WhiteCoat

Anna Brown And Appropriate Emergency Medical Care

I’m surprised that this case hasn’t gotten more press.

A patient named Anna Brown was unhappy with the care she received at several hospital emergency departments. When she was discharged from the last emergency department, she refused to leave. Police were called and the patient was carried to a police car. She said that she couldn’t walk. Police took her to jail, carried her into the cell and left her laying on the floor. About an hour later, she was still laying there … dead.

From the public’s point of view, the case appears outrageous. But as I read through the description of what happened and thought about what could have been done different, from a physician’s point of view, I’m not sure what else could have been done.

Christine Byers wrote an excellent article describing events that took place, and then wrote a follow up article in which the hospital defended its care. I’m hoping that the St. Louis Post-Dispatch commends her for her work. She did a great job with the stories.

Background
A summary taken from Ms. Byers’ article shows that Anna Brown was admitted to the hospital for spraining her ankle while walking near a ditch. EKGs, blood tests, and lab work were performed. Ms. Brown was in the hospital from Sept 13 to Sept 15 and then discharged. She walked on crutches after her discharge.

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Early in the morning of September 20, 2011 Ms. Brown returned to the hospital complaining of knee and ankle pain. X-rays were taken and were negative. She was discharged with a prescription for pain medicine, but refused to leave.

At 5AM she wheeled herself next door to the children’s hospital. Doctors there found tenderness in her legs, but did not want to treat her since she was an adult seeking care at a children’s hospital. Ms. Brown demanded to be sent to a “better hospital.” She was then transferred to a third hospital.

She arrived at the third hospital at 11:45 AM. At the third hospital, her left ankle was swollen. During this visit, ultrasounds were performed on both of her legs and showed no blood clots. A nurse witnessed the patient standing. Ms. Brown was discharged at about 7PM.

At roughly 3AM the following morning, Ms. Brown came to the third hospital again by ambulance, this time complaining of abdominal pain. Some reports also state that she was continuing to complain of leg pain. She was in the emergency department for another 4 hours and was then discharged at approximately 7AM. The article did not mention if or what type of testing the patient may have had on that visit. She refused to sign discharge papers.

By 10 AM, Ms. Brown was complaining to a security guard that she “did not receive adequate medical attention” and therefore did not wish to leave. Police came to the scene and Ms. Brown was told to leave or she would be arrested for trespassing. Ms. Brown yelled that “You can’t arrest me … I can’t even stand up!”

At 12:30 PM, Ms. Brown had been re-examined by a physician and the physician completed a “fit for confinement” report. Police stated that Ms. Brown yelled “My legs don’t work!” while she was being wheeled from the room.

Police then took Ms. Brown to jail. She refused to get out of the vehicle, stating “I can’t put pressure on my legs.” Officers then carried her into a jail cell and left her laying on the floor.

At around 2 PM, Ms. Brown was found dead. Cause of death was pulmonary emboli – blood clots from her legs that dislodged and went to her lungs.

An investigation by the Centers for Medicare and Medicaid services did not find any violations involving Ms. Brown’s treatment.

Discussion
There are other issues with Ms. Brown, but I think that they tend to detract from the issues regarding her medical care. Ms. Brown was homeless. She had lost custody of her children. She had nine other siblings with whom she did not live during her homelessness. After being admitted to the hospital for spraining her ankle, she resisted discharge at that time as well. Ms. Brown also had potential psychiatric problems and refused some psychiatric testing a court had ordered relating to her child custody problems.
There were also questions about the appropriateness of police leaving Ms. Brown laying on the floor instead of putting her on the bed when she arrived at jail.

As I looked through the newspaper article, I kept asking myself: What I would have done differently while she was in the emergency department. I couldn’t think of much.

Ms. Brown had been evaluated by multiple physicians for her complaints. She received x-rays, blood tests, EKGs, and even a cardiology evaluation. An ultrasound performed less than a day before she died excluded the very disease process that ended up killing her – even though she had the same complaints for more than a week.

