ICU Telehealth Lawsuit

[randomdoc1]

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Has anyone been following this?

26yo dental student. etoh pancreatitis. On admission deteriorated and was admitted to ICU. Sounds like passed of complications of etoh withdrawal. I obviously only have limited details.

I know telehealth has a big variety of takes on how people feel about it. Me, I feel very nuanced. It's like a medication, you can't just give it to anyone. It's the right choice in some cases, not in others, the diagnosis or clinical picture is fluid and not static. I definitely feel like it's been used in inappropriate ways and is vulnerable to abuse/misuse. Not saying that is what happened here necessarily. Likely his clinical picture changed rapidly. But, this is one of the reasons I err on more in person than not. You just don't know what will come through your door, whether it's a new patient or established patient. Depression can evolve to actually be bipolar. Your high functioning executive on low dose prozac can have etoh withdrawal. If you happen to be on a screen...it's just a lot harder.

I mean, this is ICU which is a whole different beast. But...as some know from my other posts, I've ran into more risks in running the practice when providers tried to increase their telehealth and stay home and decrease in person days (in a non-judicious manner). This included decompensated eating disorders, missing complications of etoh use (e.g. evidences of liver disease like ascites or jaundice that affects prescribing decisions), tardive dyskinesia. I mean, the patient won't be aware of what to look out for, that's why we're the experts and we notice things when we see them. Like wow, they look really jaundiced. Oh, they are really thin...that's why they wanted to stay remote. Patient thought it was "just a tic" or quirk but it was TD.

Opinions aside, I think it's a great discussion the article brings.

 

[comp1]

Doesn't seem tooooo psych related, although I guess alcohol withdrawal is our bailiwick (although certainly not MICU level). For those interested, here's an article:

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

The telehealth aspect of it seems more of a sensationalism thing (ICU!) to make sure the hospital settles right quick. It's not at all clear that telehealth was the proximate cause of his death. We all have no way of telling if there was actual malpractice from the very limited info available. People die from severe bleeds often, no matter how many doctors are physically surrounding them. The family seems to be arguing that tele-ICU itself is below the standard of care definitionally which would be a relatively large burden to prove since it's present in a heck of a lot of places. There was an attending on site (who intubated him). I don't foresee changes coming from this and I'm not sure if any lessons here can be translated to psych practice. Telehealth is generally a great thing, for patients and providers. There are some situations where it doesn't work, of course, but they do grow smaller in number every day. I know I'm certainly not into driving over to my PCP pretty much ever and there wasn't much of a justification even prior to COVID given the overall quality of physical exams.
In regards to your specific examples, I don't want doctors relying that much on a visual exam when managing liver issues and severe alcohol use disorder. Jaundice can be extremely subtle, including in person. These patients should be getting regular labwork. In terms of TD, I'm a firm believer that we need a MUCH more patient centered approach to its treatment. If the patient, themselves as opposed to the clinician, wants to address some movement, then we should, whether it's a tic, quirk or TD. That can also appropriately be diagnosed by telehealth, of course. I say all this as someone who never does any telework, so it's nothing personal on the professional side. I do think that we need to appropriately reimburse professionals for non-telework as it is most costly to provide and we need to justify to patients if there is some specific reason they need to be seen in person.

 

[randomdoc1]

I'd agree that I too definitely do not think there is a blanket statement. From what little data I could find, one article said CIWA was not done. I mean,, hopefully it was. Does look like there was an on site physician but they did not know how to get to the ICU, which was argued as a delay in care. We will never know. Lawsuit alleges there were major communication gaps and poor hand off of care. I can't speak to the specifics of this case. But I can speak to the specifics of my practice. I also see logistical wrinkles in telepsych that can make or break the outcome like compared to in person, more easy lapses in communication, unclear communication, unable to reach provider (on telehealth some are conveniently never able to be reached), tele visit not actually being privacy compliant, provider not fully focused on the encounter, provider trying to multitask or getting multiple distracting pings during the visit. In terms of the liver disease case, without boring anyone with the details, it was something I noticed in a patient that was not even mine that was easily missed on a video visit and the provider could have gone months or years with psychotropic dosing that was harmful. I like my practice but the thorn is I share liability in all the cases. I think what I notice in a multiprovider practice is the slippery slope. One missing metabolic labs become 2, 3, 40. 6 months turn to 12, 24, 36. And I'm not spending my unpaid time babysitting. Less communication with staff on pertinent time sensitive matters a few times to it becoming the norm. Do all providers do that? No. I find very disciplined and thorough ones, make it work the way it should. They optimize it for themselves and the right candidates. But make a habit to carefully select and reassess the ones on telehealth are still right for it. They tend to keep good track of their metabolic monitoring and statutes and know when their patients are due for what and arrive on site. It's a matter of how the provider approaches it. Just like how prozac is great for the right patient, but not all patients. And for patients it worked well for, it's not necessarily forever, so reassess.

