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           When critically ill patients present for treatment to a hospital’s emergency room, the emergent nature of their health raises a number of issues for the institution to deal with.  One of the issues emergency room personnel are often confronted with is notifying the patient’s family members about the fact that their loved one has been admitted in critical condition.  Another issue this raises is whether the hospital has sufficient resources to properly care for the patient, and if not, what steps can be taken to transfer this patient’s care to a more appropriate facility.  Since the stress level in the emergency room setting can be challenging for the individuals caring for this critically ill patients, it is important for hospitals to have policies and procedures in place to deal with these types of issues.  Two recent superior court cases illustrate just how important these policies and procedures can be. 

            In the first case, a Florida hospital was ordered to pay the family of an emergency room patient five million dollars in damages.  The patient was taken to the emergency room at this hospital after sustaining injuries in a car accident.  The patient was seated in the back seat of the automobile and was wearing a lap belt without a shoulder strap.  Although she had no visible signs of injury, the patient was complaining of abdominal pain.  The emergency room physician consulted with a surgeon regarding this patients condition and they decided to admit her to the hospital for observation.  The physicians did not order any radiographic imaging of the patient’s abdominal because the hospital did not have a CAT scan with contrasting capabilities available.  Over the course of the night, the patient’s symptoms worsened and the nurse contacted the surgeon several times.  In response, the surgeon advised the nurse that he would come to see the patient in the morning. 

            When the surgeon examined the patient the next morning, he detected a tear in her abdominal wall and recommended emergency surgery to repair the tear.  At the patient’s husband’s request, the patient was transferred to a local trauma center to have the surgery.  By the time the patient arrived for surgery, severe infection had set in as a result of her bowel contents being emptied into her abdomen.  The patient died 31 days after the surgery at the trauma center. 

            The patient’s husband filed a lawsuit against the surgeon and the hospital claiming the hospital should have had protocols in place requiring its physicians to perform more extensive testing on patients such as his wife who were in car accidents.  The patient’s husband also claimed that the hospital should have had protocols in place addressing the issue of transferring the care of patients in need of testing that the hospital did not have the capabilities of performing.  The surgeon countered the allegations of negligence by arguing that the patient was doing well at the time he transferred her care, and her condition did not deteriorate until after she underwent surgery.

            The second case involved a man who was found in a restaurant suffering from a drug overdose, who was taken by ambulance to a local emergency room in New Jersey.  Attempts to resuscitate the patient were unsuccessful and he expired in the emergency room.  Although this patient had discharge papers in his pocket from a recent hospitalization which contained the name, address and telephone number of his parents, no one in the emergency room undertook any efforts to contact this patient’s parents.  In the meantime, the parents had contacted the police to report that their son was missing.  The patient’s parents even contacted a psychic in the hopes of locating their son.  The parents learned that their son had died twenty-nine days later when they received a bill for services from the emergency room their son was taken to. 

            The parents brought a lawsuit against the hospital claiming that the personnel working in the emergency room violated hospital policy by failing to notify them about their son’s hospitalization and death despite the fact that they had a clear record of their name and phone number.  The case went to trial and the jury awarded the parents $425,000 in damages for their pain and suffering.

            Both of these cases illustrate that hospitals must provide good health care to their patients as well as delivering quality health care services. The Florida case illustrates how important it is for physicians to perform routine testing on patient’s who sustain injuries in car accidents to rule out internal injuries.  This case also raises liability issues for the hospital.  When hospitals provide emergency treatment to patients, they must have either the necessary medical equipment to treat these patients or specific policies in place to effectuate the transfer of such patients to a more appropriate facility.   The Florida case also raises the issue of whether hospitals should implement policies to address the issue of how to manage the care of a patient whose physician is not responsive to the patient’s complaint.   Hospitals may consider making additional resources available to nurses who are faced with this situation. 

            In the New Jersey case, he personnel in the emergency room was so focused on saving lives that they did not realize that no one had contacted the patient’s family about his death.  In light of this case, it is not enough for a hospital to have a policy stating that the family of a patient admitted to the emergency room must be notified. The policy should designate who specifically has the responsibility to notify the families.  If a specific person is assigned the task of contacting the patients’ families, the emergency room personnel will not simply assume that someone working in the emergency room must have called the family.


Notifying Family Members that a Loved One is in Critical Condition

by Attorney Frank E. Reardon

November 2002