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Dental Student dies in ICU NO ICU DOC Available
Started by NPJR
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Tons of icu are staffed by NP or PA after 7pm these days with icu docs on standby by “tele icu”. Even the VA hospitals have tele icu.
The tele crap has got to stop but it won’t.
I had to go intubate a “tele” icu patient a couple of years ago at 1am because ER doc wasn’t available (he was in his own mess in the ED tending to unstable ED patient). The NP couldn’t intubate. I happened to be in house just got finished with epidural for ob (we don’t have to stay in house for OB) Becuase less than 15 minutes away
The “tele icu “
Doc was 1 hr away. ….at comfort of their homes.
But hospitals will play this the long game with the tele icu and risk it. For every patient death. Even if they pay out 5 million (which is covered by their own insurance). It’s worth saving money.
Now if we can only get our tele radiologist back in house at night for on site consultation…that ship has sailed.
People are lazy. They don’t want to go back on site.
The tele crap has got to stop but it won’t.
I had to go intubate a “tele” icu patient a couple of years ago at 1am because ER doc wasn’t available (he was in his own mess in the ED tending to unstable ED patient). The NP couldn’t intubate. I happened to be in house just got finished with epidural for ob (we don’t have to stay in house for OB) Becuase less than 15 minutes away
The “tele icu “
Doc was 1 hr away. ….at comfort of their homes.
But hospitals will play this the long game with the tele icu and risk it. For every patient death. Even if they pay out 5 million (which is covered by their own insurance). It’s worth saving money.
Now if we can only get our tele radiologist back in house at night for on site consultation…that ship has sailed.
People are lazy. They don’t want to go back on site.
Yea,
But i am sure the hospital saved a bunch of money by not using in house intensivists
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Might just use an AI intensivist.
A.I. prob would have recognized he was in trouble before the human.
"Heroes work here"
What is next? Tele- police. What is the nature of your emergency?
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"Hospital administrators are lazy"
Pay an intensivist a fair wage to stay in-house overnight and it won't be a problem.
RT couldn't intubate? That seems weird.
Promising dental student died in ICU overseen by remote ‘tele-health’ physician, declared dead via video: lawsuit
Conor Hylton’s family slapped the wrongful death lawsuit against Bridgeport Hospital Milford Campus last month for allegedly not having a physical doctor onsite when he was admitted to the IC…
I'm sorry but there's nothing "promising" about a 20-something alcoholic... Sad he died but let's not forget his own bad decisions led to his death.Promising dental student died in ICU overseen by remote ‘tele-health’ physician, declared dead via video: lawsuit
Conor Hylton’s family slapped the wrongful death lawsuit against Bridgeport Hospital Milford Campus last month for allegedly not having a physical doctor onsite when he was admitted to the IC…nypost.com
I don’t drink alcohol. But we all make mistakes. Few of my colleagues have been held in “holding areas” for acute alcohol intoxication
And I’m not sure your experience. But during my almost 25 plus years in the anesthesia world. I’ve been called to intubate alcoholics, many of them young in the icu.
It seems the icu care especially tele icu failed the young man. Any lawyer can argue if real icu doctor was on site. Patient should have been intubated hours earlier
Thats also a fairly sick kid. He had wrecked himself.
Obviously should have survived the 1st day @ least but with the seizure has to be acute severe pancreatitis so by definition 10%+ mortality
cittykat
Full Member
Seizure could have been from severe pancreatitis or from alcohol withdrawal or a combination of both. Hard to know without more information.
We know, at least, he was never examined by a physician.
Im not an intensivist but if they got in front of this the minute his condition deteriorated he could have had a chance. Ya cant do that on the phone.
Then perhaps it's good this story is getting so much publicity. If financial losses don't change things, perhaps negative publicity might make a difference.
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Theres actually a big push in icus these days to allow nurse monitored sedation with precedex often to quite high doses with minimal monitoring, non intubated, certainly far below the bar required for us in an intraop MAC case. No etco2 etc
A lot of my fellow intensivists have been mislead to think precedex is safe without a secured ett or @ least safer than propofol or midaz or more traditional sedation. Unfortunately this can be very untrue and these patients can obstruct or go apneic very commonly.