 

[comp1]

I think Prozac is a great example to compare with telehealth. There are certainly limited situations where it's inappropriate (eg florid mania), but geeze is it appropriate in a heck of a lot of cases, even if something else might be a bit better relatively. Poor communication, particularly between systems, is in no way limited or even particularly increased in telehealth.

 

[randomdoc1]

I think Prozac is a great example to compare with telehealth. There are certainly limited situations where it's inappropriate (eg florid mania), but geeze is it appropriate in a heck of a lot of cases. Poor communication, particularly between systems, is in no way limited or even particularly increased in telehealth.

it also causes a lot of sexual side effects. it may be working, but being thorough and reassessing gives long term adherence. Many patients are too shy to talk about their erectile dysfunction or unsatisfactory climax and just stop taking it. Oh, and don't forget the drug interactions in cyp2d6 (along with including non psych meds). And many patients do not reach remission on a monotherapy, so assess for possible need for augmentative options (pharm and nonpharm). And the elderly with risk of GI bleed, SIADH. Gotta be careful with medical comorbidities like our a fib and PE seniors with their blood thinners.

Something interesting I observed. Although there is data about the benefits of telemedicine, which I do not disagree, there is a strong patient preference for in person care (such as Patients’ perspectives and preferences toward telemedicine versus in-person visits: a mixed-methods study on 1226 patients - PMC). Which can also be a factor in liability risk. How the patient perceives their care affects their engagement in care and risk management. Would the dental student have objectively different care if a physician was on site the whole time? No idea. But the family did not feel the communication was good and certainly weaponized it in the lawsuit. It won't look good in front of a jury either, even if peer reviewed articles were shown. We know a large portion claims are filed even if the medical decision making was standard of care. But if the patient family felt heard/communicated with/genuine effort is a big deciding point on if they will proceed with a complaint.

My own practice, a provider tried to go all virtual. I won't go on more about how much more their clinical performance deteriorated, and it did. But patients were very untrusting during that time period. One went so far as to report them for insurance fraud and a case was opened in a special investigations unit. Claims were paused and it cost me in paid labor to produce the records. Monetarily, it had some elements of a lawsuit for sure. It definitely cost me (and them). I was not pleased. Never had that happen with in person.

But we will agree to disagree. Don't get me wrong, I do enjoy the various convos we have here!

 

[shoomer]

I am old school and dislike telehealth except for circumstances where the absence of a virtual option would lead to no medical care at all. I like that it can increase accessibility for patients with transport issues, or providers needing to cover multiple remote areas concurrently, but I'm not a fan of it otherwise.

 

[Stagg737]

I think a valid question in this situation is to ask WHY this ICU is being staffed with telehealth? If this were some rural hospital dependent on telehealth just to have staff or if staffing has chronically been an issue, it’s one thing. However, it looks like this hospital is near New Haven and affiliated with Quinnipiac University and part of the Yale New Haven health system, so I’d be more inclined to believe this was a financial decision. IMO, that’s going to make a difference to a lot of people. I don’t think I have unreasonable expectations, but I would never let my family be treated somewhere that I know the ICU is going to be staffed via telehealth. Certain settings should require on site staffing and imo the ICU is one of them.

