call, the Duke surgeon said he wanted documentation that UNC had refused to accept the transfer of a 20-month-old child who needed orthopedic services. The surgeon said Duke was "getting dumped on by UNC Hospitals" and that he was "tired of this." Finally, the surgeon asked the Duke transfer center to call Bladen County Hospital and begin the transfer. Marcus then was treated; his finger was stitched back on, not actually reimplanted.

Can anyone else say, M-A-L-P-R-A-C-T-I-C-E.

State regulators also reviewed Duke's part in Marcus' treatment. The state recommended that Duke also be found in violation of the federal emergency care law, which also specifies that hospitals may not delay emergency treatment. But the federal government disagreed. Duke officials got a letter from federal regulators in July indicating that Duke had met its obligation to provide care.

I for one call Bullshit. Duke is every bit as much to blame as UNC. UNC might have made a bad initial decision, but they made it quickly. Duke dragged this shit out for hours and hours, which probably helped in the loss of a 20-month old's fingertip. But, hey, it's just a fingertip and he's only 20 months old - he'll never miss it.

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