Did Ms. Brown receive appropriate medical care?
Many people who commented on Ms. Byers’ article stated that animals get better treatment than Ms. Brown received. I disagree. She received multiple evaluations from multiple physicians for her complaints. No emergency was found. Hospitals can’t admit people just because they might develop a disease in the future.

Probably the most troubling part of this case for many people was that Ms. Brown died from a problem related to her repeated complaints of leg pain. To those people who suggest that additional evaluation was needed, I ask what should have been done? Another ultrasound? How often should patients who have leg pain and swelling receive ultrasounds? Daily? Weekly? Hourly? How many ultrasounds should every patient with these symptoms receive in order to exclude a blood clot in the legs? It is easy to look back and say “they should have done this differently.” But to be fair, we have to look forward and ask ourselves what medical care is appropriate for all patients with similar complaints.

Retrospective bias is a powerful contaminant in Ms. Brown’s case. The autopsy showed that she died from a blood clot which was presumably in one of her legs and which presumably dislodged and went to her lungs at the time of her death. Therefore, many people who know the end result think that there is no way the blood clot should have gone undiagnosed. However, Ms. Brown didn’t come in complaining of a “blood clot.” She complained of leg pain and swelling after having suffered a leg injury the week prior and received multiple evaluations and tests to address those complaints. There is no medical evidence that all patients with leg pain and swelling should receive multiple ultrasounds on their legs to rule out DVTs. Without some type of scientific evidence as substantiation, allegations that the medical providers “didn’t do enough” for Ms. Brown really don’t hold much water.

Was Ms. Brown treated inappropriately?
This is a difficult question. Of course she could have been treated more humanely, but we also have to consider the events leading up to her treatment that day. She had multiple tests performed at multiple hospitals to evaluate her complaints. Those tests did not reveal a cause for her problems. When asked to leave, she became uncooperative with the police. Unfortunately, many patients feign illness when faced with the possibility of being incarcerated. This may have caused some bias in the minds of the police officers, thinking that Ms. Brown was feigning illness as well. Even so, police acted appropriately by requesting that Ms. Brown receive medical clearance before being taken to jail.
Should Ms. Brown have been left on the floor of the jail? Not really a medical issue, but what if the police put Ms. Brown on the bed and she fell off the bed and injured herself? If there is a bad outcome, police are going to be blamed for inappropriate behavior as well. Again, retrospective bias creeps in.

What should have been done differently?
Before answering in the comments, I want you to consider whether you would still feel that way if Ms. Brown had instead been complaining for several days at a restaurant because the food was poisoned, at a department store because a display was dangerous, or at a place of business because the services weren’t performed properly, and those complaints were properly investigated by the involved business. If it were your business or your home and the circumstances were the same, would there be any change in the expectations of how Ms. Brown should be treated? Remember, you need to look at the case prospectively, not retrospectively.

One reader sent me an e-mail that summarized this case better than I could ever do. “This case was the perfect storm of homeless woman perceived to be crazy who had a serious medical condition that didn’t show up on diagnostics, who was arrested by indifferent police officers, and which included a series of personal circumstances that would have driven anybody nuts.”

Additional stories (and comments) on the case can be found at the Daily Kos and at MSNBC.

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43 Responses to “Anna Brown And Appropriate Emergency Medical Care”

  1. Bloodshot says:

    I’d say: This was a one-in-a-million.
    In a perfect world, she would have been diagnosed with the disease, would have been treated more humanely and would have been alive.

    But this is not a perfect world.

  2. David Wander says:

    Major police misconduct. There is no excuse for an ill woman with a serious medical complaint (whether “medically cleared” or not) to end up on a concrete floor of a jail cell, unattended for an hour and a half.

    The other kind of bias I suspect is not “retrospective.” It’s anticipatory, by the doc who gave the medical clearance. A difficult patient was handed off to law enforcement “fit for confinement.”

    But ok, let’s give the doc the benefit of the doubt, (although no one gave the victim the benefit of the doubt on her inability to walk and her severe pain).

    Still, why was she on the jail floor? Why was she unmonitored, i.e., left alone? Why did she need to be in a cell at all? Why not cited and released?