In regards to your specific examples, I don't want doctors relying that much on a visual exam when managing liver issues and severe alcohol use disorder. Jaundice can be extremely subtle, including in person. These patients should be getting regular labwork. In terms of TD, I'm a firm believer that we need a MUCH more patient centered approach to its treatment. If the patient, themselves as opposed to the clinician, wants to address some movement, then we should, whether it's a tic, quirk or TD. That can also appropriately be diagnosed by telehealth, of course. I say all this as someone who never does any telework, so it's nothing personal on the professional side. I do think that we need to appropriately reimburse professionals for non-telework as it is most costly to provide and we need to justify to patients if there is some specific reason they need to be seen in person.

As someone who actively does telehealth and also previously saw patients with very obvious signs in the ER that were missed by telehealth, I’m going to push back here. Telehealth is just inferior to in person care. Psych is more amenable to telehealth, as the physical exam is far less important than other fields, but it’s still relevant.

In my outpatient telehealth clinic I have had a few patients developed tardive dyskinesia from meds I either started or continued where I was unable to identify those signs in time to prevent permanent symptoms. Of course, I warned all of these patients that this was a possible side effect, but that did not change the fact that I cannot perform an AIMS electronically and I was unable to see the involuntary movements until they were obvious and significant. This is something that I absolutely would not have missed with in person appointments and doing a basic but confident physical exam/AIMS.

Unfortunately, my clinic is one where telehealth is necessary as my patients are somewhere between 4 to 9 hours away from me and the nearest psych NP may be two hours away or more. I think it depends on what we say is “appropriate” vs “acceptable due to limited availability of resources”.

 

[randomdoc1]

I think a valid question in this situation is to ask WHY this ICU is being staffed with telehealth? If this were some rural hospital dependent on telehealth just to have staff or if staffing has chronically been an issue, it’s one thing. However, it looks like this hospital is near New Haven and affiliated with Quinnipiac University and part of the Yale New Haven health system, so I’d be more inclined to believe this was a financial decision. IMO, that’s going to make a difference to a lot of people. I don’t think I have unreasonable expectations, but I would never let my family be treated somewhere that I know the ICU is going to be staffed via telehealth. Certain settings should require on site staffing and imo the ICU is one of them.


As someone who actively does telehealth and also previously saw patients with very obvious signs in the ER that were missed by telehealth, I’m going to push back here. Telehealth is just inferior to in person care. Psych is more amenable to telehealth, as the physical exam is far less important than other fields, but it’s still relevant.

In my outpatient telehealth clinic I have had a few patients developed tardive dyskinesia from meds I either started or continued where I was unable to identify those signs in time to prevent permanent symptoms. Of course, I warned all of these patients that this was a possible side effect, but that did not change the fact that I cannot perform an AIMS electronically and I was unable to see the involuntary movements until they were obvious and significant. This is something that I absolutely would not have missed with in person appointments and doing a basic but confident physical exam/AIMS.

Unfortunately, my clinic is one where telehealth is necessary as my patients are somewhere between 4 to 9 hours away from me and the nearest psych NP may be two hours away or more. I think it depends on what we say is “appropriate” vs “acceptable due to limited availability of resources”.

ditto. I will also include, the paradox is that although physical exam is less needed in psychiatry, in office is a vital part of the treatment plan. I mean yes, psych is very amenable to virtual, no disagreement. But a huge part across all specialties and especially psychiatry is people want a therapeutic relationship. We know much of our treatment is non-pharm elements.

And this too, data that surveyed the general population, imho rightfully so, they see "real doctors" as those who give patients the autonomy to decide if they want telehealth versus in person. We are patients too, and I also value my decision making autonomy. This also includes within reason flexibility of scheduling options, geographic distance, how I pay my bills, choice of provider, etc. In my patient experience if a provider is virtual only and there is not a strong clinical indication for the why, they are not the first choice for me. I do use telehealth, but the dynamics surrounding it are huge.

Hit the nail on the head, it's the why telehealth is being used.