I hate it and stop this nonsense immediately. If they need that much sedation the buy themselves an endotracheal tube... alas video doc here had no such qualms
We can't control what the kid does with his life. We can judge all you want but fact is he shouldn't have died this way.. going to an ICU that isn't really an ICU
From what I read, it was the alcohol withdrawal that caused the seizure. Alcohol withdrawal has a much lower mortality rate and if that was the reason for admission to ICU then they definitely effed up
Family of young ICU patient who died while in the care of a ‘teledoctor’ sues hospital
The family's lawsuit says staffing issues prevented constant and consistent care in the 18 hours Conor Hylton, 26, was hospitalized.
www.nbcnews.com
I don't disagree with you, at all.
Unrelated question: is it normal for dental students to wear a white coat and stethoscope?
This hospital is part of Yale.
Zero excuse for cost cutting by running an eICU
Zero excuse for cost cutting by running an eICU
Things would only change if hospital administrators could get named in malpractice lawsuits.
Currently they can run wild with any number of insane cost cutting measures because they are completely shielded. If they had even a slight chance of liability, things would change for the better.
Yes they must listen to the gums to ensure good perfusion
Where did the story mention precedex?
This was a failure to recognize he needed to be transferred to one of their more capable ICUs, there are two much larger Yale hospital/ICUs both only 10 mins away
Fifth paragraph
Transferred? Lets start with GO EXAMINE the patient. Lets start there.
PE: patient resting comfortably without complaint.
Because no longer breathing
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Wow this addituonal jnfo make the whole story even worse
because DEAD
cittykat
Full Member
He had a condition……
Oldie but goodie.
One of my faves
I would fully support tele-police. They seem to exist as modern day pirates where I live.
This young man died of an alcohol withdrawal seizure with the possibility that sedation and loss of airway contributed to his death. Now, almost every doctor can take this kids history and look at him and realize he is in withdrawal and likely needs escalating sedation with a secured airway. Again, this is egregious care in this day and age.
Very heroic of you to voice this opinion, thanks for standing up to this POS!
yea I get it - his bad decisions- and patients piss me off daily with their attitudes despite using illicit drugs or having a substance abuse problem… but as long as EMTALA is in place it’s all our problem and we have to take care of patients. Dont like it - advocate to repeal EMTALA… until then it’s our problem. This was deviation from the standard of care.
Lawsuits against administrators is a fabulous idea. This would be a huge step in the right direction.
Currently you can only sue health insurance companies for the cost of the denied care after a poor outcome - going after them for damages would be key too
Lawsuits against administrators is a fabulous idea. This would be a huge step in the right direction.
Currently you can only sue health insurance companies for the cost of the denied care after a poor outcome - going after them for damages would be key too
The tele-ICU thing is a ****show. The thought that places like this have no intensivist on site at night is horrific, and I’m sure this isn’t the first time someone has died because of it.
However.
I also had a number of other thoughts when I heard of this last night, including:
- This guy was a dental student. Had anyone at his program noticed that he was having an issue with alcohol? He clearly was drinking heavily for a long time…
- Personal responsibility is imperative as a physician. By no means am I saying that this guy “had it coming” or something, but he clearly was making poor choices for a long period of time. And in medicine, dentistry, podiatry, etc etc, you have to be able to perform your job properly, period. If you’re a medical professional, your own drug and alcohol problems can start to endanger not just yourself but the people you care for.
A couple years back, I had to cover for one of my partners (I’m a rheumatologist) while he went to rehab. And it was freaking ugly. This guy had been giving really poor quality care to his patients for a long time. I fixed so many crazy errors and problems, and really pulled some pts back from the brink of what he had been doing with them.
He came back from rehab and is working again. But I’m never going to trust him (or his care) from this point forward. I’m still bothered by some of the really insanely incompetent things he’d been doing before another set of eyes was laid on his pts.
This dental student was someone who appears to have been headed down that path. And in our arena, that isn’t ok. You can’t maim or kill other people because you can’t get a handle on your own problems.
Again I think the whole thing is sad, and I think this kid may still be alive if he was properly cared for. But I wonder if anyone would have ensured this kid got proper help afterwards, or if he would have been quietly wisked back to his dental classes…
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