    • Nurse K says:

      Where I work, probably daily someone is escorted off the property who is refusing to leave for any number of reasons, usually that they’re in severe pain and need narcotics. I don’t know about taking someone to jail, but it’s normal to at least escort someone off the property to the nearest public area, like a sidewalk across the street and perhaps charge them with trespassing if it’s bad enough.

      Problems occur if you go to every hospital in town for the same problem. Probably she would have gotten U/S #1 and that was negative. If she came back to the same hospital and the leg was significantly worse, she might have gotten a 2nd ultrasound. If you’re going all over the place, you don’t have anything to compare to, unless she tells you all the dates of previous visits, which happens once in 1.5 million visits from loud, insane-sounding people.

  3. For a quite divergent take on this story from the one here, authored by another emergency room physician, you may want to read the following: http://torontoemerg.wordpress.com/2012/04/02/when-labelling-patients-causes-patients-to-die/

    • WhiteCoat says:

      Thanks. I responded to that post in the comments section. Unfortunately, the author appears to be suffering from the same hindsight bias that many people are exhibiting in the comments section to the article linked.

      • Rich says:

        I am largely in agreement with you (I am not a healthcare provider, I am a consumer) but this quote from the article gives me great pause; “If Anna Brown had been a middle-class white woman with a nice home, a job and a car, I am willing to bet — no, I know the outcome would have been different — or at least, she would not have died, gasping for air, from a pulmonary embolism on a cold jailhouse floor.”, although my doubts rest largely on law enforcement rather than on medical professionals.

      • WhiteCoat says:

        “although my doubts rest largely on law enforcement rather than on medical professionals”

        This is a tough call.

        Police aren’t medical providers. They don’t know how to determine whether or not a person in custody is truly ill or faking their symptoms. They depend on the medical providers to state whether a person is fit for jail.

        Arrestees frequently feign illness to try to get out of jail. Often it works. Police don’t want to have to pay the bill if the patients are in custody, so the patients get a personal recognizance bond once they get to the emergency department. Then they don’t show up to their court date. A warrant for their arrest gets issued, they get picked up on a warrant later, have another medical emergency, and the issue repeats itself.
        Sometimes the police will bond a patient out and then wait outside for the patient to leave the hospital, then re-arrest the patient.
        Sometimes the patient gets sent to the maximum security detention center two hours away that has its own medical wing. When people hear that they may be going to “Alcatraz,” suddenly their symptoms improve.

        Unfortunately (or perhaps fortunately), this is a side of medicine/law that members of the public rarely see. Hopefully it gives you a little better of a picture why the police may have acted in the manner that they did.

      • Thanks for checking that out. Alas, hindsight bias can work in another direction. Quoting from the Wikipedia article you cited: “Following a negative outcome of a situation people do not want to accept blame. Instead of accepting their role in the event, they view themselves as caught up in a situation that was unforeseeable and therefore they are not the culprit, which is referred to as defensive processing, or view the situation as inevitable and that there was nothing that could be done to prevent it, which is retroactive pessimism.” Avoiding blame is a natural human instinct, particularly when the villagers have come at you with torches and pitchforks. I hope that, in Anna Brown’s memory, Dr. Kelly’s admonishment holds: “But the haunting image of Anna Brown dying alone in a jail cell should compel us — all us of, not just hospitals and health care professionals — to come together as a community so that no one else will experience the sad circumstances of her death.”

        Notes: 1) Dr. Stephen Kelly is chief medical officer of SSM St. Mary’s where this incident took place. He is quoted here: http://www.stltoday.com/news/opinion/guest-commentary-in-living-memory/ 2) I may have been mistaken earlier when I indicated that the cited article was by an emergency room physician rather than an E.R. nursing professional.

    • mark says:

      WhiteCoat says:”I responded to that post in the comments section”
      The response was published. You were not patient enough.

  4. Marni says:

    I’d like to know how she got admitted for two days for a sprained ankle.

  5. Brighid says:

    Good discussion, WhiteCoat. It’s very easy in hindsight to see that something went wrong here, but it’s very hard to see precisely what.