 

[comp1]

I do agree that it's odd that a hospital within visual distance of Yale would be using a tele-ICU at all. Of course the concern in malpractice is below the standard of care, not below ideal care (assuming without evidence that in person is gold standard). Maybe you could argue that it's not standard within a certain distance of a major metropolitan center or medical school. I know standards are community based. That seems like a complex argument. Of course it's still not clear that telehealth had any particular role in the patient's death beyond the family's vague assumption. We'll never find out as this will be settled very quickly. Ultimately if telehealth is significantly inferior to in person assessments then salary and fee for service models need to reflect this clearly. At present, they don't.

 

[splik]

Tele-ICU (or "teleintensivists") have been around for a while including at Kaiser (who have data on its benefits). Also telestroke neurology is a big thing. We're typically comparing this not to in person specialty care but in person non-specialty care. This kind of thing often grabs sensationalist headlines but from a negligence perspective, what matters is what a reasonably prudent teleintensivist would have done under similar circumstances. For the hospital, they need to be able to explain the reason for this model. Many hospitals don't have specialty or closed ICU care at all. Things like telehealth, asynchronous care, collaborative care, econsultation and other once novel models are about expanding access to care and it is very silly to argue against these when used appropriately. The access issues are only getting worse as the government deports physicians and the J1 waiver program (which allows foreign physicians to serve 3 years in an underserved area en route to getting their green cards after residency) have been affected by this $100k visa fee for H1-b visas.

 

[FlowRate]

Although there is data about the benefits of telemedicine, which I do not disagree, there is a strong patient preference for in person care (such as Patients’ perspectives and preferences toward telemedicine versus in-person visits: a mixed-methods study on 1226 patients - PMC).

That study was conducted in Iran and was not exclusive to mental health concerns.

We are still 1 required in-office day per week and even those in-office days are usually a mix of telehealth and in-office appointments. The organic patient demand for in-person psychiatry appointments is very low. It's significantly higher for proper psychotherapy, however.

 

[FlowRate]

I do agree that it's odd that a hospital within visual distance of Yale would be using a tele-ICU at all. Of course the concern in malpractice is below the standard of care, not below ideal care (assuming without evidence that in person is gold standard). Maybe you could argue that it's not standard within a certain distance of a major metropolitan center or medical school. I know standards are community based. That seems like a complex argument. Of course it's still not clear that telehealth had any particular role in the patient's death beyond the family's vague assumption. We'll never find out as this will be settled very quickly. Ultimately if telehealth is significantly inferior to in person assessments then salary and fee for service models need to reflect this clearly. At present, they don't.

Not sure about odd. I rotated at a smaller hospital in Boston that had tele-ICU coverage overnight. I think it's just a financial decision. A closed ICU with 24/7 intensivist attending coverage probably requires a certain size of hospital and ICU.

 

[randomdoc1]

That study was conducted in Iran and was not exclusive to mental health concerns.

We are still 1 required in-office day per week and even those in-office days are usually a mix of telehealth and in-office appointments. The organic patient demand for in-person psychiatry appointments is very low. It's significantly higher for proper psychotherapy, however.

I think there's arguments either way. Iranian hoomans are still hoomans. In my clinic I'm seeing very similar stats. We get hundreds of intakes a year. Once you say "virtual only provider" or a provider with just fewer in office days, about 70% opt to not schedule. Most patients are looking for hybrid but rather come in when feasible and to make the virtual call with them leading the decision instead of the provider. Another logistical event I've seen too is many patients when they scheduled for virtual will still show up and get upset if the provider is home. Even though it's the patient's fault, being in office decreases the logistical snags.

For providers that have more telehealth, it is often at least in part because there was a selection for virtual patients. I've seen providers here schedule the virtual more often (and yes, it eliminates commute) and the in person get scheduled further out (commute is part of it, but even those who needed to be seen sooner still got pushed out even though they were receptive to a one time virtual visit, there's some conscious or subconscious selection on some providers). There's an unspoken dynamic too. For example, I like working with MDD and I'm horrible at doing stims. My panel evolved to more MDD w/o stims. Patients can also pick up our level of enthuse (or lack of) for the appointment. If a provider's schedule is mostly virtual days, it will self select for virtual leaning patients. The people preferring in office tend to just find another office with more in person slots. At least in my geo area, there's no shortage of psych services so patients definitely do shop around.

