WhiteCoat

GNYHA STOP Sepsis Collaborative Guidelines Revealed

The Greater New York Hospital Association guidelines Jim Dwyer cited in his Rory Staunton articles about physicians who “missed obvious signs” of sepsis were hidden in his article.

Fortunately, Alissa D’Amelio who is the Senior Project Manager for Regulatory and Professional Affairs at the GNYHA was kind enough to forward me a copy of the guidelines.

The disclaimer at the bottom of the guidelines that was partially hidden in Mr. Dwyer’s article stated in full:

GNYHA and UHF hereby disclaim all warranties, express or implied, as to the accuracy of any of the information contained herein, or its fitness for any particular use or purpose. These materials are intended to provide you with information and resources that may assist your organization and should not be used as a substitute for clinical or medical judgment.

In addition, Ms. D’Amelio also specifically stated in her e-mail

Also, please note that the STOP Sepsis Collaborative is a quality improvement initiative that focuses on the adult population, which is the target population for this template tool.

Jim Dwyer did not return e-mails for comment on these issues. And he still hasn’t given me the names of the editors who approved his story for publication, either.

4 Responses to “GNYHA STOP Sepsis Collaborative Guidelines Revealed”

  1. Jim Dwyer says:

    The executive editor is Jill Abramson. Her name is available on the New York Times website, or in the printed newspaper, or by using Google. I am glad to provide it and regret that you were under the impression that I was withholding or hiding what is patently public information.

    You have quotation marks around words that I didn’t write. Please don’t do that.

    Also, I didn’t fail to “return emails.” I haven’t seen a single email from you, much less multiples, even after checking the spam filters. Not that I know who you are.

    Perhaps you can re-send the original. Or originals.

    As to the substance of the matter: the 5’9″, 169 pound, 12 year old boy had abnormal vital signs for an adult or a child (two standard deviations above the high normal heart rate for a child). He had highly abnormal blood values (five times the normal band count for an adult, 7 or 8 times that of a child). Treat him as a child, or treat him as an adult. Either way, he wasn’t.

    – Jim Dwyer

  2. WhiteCoat says:

    Your article doesn’t state the name of the editor who approved your article. I attempted to find the names of the editors on the NY Times site and wasn’t able to do so. Nevertheless, the NY Times does have more than one editor, doesn’t it? How is a reader supposed to know which of the NY Times editors approved your article?

    I re-forwarded the e-mail to you.

    The “substance of the matter” is that you change the substance every time you’re called on your lack of integrity when reporting. You misused the GNYHA guidelines in multiple ways. Didn’t have a justification for that. Let’s just change that substance and hope everyone forgets about it.
    You inappropriately allege that “fever is the enemy” when that is not true. Don’t have a justification for that. Let’s just change that substance, too.
    You inappropriately apply adult criteria for sepsis to a child. Don’t have a justification for that. Let’s change that substance to make Rory look like an adult and hope that people don’t notice.
    You imply that doctors were responsible for a child’s death in an article full of retrospective bias but don’t disclose that bias. We won’t change that substance. Let’s just inflame the readers and get them upset so they don’t realize the gaps in your logic.
    You imply that doctors are trying to hide from a discussion on the topic because they don’t discuss the facts of the case with you but failed to inform your readers about the laws preventing the doctors from discussing the case. Let’s not change that substance either. Just don’t address it. After all, the article can inflame more people that way.

    Now, you’re changing the argument again. And again your argument is inappropriate. Your argument above appears to be that children with abnormal vital signs must be “treated.”
    What inflammatory rhetoric.
    HOW should children with abnormal vital signs be treated, Dr. Dwyer? What are Jim Dwyer’s universal principles of management of children with abnormal vital signs that the entire world should adopt in order to appropriately practice medicine? You repeatedly omit the substance. Are you saying that every child with abnormal vital signs needs a sepsis workup? If not, how should negligent medical providers determine which children do and do not need sepsis workups? Should everyone just inappropriately apply the sepsis guidelines for adults to children as you have done?