  6. Here’s my more detailed response: http://skyanchor.blogspot.com/2012/04/anna-brown-and-appropriate-emergency.html

    I apologize for some of my tone, but, quite frankly, reading this blog really got me worked up, and not in a particularly joyful way. I have high regard for E.R. physicians and allied health personnel; I believe E.R. departments deserve the best of everything, including software, and I worked tirelessly earlier in my career to try and ensure that.

    • Rich says:

      I agree with much of your reply but I think it may be received poorly because of the heavily loaded sarcasm. The most telling part of your reply is your observation that this lady was criticized on multiple occasions for failure to comply with orders or requests while the very nature of her complaint made it impossible for her to comply. The more I think about this the more I believe that she got short shrift simply because she became viewed as an annoyance.

    • TubeTopToney says:

      In one of comments, you stated that no patient should ever be forcibly removed from an ER. Forgive me not copying and pasting verbatim. Every ER in America has had to call the police to remove people from the premises. I have no statistics to back this up, however I did work as a travel nurse for some time. Every hospital has their frequent flyers. I am not saying this is Browns case. It is a little naive to say that people should never be removed for trespassing at a hospital. You cannot admit every person who comes in and refuses to leave. Hospitals nation wide are already over crowded and hold admits in the ER for umpteen hours. If Brown’s complaints were only of ankle pain on the first visit, most hospitals in America would not be able to justify admission. Unfortunately, hospitals can only do so much. In areas with more homeless, homeless people check in with complaints of chest pain, not because they are having CP but because they know they will either be admitted and not be on the street or be there for 6 hours waiting for the repeat blood drawn. Now that patient, who is not actually sick, is taking up a bed that someone who is ill could be occupying. An ER is not a place to house homeless. There are shelters for this. All too often people are ‘escorted’ from the premises d/t this. Brown’s care was way above and beyond what anybody with ankle pain would have got. If you read a below comment of mine, her admission to the hospital on day one was most likely the cause of the clot. Should have never happened.

      • TubeTopToney says:

        All that being said, this was a tragedy. BTW I have had a pt that had to be lifted into a police car d/t claiming he could not walk. He was there with the police, evaluated and discharged. He had had documented history of this behavior. 20 miles down the road he faked a seizure and was brought into another hospital. He then claimed he could not walk and was admitted at the 2nd hospital. Later that night after police left, the pt pulled out his own foley catheter(without deflation of the balloon) and WALKED from the hospital to avoid jail. Completely different situation, I know. Just reiterates the point that people do some wacky things in ERs

      • This wasn’t a case where she had to sit on someone else’s lap in the ER because there weren’t enough seats. There seemed to be plenty of open space in the video. It may have been more like, as one commenter sardonically stated, “She’s black and complaining and upsetting the other sick people, especially the white ones. Get the drug-assed bitch out of here.” I said in my comments that anyone “seeking help” shouldn’t be arrested in the E.R.; that doesn’t include someone threatening staff with cutting out their livers and cooking them on the grill with onions, for example, though I’d say even in that case, there would be another facility besides jail that may be more fitting. There are many ways to help people short of throwing them in a concrete and steel cage and latching the door behind them. Starting with plain old listening and conflict resolution skills. I hope a lot more caring dialogue comes out of this sad story.

    • Stephanie Lewis says:

      I couldn’t agree more with your detailed response, including the sarcasm.

  7. joebob says:

    “If Anna Brown had been a middle-class white woman with a nice home, a job and a car, I am willing to bet —

    …that she would have died of an undiagnosed PE in the hospital.

    give me a friggin break.

  8. midwest woman says:

    Having worked at the sister hospital of SLU in St. Louis, I can guarantee an insured person would have been admitted with “intractable” pain.
    That’s the way Tenet rolls.
    Also frankly it’s kind of disappointing to see everybody circle the wagons. Even if it was just one in a million it still remains a horrible tragedy.

  9. TubeTopToney says:

    It was most likely the 3 day admission, that was way beyond standard of care, that killed her. Brown probably did not move the time she was in the hospital. Injury + Immobility = bad news. I blame incorrect crutch training.