 

[Stagg737]

Not sure about odd. I rotated at a smaller hospital in Boston that had tele-ICU coverage overnight. I think it's just a financial decision. A closed ICU with 24/7 intensivist attending coverage probably requires a certain size of hospital and ICU.

So looking this up, I initially saw that Bridgeport Hospital is a 500 bed hospital with multiple ICUs. That's >90th percentile in terms of hospital size (beds) in the US and would be pretty dang hard to argue for tele-coverage for any reason other than financial ones. Then I saw that it's at the Milford campus which is actually a 100 bed hospital with only 6 ICU beds, so I imagine that they likely don't want to pay someone to be on site covering only 6 beds overnight as you're suggesting. That said, it's in a very affluent town that's a 15 minute drive from the main Bridgeport Hospital and a 25 minute drive from the main Yale New Haven Medical Center Campus. Which imo begs the question as to why they even need an ICU when they can just transfer patients to one of the two major medical centers that are 7 and 12 miles away respectively?

I do agree that it's odd that a hospital within visual distance of Yale would be using a tele-ICU at all. Of course the concern in malpractice is below the standard of care, not below ideal care (assuming without evidence that in person is gold standard). Maybe you could argue that it's not standard within a certain distance of a major metropolitan center or medical school. I know standards are community based. That seems like a complex argument. Of course it's still not clear that telehealth had any particular role in the patient's death beyond the family's vague assumption. We'll never find out as this will be settled very quickly. Ultimately if telehealth is significantly inferior to in person assessments then salary and fee for service models need to reflect this clearly. At present, they don't.

To be clear, I'm not railing on the teledoc per say, but I do think this is a situation where clearly multiple things had to go wrong for this outcome that likely would not have happened with on-site docs. Here's another article with slightly more details including the lawyer citing investigations from CMS as well as the Connecticut Public Health Dept that apparently found "substandard care". What does that mean? Idk, but since the patient wasn't seen by the telehealth doctor for several hours I'm guessing that's going to be a major argument since that kind of defeats the entire point of telehealth coverage (access and availability). There's also a CNN article on the case, but it's behind a paywall so I didn't read it.

Yale New Haven Health hospital's tele-ICU model highlighted in wrongful death lawsuit

Yale New Haven Health is being sued by the family of a deceased patient over alleged substandard care and negligence, they said, that was exacerbated by its hospital’s tele-ICU care model. | An alleged "culture of inattentiveness and substandard care" at Yale New Haven Health's Bridgeport...

www.fiercehealthcare.com

Tele-ICU (or "teleintensivists") have been around for a while including at Kaiser (who have data on its benefits). Also telestroke neurology is a big thing. We're typically comparing this not to in person specialty care but in person non-specialty care. This kind of thing often grabs sensationalist headlines but from a negligence perspective, what matters is what a reasonably prudent teleintensivist would have done under similar circumstances. For the hospital, they need to be able to explain the reason for this model. Many hospitals don't have specialty or closed ICU care at all. Things like telehealth, asynchronous care, collaborative care, econsultation and other once novel models are about expanding access to care and it is very silly to argue against these when used appropriately. The access issues are only getting worse as the government deports physicians and the J1 waiver program (which allows foreign physicians to serve 3 years in an underserved area en route to getting their green cards after residency) have been affected by this $100k visa fee for H1-b visas.

Apparently ~18% of ICU beds in the US are staffed through telehealth in some manner, which isn't a huge number but is common enough. I won't argue why I think tele-stroke is a terrible idea if it's possible to have an in person doc, but I don't think it's hard to imagine what my arguments would be.

To the bolded, I think they're going to have a hard time arguing that standard of care was met in this instance if it were to go to court, especially if the CMS and Dept of Public Health reports are as da**ing as the attorney is making them out to be. Patient was apparently not seen by a physician (of any kind) for hours after transferring to the ICU, which defeats the entire clinical purpose of telehealth. Then the physician who was supposed to physically intubate got lost in a 100 bed hospital and took excessive time just to get to the bedside is...not great. Combine that with the fact that the two major hospitals with multiple sub-specialty ICUs are 15 minutes away (one of which is the main campus for this hospital and the other which many argue is a top 3 hospital in the country) and a decent legal team is going to have a field day. I think it's an especially bad look that his death pronouncement was made via tele-health.

