Sometimes Things Ain’t What They Seem

Niagara Health is taking a beat down lately. First it was an uncontrolled C. difficile outbreak, then a provincial administrator was appointed to deal with the outbreak, and now this:

When Doreen Wallace fell and broke her hip in the lobby of a Niagara Falls hospital, she figured at least she’d get help — and fast.
But that’s not what happened.
Instead, the 82-year-old Wallace — who was leaving with her son after visiting her dying husband at Greater Niagara General Hospital on Oct. 8 — was told by staff no one could help her until an ambulance was called.
To a hospital.
“It was horrible. It really was. Everybody who walked through the door stopped and stared at me,” said Wallace, who already had a broken arm from a previous fall. She ended up spending almost 30 minutes on the ground.
“I was inside the hospital. Why did they have to wait for an ambulance to come and pick me up?”
As she lay face down on a metal grate, her right arm slashed, a security guard called for help and two nurses from the emergency room came over. But Wallace’s son said they refused to help until paramedics arrived.
“I was floored,” said Mike Wallace. “We’re probably, maybe, like a 50-yard walk, literally, down to the emergency department.”

Almost predictably, Christie Blatchford weighed in, in the context of the stupid unthinking column I wrote about yesterday.

It’s an absolute given: With the great mass of Baby Boomers getting old, we too will weaken, grow frail and fall upon the mercies of the already badly faltering health care system. That system — what an amusing moniker that is for a bizarre and impenetrable collection of flourishing bureaucracies – does not change. It does not have the institutional equivalent of a “heart”; it does not learn from past mistakes; it does not respond to terrible plights; it does not bend.
There are already examples galore — just one the case of 82-year-old Doreen Wallace, who this month was leaving a Niagara Falls hospital where she was at her dying husband’s bedside, when she fell in the lobby and was left there, with what turned out to be a broken hip, face-down on the floor because 911 had to be called and an ambulance dispatched.
This had happened at this particular hospital several times before, where emerg staff seem to have a devil of a time treating anyone who doesn’t arrive by ambulance; it is contrary to hospital policy that it should happen; yet nothing seems to change.
I know what I’d do — fire the asses of anyone remotely involved in the decision that Ms. Wallace wouldn’t be seen unless she arrived the proper way. But that won’t happen.

Funny thing, this happens fairly often, and it’s a bit more complicated than you might think. Elderly hospital visitor falls down, goes boom. Someone says, “Let’s call those all-competent emerg nurses, they’ll know what to do,” ED nurse arrives, and the first thing she thinks about is c-spine protection as part of the ABCs. The point is, you just can’t simply move a patient who has fallen from standing height without protecting their neck. Especially elderly women, whose bones tend to break like eggshells. The result from moving a patient precipitously could be catastrophic if they have a cervical spine fracture. Patients in these situations need to be immobilized, which requires special training and equipment. (I’ve been trained how to immobilize necks, but that is by no mean true of all ED nurses. Or physicians, for that matter. In any case, I don’t do it often enough to be an “expert” practitioner by any means.)

Blatchford’s implication that hospital staff stood by callously and incompetently — her perennial complaint and modus operandi — is deeply unfair. If you don’t have trained staff or an available spinal board, the way give the best patient care is to call the paramedics, who are trained and have the equipment to offer c-spine protection. (In any case requiring spinal immobilization, I would defer to EMS without thinking twice.)

Or to put it another way, do you really want a porter (or whoever) scooping an elderly visitor into a stretcher and racing down the hallway to the ED for the sake of appearances (and drama, I might add) without knowing whether she has any c-spine trauma? The first rule of health care, after all, is to do no harm; on balance, it’s probably better to wait thirty minutes in relative discomfort (for the patient) for a paramedic with a spinal board, than face permanent paralysis or even death. The staff at Niagara Health probably made the best possible decision given the circumstances.

Granted, there’s the question of whether hospitals should provide the training and equipment so nurses can manage visitors who fall or otherwise injure themselves in public areas of the hospital. I would argue strongly yes. But I think that’s a separate discussion, involving prioritization and spending in an era where every health care nickel is being squeezed for the best possible value. Niagara Health could have done better, certainly, but not for reasons that Blatchford, or the rest of the media for that matter, imagines. Maybe she needs to, like, speak to an Emerg nurse or physician before rushing to conclusions.


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  1. #1 by The Nerdy Nurse on Tuesday 25 October 2011 - 2308

    The unfortunate thing here is that the general population do not understand stabilizing a c-spine. The understand letting an old lady lay on the ground. I wonder if there was a press release or anything from the hospital clarifying the reasoning behind needing to wait for the ambulance, c-spine stabilization, and so-on. I truly find that when people have an explanation and and an apology, they are usually satisfied. They just want their concerns acknowledge.

  2. #2 by Aurelia on Wednesday 26 October 2011 - 2201

    Are you aware that staff just walked right past her, and her relative? While I understand that you need to stabilize a neck–no one stopped and stayed with them. No one helped them call an ambulance, no one checked if there was any staff who could stabilize her neck or get a backboard or even god forbid check her pulse, see if she’s stroking out.

    At some point–this is all crap. The Niagara Health Care system has devolved into disaster. The best staff left, long ago. This is not your hospital.

  3. #3 by torontoemerg on Wednesday 26 October 2011 - 2226

    According to the news reports, staff were summoned, at any rate… I’m not sure what they did at that point, as the reports don’t elaborate. In any case the point remains: the press (and the public in turn) always have an incomplete picture of the realities of health care. I’m pretty sure if you talked to the staff they would have a very different view of events. I guess the other thing the bothers me about this incident that the ED nurses were being set up to fail no matter what they they did. Clearly, moving the patient without proper c-spine stabilization was unacceptable, but the expectation was that they needed to “do something” — what, I don’t know. Take vitals? Even of her BP was bottoming out, they still couldn’t move her.

    Are you familiar with Niagara Health? I’m rather guessing the culture there doesn’t really support nursing excellence.

  4. #4 by Aurelia on Thursday 27 October 2011 - 1034

    Yeah, a friend of mine recently had a major medical disaster behalf his mom there….a Doctor admitted someone screwed up, almost killed her, but won’t say exactly what, why. He suspects she was part of the C.Difficile outbreak. She went in for a simple operation, one dirty catheter later she was in kidney failure, unable to walk. They’ve spent 1000s they didn’t have on home care, physio, and no help from that hospital or the LHIN to cover their bills. Anyway, they used to have great hospitals, but after multiple closures, layoffs, and cutbacks….it’s a mess.

    You think I’m being unkind? You should read the scathing opinions of the many people who live down in Niagara. They used to LOVE their hospitals and raised money…would defend them endlessly. Now? Oh, it’s bad. Stories are rampant, flying.

    This is why I don’t like LHINs….they control a lot, but don’t take responsibility, The minister’s office gets blamed, after LHINs don’t consult with the public, don’t open communication, let good staff leave, lower infection control standards, contract out cleaning. Everything falls apart, they just look around and say, gee, we don’t know.

    So, yes, I do know it, and this story is mainly making the news because it’s one symptom of much deeper problems.

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