    Regarding the “highly abnormal blood values,” you still haven’t even established that the doctors were aware of the lab values in Cory’s case. If you look on the guidelines in your own article, they show that if the patient meets three criteria, then the user should go to the “NURSING Sepsis Panel Orders.” Did you even explore the possibility that the doctors in the case may not have known that the tests were even ordered? If so, you conveniently omitted that information as well.

    Your last sentence makes little sense. “Either way, he wasn’t”? He wasn’t a child or an adult? Mistakes like this from someone whose career involves writing? If you’re instead alleging that Rory wasn’t treated, again, you have failed to establish what prospective rules were violated that made it medically appropriate to treat Rory.

    You’re so blinded by retrospective bias that you don’t even see what is wrong with your logic. Your attempts to extract vengeance for your friend are just an example of inappropriate journalism.

    Please don’t do that.

  3. Jim Dwyer says:

    Hi White Coat.

    Here’s the original article:
    http://nyti.ms/NjLrPH.
    You and your readers will be able to find follow up comments attached with vigorous discussions. Jill Abramson is the executive editor of the Times.

    I don’t recall writing, stating, implying or thinking that “fever is the enemy;” I’m not going to debate things I neither said nor wrote.

    I take your point that GNYHA now says the sepsis guidelines are for adult patients. They were used by NYU as part of the assessment of Rory Staunton. As I noted in the article, under those guidelines, he had two of the necessary three triggering symptoms during triage, and not until after he was effectively discharged did he have all three.
    I understand that the single symptom of elevated heart rate, in children and adults, is now used by Baylor and a consortium of hospitals as a trigger to do additional sepsis screening. They report great success with it.

    I don’t know who saw Rory Staunton’s lab values, but they were not used in his treatment. NYU says they will make sure that doesn’t happen again. You seem to have contempt for this outcome, even though you apparently believe the lab results would have been relevant to his care.

    As for being disingenuous about hearing from the doctors, and not seeking a waiver from the family, you’re just wrong. Here’s the text of an email I sent to NYU’s representative on June 29th:

    Dear Lisa:

    As you’ve known for some time, I am working on an article about a very serious matter involving the death of Rory Staunton, a 12 year old who was seen in the NYU emergency department on March 29 and sent home. If I don’t hear from you today, I will assume that NYU does not want to have a voice in this article. I hope that is not the case.

    I recognize that the hospital faces regulatory limits on the information it can share about individual patients, though my understanding is that Rory Staunton’s parents are willing to grant permission, in writing if need be, to permit discussion of his care.

    Leaving aside the particulars of his case, the professionals who work in the emergency department deserve to have their perspectives known and represented in the article. I am eager to include it, and willing to work within your and their limitations to 1. respect your regulatory and ethical requirements; and 2. give a full, fair picture of various challenges faced in circumstances like the one I am writing about.

    This would be my responsibility under any circumstance, but you should know that my personal ties to the emergency department at Bellevue – and by extension, NYU — go back decades, and I have the greatest respect for the people who work in both places, their dedication and professionalism.

    I have questions about blood work procedures at NYU.

    1. What values are considered “panic level,” that trigger immediate calls from the lab to the doctor?
    2. What happens when a significant result in blood work comes back after a patient has left the hospital? How long does it take before someone reviews the chart?
    3. Are band values above 50% in blood differential work considered “panic level” to be brought to the immediate attention of a treating doctor, and if not, is there a reason why not, and is there any consideration to changing that?
    4. I understand that the HHC hospitals have installed a video monitor that displays abnormal blood values on a screen in a way that calls attention to them. Is such a system under consideration for NYU?

    WhiteCoat, I don’t assume this will alleviate your concerns about the accuracy or integrity of my reporting, and I don’t think anything else I can say or do would. Thank you for publishing my replies.

    • BirdStrike says:

      In what way was printing the names of the physicians involved necessary to accomplish the goals of your article?

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