  10. Joe DeLucia, DO, FACEP says:

    I believe the first physician who evaluated Ms. Brown was negligent. Why did she get an EKG, blood work, x-rays and a 2 day admission for ‘spraining her ankle while walking near a ditch’.
    Her initial assessement should have been application of Ottawa Ankle Rules, grading of her sprain, and discharged to home.
    The most likely cause of the DVT/PE was the 2 day hospital stay.
    Ms. Brown was a victim of too much medical care all readily and freely available. I’m sure the first physician was practicing ‘defensive medicine’, which is insane and illogical. He injured the pt and put himself at higher risk.
    PRACTICE BY SCIENCE, NOT EMOTIONS AND FEAR.

  11. FloridaEP says:

    This case exemplifies why we need regionalized computer records and timely information sharing. When patients doctor or hospital shop, we should be able to access images and even notes to guide the diagnostic and treatment process.

    Patients frequently refuse to leave or demand additional tests. They cannot always get what they want and giving in is often not in their best interest. This is an unfortunate outcome that I don’t believe any of us would have predicted,

  12. bls says:

    Wow! And I thought I ordered a lot of tests!
    An ECG, labs for someone with a sprained ankle?

    Did I miss the history section? And 3 day admission? I can’t get anybody admitted.

    I will go back and reread. I must have missed something.

  13. Niko says:

    this history is incomplete. An ECG, labs for someone with a sprained ankle?
    However everyone is commenting on info we have here. So based on the info here the patient received great care and the police did nothing wrong.
    The comments here are laughable and often must be comng from nonmedical people.

    “There is no excuse for an ill woman with a serious medical complaint (whether “medically cleared” or not) to end up on a concrete floor of a jail cell, unattended for an hour and a half”

    She can be left unattended for 30 hours because she was discharged.

    There was no inhumanity to the lady. If she would have acted like a normal person she would not have been arrested and she could seek care from others if she disagreed with the diagnosis

    We dont admit intractable pain to the hospital. This happens rarely and we have to beg and it has nothing to do with insurance. Its usually a person who cant take care of themselves and they have no help..

    And the most ignorant:
    “From the public’s point of view, the case appears outrageous. But as I read through the description of what happened and thought about what could have been done different, from a physician’s point of view, I’m not sure what else could have been done. [I don’t know… maybe save her life?”

    Oh I don’t know maybe you need to go to medical school?
    The key part is “From a physician’s point of view…”

  14. Niko says:

    Didnt finish above post.

    When doctors say nothing else couldve been done they mean in the context of medical knowledge and on the basis of the information they have. To answer that with a sarcastic “Oh I dont know maybe save her life” means you don’t have that knowledge.

    • I removed that sarcasm (see link, I kept the original as well just so others know you weren’t making it up) so hopefully you can get past it. Rich was correct in that it detracts from the discussion. Although, it was Dostoyevsky who wrote: “Sarcasm: the last refuge of modest and chaste-souled people when the privacy of their soul is coarsely and intrusively invaded.”

      There was a comment I made in the St. Louis Post Dispatch that I’d like to quote from here: “Dr. Kelly may be right in that there is no medical science that can confirm a patient’s report of pain. But this only makes it all the more crucial to listen when the patient complains of pain, to not write them off as just being superb actors. That’s what is so deeply chilling: the idea that once she was so labeled and written off, Anna Brown was a dead woman sitting. Nothing she could have done or said–no cry or scream–could have halted the abuse she endured right up until the moment of her death. Imagine yourself in a similar situation. Is there a better example of hell on earth?”

      • Niko says:

        I know I’m wasting my time but here goes. The sarcasm was the least of your problems. The main problem is you don’t know how medicine is practiced or the nature of deep venous thrombosis and pulmonary embolus. So here it is:

        1) Once you are evaluated in the ER and discharged the level of your pain does not entitle you to refuse to leave. Doctors discharge patients all the time with pain and with appropriate pain killers. (Even if this is done inappropriately then you should go to another hospital, hire a lawyer, complain to administrator, etc )

        2) Inability to walk is no excuse. Otherwise we would have to admit all fractured legs. If you have a spinal cord lesion that is progressing and requires surgery then we do admit that. But inability to walk qua inability to walk is not automatically admitted.