I'm sure YNHH will want to settle this ASAP as it looks like bigger news outlets are picking the story up and this is exactly the kind of story that a politician could sink their teeth into to try and get their 15 minutes. Seems like it's got prime potential to be a modern Libby Zion situation espousing the dangers of telehealth and technology, especially if money isn't a priority to this kid's parents (they're both dentists in the New Haven area) and they're looking for a more meaningful legacy. I doubt that will happen, but I could see this being a case that could influence the trajectory of telemedicine significantly.

 

[comp1]

Where are the CMS and Dept of Public Health reports?

 

[Stagg737]

Where are the CMS and Dept of Public Health reports?

Does Connecticut make them publicly available? If so, I can’t find it but I’d be interested in reading it. Apparently multiple sources have referenced it, here’s one with a few more details. Per the article, a 2025 investigation by the CT Dept of public health report concluded the hospital failed to ensure he received appropriate care and the hospital also apparently had a policy that on site physicians had to attend to patients. So just looking worse for the hospital if that’s all accurate…

Telehealth ICU Sued for Death of Dental School Student - FindLaw

The parents of a UConn dental student are suing Yale New Haven Health over substandard tele‑ICU care in a wrongful death case. FindLaw explains.

www.findlaw.com

 

[randomdoc1]

Does Connecticut make them publicly available? If so, I can’t find it but I’d be interested in reading it. Apparently multiple sources have referenced it, here’s one with a few more details. Per the article, a 2025 investigation by the CT Dept of public health report concluded the hospital failed to ensure he received appropriate care and the hospital also apparently had a policy that on site physicians had to attend to patients. So just looking worse for the hospital if that’s all accurate…

Telehealth ICU Sued for Death of Dental School Student - FindLaw

The parents of a UConn dental student are suing Yale New Haven Health over substandard tele‑ICU care in a wrongful death case. FindLaw explains.

www.findlaw.com

Interesting discussion indeed. Says he had a history of etoh withdrawal seizures. Had concerning objective findings for withdrawal. And article suggested he did not get pharm care earlier that could have been risk reducing. Was not clear in the chain who owned next step of care. Potential gaps in communicating the full caliber of his severity and/or getting a timely response on arrival/transfer of care. Lots of holes in the Swiss cheese. At the risk of sounding redundant, telemedicine can be very beneficial but it’s also really easy for those holes to gape. Which I argue is especially true for telemedicine.

 

[Sushirolls]

Well the future will be all ARNPs and its just a matter of which "specialist" will induce iatrogenic harm to us as we age.
Things are only going to get worse.

An approach to avoid doctors, historically viewed as poor, may actually be wisdom in coming decades as the "doctors" are worse than the disease.

 

[randomdoc1]

Well the future will be all ARNPs and its just a matter of which "specialist" will induce iatrogenic harm to us as we age.
Things are only going to get worse.

An approach to avoid doctors, historically viewed as poor, may actually be wisdom in coming decades as the "doctors" are worse than the disease.

You'll be thrilled at the vertical models that healthcare insurance companies are rolling out. United is the most notorious. I mean, I can see where a vertical model can thrive and help all. But knowing some companies, they use it as a means of abuse. Get lower trained professionals for cheaper. Keep a small panel of providers, collect premium money, put a bottle neck on a patient's ability to actually utilize needed care while premiums continue to roll in. Massive profit. Drive us out and try to outcompete us.

You know me by now. I'm just going to keep digging my heels in. Have my investments as a back up. Keep practicing good medicine when I want and how I want. Do some teaching. I'll see how the YT channel grows. I'm slowly trying to use that as a means to provide some patient education, ideally, it can scale what I contribute to the community so it's no longer tied to hourly time. And then...maybe talk some smack about insurance. I'm becoming an avid supporter of those who are making painfully honest documentaries about the dark behind the scenes of insurance. There are some local nonprofit insurance that use the model ethically. I praise that. But the unethical, makes me want to give the finger in 4k.

