^^^^True, and if and when a family complains about our care, usually without knowing what they are talking about in terms of clinical issues, when they go public with criticism, threaten lawsuits, say whatever they want, etc., without waiving their HIPAA rights, we have no choice but to say absolutely nothing in our defense. Any information which could clarify and present a more balanced version of events remains their little secret. I can imagine how frustrating it would be to be a nurse or doctor on duty that day who has basically been accused of gross negligence (if not worse) online for years now.
I beg to differ. You have been highly critical of the health care team, based on very scant information and the recollections/interpretations of a family with very little medical knowledge, biased and understandably passionate emotions, and their own compelling financial reasons for seeing things the way they do.
Working in ICU, I’ve seen many bad outcomes. You absolutely cannot assume that a bad outcome indicates poor practice. You MUST examine the medical records to come to any solid conclusions about anything.
“Until this sad case goes to trial we will never know what causes Jahi to bleed that day”
Highly unlikely this case will go to trial. A case like this is a textbook example of no matter what actually happened it will be less expensive to settle and keep everything confidential. Even if the hospital had video evidence that the grandmother caused the bleeding (I’m not saying they do, just offering an extreme example) and that the hospital did everything 100% correctly, the awful publicity and the ongoing accusations of racial bias would be a greater financial threat than whatever millions they will pay to make this go away quietly. Cases like this don’t hinge on who was right or wrong or whether the correct care was given, they are settled because it is less expensive to settle and avoid the other negative implications even if there were no errors on the part of the hospital. Doubly so if there were errors on the part of the hospital.
It’s my understanding that according to CA law, there is a cap on cases of this nature of $250K, not millions. If Jahi is considered alive but disabled due to medical negligence, there is no such cap. This is why it is so important to the family’s interest to have her brain death diagnosis invalidated.
I followed this case closely after it happened because my son had a very similar surgery a couple of years before Jahi. I believe she had more reconstruction on her throat than he did. Some level of surgery is commonly recommended for pediatric sleep apnea patients as opposed to adults where it is rarely recommended. Teens fall into a grey area in between. In my son’s case we tried less invasive alternatives and sought multiple opinions before he had surgery. His surgery was in a regular hospital, not pediatric, and he went to the standard post-op floor to spend the night before going home. He was limited to fluids while in the hospital. I think they also had to be cold, but I could be wrong on that. At home he slowly added more solid foods, working up from things like apple sauce and pudding to mashed potatoes then pancakes.
The cheeseburger story came from an online comment on a news site from someone who claimed to be the parent of another patient in the PICU. The stories about a circus of Jahi’s family members also came from online comments. The grandmother admits suctioning, but claims the hospital nurses told her to suction. The grandmother is an LVN.
I am surprised this was not settled long ago, but that may be due to the CA limits on payouts for deceased patients. The lawsuit would be worth much more if they can get her declared to be alive. I don’t think we will ever get a chance to hear the hospitals side.
I remember reading the online comments from several people who claimed to either be in the vicinity of Jahi and family in the recovery area and later, the PICU. At the time, I pretty much thought, “absolutely cannot take these as fact,” but wondered if the medical record confirmed any of it. I still think the same way. Without access to the medical record, we just do not know if negligence on anyone’s part occurred.
When I worked ICU, I documented the hell out of every case I worked on. I documented instructions I gave to family members, I documented time/content of every phone call or conversation I had with physicians. If I called a doc and updated him on any changes in patient condition but he didn’t give me any new orders, I documented that. If I paged a doctor and he didn’t call me back, I documented it and paged him again until he did respond. If he did give orders, it was noted in the chart. I read every doctor’s progress note when I came into the unit in the morning, and I read the doctor’s progress notes as soon as the doctor wrote them as they came in during the day. I read PT progress notes and respiratory therapy progress notes. If family members were undermining our policies and instructions, I documented it. I documented bleeding meticulously, measuring it at intervals or noting amounts in drains as appropriate. I calculated fluid balance (what the patient received via IV and by mouth vs. amount of blood/urine out) every shift. I posted EKG strips at change of shift or any time there was a deviation from normal. I documented the patient’s respiratory rate and oxygen saturation at appropriate intervals. Vital signs are recorded frequently in the ICU vs. the regular floors. The point is to stay on top of the patient’s condition at every moment so that if a change happens, you see it early and intervene early. You want to anticipate problems, not react to a crisis when it’s too late to effect the outcome.
What I’m describing above is only possible in an ICU, because nurse to patient ratio is kept very low. I am very confident that this kind of detail is present in the medical record and will give great insight into what happened that day and who, if anyone, contributed to her poor outcome. Without these records, anything we have to say is pure conjecture, and anything the family has to say is based on their very limited perceptions/interpretations/understanding/knowledge of the whole picture. There are a lot of pieces to this puzzle, and we only have a few of them.
I would so love to read the chart, but probably won’t ever have the chance. Currently the only records available to the public at this time are the brain death test results, because they were part of the court record when the family was challenging the hospital’s attempts to remove mechanical support.
@Nrdsb4 , thanks for posting some very useful background to help understand this situation. Most of us that walk into a hospital for care or to visit a patient have very little understanding of what is going on. And we’ll never know about the details of this case in particular for the reasons mentioned above.
The family was upset and scared and angry and grieving about the outcome, which are all valid and expected emotions. But the validity of their feelings does not mean that the hospital or its staff is at fault. Maybe they are, maybe not. But the family can talk to the press and solicit sympathy while the hospital can’t say a word. Remembering that imbalance is important to making judgements about anything that comes up in the media.
-" we report every error and every near miss event." (sly123)
I applaud every health institution that has that as their mantra because that is how systems improve.
I’ll sign up for your hospital when I get ill.
I know that doesn’t happen across the board. It should but not always.
" I am very confident that this kind of detail is present in the medical record and will give great insight into what happened that day" (nrdsb4)
That’s a pretty lofty statement. Well, you haven’t read the record either. You make as many assumptions as you think I’ve made.
@gouf78, in ICU, you are required to document most of what I’ve described. The electronic charts are set up that way. It’s no assumption to say I’m confident the record contains many details. If I said that the record will clear the staff-THAT would be an assumption.
Just as telling as details charted are things NOT charted. If there is no record of blood loss, that indicates that the nurse wasn’t keeping any tabs on it whatsoever. This is the kind of information the medical record reveals. Nurses have a saying: if you didn’t chart it, you didn’t do it. You can’t later claim you did something necessary if you didn’t chart it.