        3) The woman dying although very sad does not prove the doctor necessarily did anything wrong. One doctor wrote he did not know what else could be done. He meant in the context of this presentation and on the basis of the tests run there was nothing else to do. Even so you can walk out and die no matter the clean bill of health.
        Another ex: You can walk out of a cardiologist’s office after an angiogram shows your arteries are completely clean and still die of a heart attack. If the cardiologist appropriately says “What more could I have done?” telling him “Oh I dont know, maybe save his life” would be ludicrous.

        4) Finally it would help to know something of the nature of her disease. She presumably died of a lung clot which had dislodged from her leg. These usually cause mild to moderate pain. Certainly not the severe pain described in this story.
        Its usually unilateral. It would be very bizarre for a leg clot to hurt so much even if in both legs (which happens rarely) to prevent someone from walking. If i saw a patient writhing around screaming I would put a venous clot lower on my list of possibilities. (although I would still do an US. Which the doctor did)

        Did the irrationalist Dostoyevsky have anything to say about Wells scoring and ddimers?

  15. She did ask for help says:

    She did ask for help. The “fit for confinement criteria” has an unacceptable error rate of death and either the application or something else should be re-examined. In this case the consequence was death. The patient did make her concerns known. She did attempt to communicate them. How can we frame the question so we can prevent this consequence of death. Could the fit for confinement criteria have been applied differently? Could her communication for help have been received differently? I have tried to ask for help before and found no one was listening or taking it seriously or they just didn’t want to hear the concerns. How does this change?

  16. Who or what is the "safe" guard? says:

    Is this an unacceptable mortality rate from the “fit for confinement” criteria? Is there a safeguard for communication from a patient that the medical issue has not been resolved that will work to prevent further harm or death?

  17. Stephanie Lewis says:

    1) That initial Post-Dispatch article was atrocious – a few paragraphs on the “facts” of what happened in the hospital and police station and then much more on how poor, dysfunctional in parenting, and mentally ill Anna Brown was (supposedly). I read the whole thing as deconstructing the credibility of the victim. That is very poor journalism.
    2) I had a similar experience as Anna Brown – visited multiple doctors with multiple misdiagnoses; was given pain relief at one point. Finally went to an emergency room where I was almost sent away with pain relief again, but the hospitalist decided to run a simple D-Dimer test on a hunch. This woman couldn’t have gotten a D-Dimer test? Is that an inconvenience or a high cost test? No, it is not. I finally got help and survived my pulmonary embolism because I am white, middle class, with a job and a car. Anna Brown was not any of these things, so in the mind of many Americans, including our supposedly educated ones in a supposedly compassionate field like medicine, she was deemed to lack credibility and worth. That’s what happened.

    • justadoc says:

      D-dimer is a screening test. Ultrasound is the follow up and more definitive test. The odds of her not having had a d-dimer even though it is not specifi ally mentioned is very low. But even if not claiming that dvt was not considered and tested for it is like saying coronary artery disease was not considered in a patient who didn’t have cardiac enzymes tested but did get a heart cath

      • Stephanie Lewis says:

        My D-Dimer led my hospitalist to order a CT Scan, a VQ Scan, and Ultrasound on my legs and arms. The first two showed clots in my lungs. The ultrasound showed nothing and I had had no history of leg swelling or pain or clots in my legs – ever. They ran genetic tests because of having no apparent cause for my PE and found out I am both Factor V Leiden and have the Lupus Anticoagulant. This all happened two days after my 40th birthday. Now I am on lifetime anticoagulants. To me, if the article is at all accurate about how well she was treated in the hospital, she did NOT receive the thorough care that I did and now she is dead. I sincerely doubt she received a d-dimer screening since they weren’t initially going to do it for me. Luckily, I had an excellent hospitalist who was a creative and critical thinker.