 

[Sushirolls]

Good goal.

But no one really cares about UHC and insurance issues.

My neck of the woods, we got a great non-profit, doctor established health insurance company. They don't farm out their calls to international call centers, you get real Americans on the phone, and they have good payments for doctors and I even had it for few years as patient, no complaints. Few chances to whisper in CEO ears of smaller hospitals and other businesses, they were not interested in changing over their employees and prefer either cheapest or a Blue.

Buffet has purchased UHC...
CEO was assassinated...
Lawsuits catch their fraud or other shady dealings...
Nothing is slowing UHC and its tendrils down.

The fastest way to universal healthcare is just let UHC take over, for those who are proponents (I am not one). No need to have government reinvent wheel, let UHC gobble everything up, then just legislate them into something more palatable.

 

[Ahamis]

I think it is unfair to compare ICU telehealth versus outpatient psychiatry telehealth.
Two different animals with very different risks.
Of course the risks of adverse effects are much higher with ICU telehealth.

 

[randomdoc1]

Well the future will be all ARNPs and its just a matter of which "specialist" will induce iatrogenic harm to us as we age.
Things are only going to get worse.

An approach to avoid doctors, historically viewed as poor, may actually be wisdom in coming decades as the "doctors" are worse than the disease.

I agree with most of it. I could almost be okay with UHC taking over. Minus the part where they prey on seniors (inappropriate, aggressive and misleading marketing paying brokers generous commission and then violating private data to unearth more seniors to prey on), take the funds from their careers of paying tax. Then when they get more frail, pressure them to sign dnr orders and use that to decline acute admissions or anything else that’s not outpatient preventative care. “Now that you’re older, please die asap so we don’t have to pay for your care. Thanks for the money”. They first degree murders in a fully scaled fashion!

 

[Merovinge]

Tele-ICU (or "teleintensivists") have been around for a while including at Kaiser (who have data on its benefits). Also telestroke neurology is a big thing. We're typically comparing this not to in person specialty care but in person non-specialty care. This kind of thing often grabs sensationalist headlines but from a negligence perspective, what matters is what a reasonably prudent teleintensivist would have done under similar circumstances. For the hospital, they need to be able to explain the reason for this model. Many hospitals don't have specialty or closed ICU care at all. Things like telehealth, asynchronous care, collaborative care, econsultation and other once novel models are about expanding access to care and it is very silly to argue against these when used appropriately. The access issues are only getting worse as the government deports physicians and the J1 waiver program (which allows foreign physicians to serve 3 years in an underserved area en route to getting their green cards after residency) have been affected by this $100k visa fee for H1-b visas.

From a malpractice for that specific doctor perspective, sure that's what matters. From a human and reasonable healthcare perspective, why the heck are we supporting a tiny ICU with tele-ICU coverage when the patient could be transferred a few minutes away to an appropriately staffed facility? These type of tele services are reasonable for rural communities where it meets a healthcare need. It's absurd in a highly resourced metro/suburban location that have plenty of doctors. I would be aghast if my family was sent to a hospital with a tele-ICU setup when a nearby hospital 15 minutes away had full service intensivists. And the exact thing we should be studying is in-person specialty vs tele-specialty care because that's exactly what the option is here.

 

[smalltownpsych]

Interesting case although I don't know if telehealth was as much the issue as how the handoff from ED to ICU was handled. At the hospital I worked at for a number of years, there was always communication between the hospitalist and the ED physician about the plan of care. I was directly a part of that planning and when patient had significant medical concerns, they tended to run their thoughts by each other in a collaborative way. If the ED just sent them up and no one picked up the ball, that doesn't look good. Also, makes me wonder if the ED did their job correctly too or did they just have a bed in ICU and needed a bed in the ED. Those pressures always exist, but good providers, and maybe being onsite helps too, ensure that the gaps are minimized.

 

[comp1]

The more I reflect on it, the more I am convinced telehealth had nothing to do with this and it's purely a sensationalization thing to help the case in the court of public opinion. I do agree that if there was a miss (completely unclear from what we know), it appears to be in the handoff.