      • JustADoc says:

        By your own admission your presentation was completely different than this patient(leg swelling and pain verus your ‘no history of leg swelling or pain or clots in my legs – ever.’
        So the comparison is pretty much invalid to begin with.
        However, with leg swelling and a 3-4 day hospital stay it is unlikely she did not have a D-dimer. However, even if she did not, the follow up test for that would be an ultrasound, which she did in fact have.
        There is no mention in this article of her complaining of shortness of breath or chest pain that would prompt one to consider a PE.

        Your story is in fact almost the exact opposite. You had a CT and a VQ of your chest that showed clots. I presume you had either chest pain or shortness of breath or some similar complaint that led to such studies. Honestly, in your case, the D-dimer being done after a positive CT scan and positive VQ scan added nothing to your case except cost.
        They then looked for a clot in your legs as the most likely source of the clot and didn’t find it. They then did a work up for clotting disorders, which it turns out you have.
        Other than you and Ms Brown both having a clot, I do not see any similarities in your cases at all.

      • JustADoc says:

        My mistake. I misread part of your comment. You had the D-dimer before the CT and VQ.
        However, I still stand by the fact that leg swelling and leg pain and ‘no history of leg swelling or pain or clots in my legs – ever.’ are very different chief complaints.

      • Stephanie Lewis says:

        Actually, I only had pain in my lower back and diaphragm which was misdiagnosed by four physicians as pleurisy. Breathing was fine until the pneumonia I was getting took hold in the hospital – that was after all of the tests I had in this order: chest x-ray (negative), d-dimer (positive), CT Scan (showed “suspicion” of clots, and positive for pneumonia), ultrasound of legs and arms (negative), a VQ Scan (confirmed clots), and finally another chest xray to see my progress while being an admitted patient in the hospital (which is what showed my pneumonia getting worse and then the breathing problems started). A month prior (with my doctor and I looking through the “retrospectascope”), I had had a pulmonary embolism that I survived, but another doctor at the time interpreted my coughing up blood as throat irritation from my “seasonal allergies”. I believe doctors are human and usually treat them as such; for instance, I am not litigious at all and would only sue one if they committed some egregious infraction like operating on me drunk. Since they are human and flawed, they also make excuses for themselves and their colleagues (for fear of the truly litigious). I’m my own patient advocate and had my husband with me at all times while I was heavily medicated to make sure these humans didn’t make mistakes.

    • JustADoc says:

      My apologies, I do see how a complaint of lower back pain and diaphragm pain(the next time I hear that complaint will be the first time in person) versus a complaint of leg pain and swelling should lead to an identical work up. The next time I see someone with ankle pain after a fall I will order a D-dimer and CT chest with contrast.

    • Rich says:

      Stephanie, just keep adding details to your massively complicated narrative and at some point perhaps someone will grasp the relevance.

  18. Stephanie Lewis says:

    BTW…my hospital billed my insurance $99 for a D-Dimer test. Not expensive or difficult.

  19. [...] and found dead on the floor of a jail cell. Report. And some reaction thru the blogosphere: Sad outcome, proper treatment. Limited press for sad case. Labelling patients. Your thoughts? Could the doctors have done [...]

  20. Im not a Doctor or a Nurse but I will say this before anything were all Human and it seems to me that if nothing else the Medical staff and the Police department neglected to treat her like a Human I always thought that most people in the medical and law enforcement profession cared about people these day its all about a dollar pretty it up all you like they could have ran whatever test they wanted to what it all boils down tois that noone cared about Ann and because she didnt have insurance they were not going the extra mile nomatter what Ann complained about they did all they were going to do Does anyone care that someone died that didnt have to

  21. usa says:

    All is assumptions I believe a lot could have been done don’t matter how many ultrasounds ,x rays etc needed she wasn’t satisfied and she wasn’t well so she shouldn’t have been discharged she should have been admitted with more test. It doesn’t matter if her background wasn’t perfect no ones background is,but because of her background she was treated like a animal. That’s just not right she deserved better treatment and what about medical treatment in the jail why wasn’t she seen by a nurse there. To me she was discriminated against and its not fair to her children , parents and friends.

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