Inquiry Into Reporters Death Finds Failures

[Guest]

ny times article

Inquiry Into Reporter's Death Finds Multiple Failures in Care

By DAVID STOUT

New York Times

WASHINGTON

June 16 — Firefighters, ambulance technicians, police officers and the nurses and doctors at a Washington hospital committed "multiple individual failures" in responding to the ultimately fatal beating of a journalist near his home last January, an official inquiry concluded on Friday.

Describing "alarming levels of complacency and indifference" in emergency medical care in the nation's capital, the District of Columbia's inspector general reported sloppiness and mistakes by almost everyone who initially responded to the lethal attack on David E. Rosenbaum, a retired reporter for The New York Times. Mr. Rosenbaum, 63, died two days after he was found lying semiconscious on a sidewalk near his home on Jan. 6.

A string of mistakes and inadequate training led to a collective and erroneous conclusion that Mr. Rosenbaum was drunk when in fact he had been beaten with a metal pipe and robbed, the inquiry found.

The assumption that Mr. Rosenbaum was drunk led ambulance technicians, police officers and the staff at Howard University Hospital to handle him with far less urgency than was necessary for a person with a serious head injury, it said.

The report said vomiting and other symptoms displayed by Mr. Rosenbaum were consistent with brain trauma as well as intoxication, and should have been recognized as such.

"Apathy, indifference and complacency — apparent even during some of our interviews with care givers — undermined the effective, efficient and high-quality delivery of emergency services," wrote the inspector general, Charles J. Willoughby.

The report, first reported in The Washington Post on Friday, did not speculate on whether Mr. Rosenbaum might have survived had he been treated better and faster.

But it did say that the failures pointed to a much broader need for oversight and better internal controls in training, certification, communications and standards for patient care.

Mayor Anthony A. Williams said reforms were under way. Howard University Hospital said it had put in place "immediate and ongoing measures" to ensure "the highest standards of emergency care."

The inspector general said emergency operators and dispatchers reacted properly when they received a 911 call shortly after 9:20 p.m. that a man, later found to be Mr. Rosenbaum, was lying on a sidewalk — but that almost everything that happened afterward was wrong.

Because Mr. Rosenbaum had been vomiting and smelled of alcohol, firefighters thought he was drunk and reacted with no urgency. An ambulance arrived late because the driver got lost. Then, instead of taking Mr. Rosenbaum to a nearby hospital, the ambulance went to the more distant Howard hospital because it was closer to the driver's home.

At Howard, the report continued, Mr. Rosenbaum was left unattended on a stretcher for far too long because nurses and doctors did not communicate well with one another and were slow to realize that he was gravely injured.

Finally, the police delayed in designating the attack site a crime scene because of the initial impression that Mr. Rosenbaum was drunk. The day after the beating, activity on Mr. Rosenbaum's stolen credit cards was reported, and two suspects were soon arrested.

The inspector general said the multiple failures "suggest an impaired work ethic that must be addressed before it becomes pervasive."

Marcus Rosenbaum, the victim's brother and a Washington resident, called the report "an excellent, thorough examination of what went wrong." He said the mayor should hold accountable not just "the people who were on the street and in the emergency room" but also the officials who supervise them.

"All of them hold life-and-death jobs," Mr. Rosenbaum said. "If they can't do them well, they should do something else for a living."

Inspector general report:

http://www.oig.dc.gov/news/view2.asp?url=r...d=0&month=20065

[Guest paramedico987]

While this article is GROSSLY biased and somewhat misleading it does allow us the opportunity to discuss an ongoing problem in urban EMS. It is easy to quickly render a presumptive diagnosis of acute ethenol intoxication (aka drunk) when we find a person (usually on the street) with an altered mental status, thereby leading to a sub-par course of evaluation and treatment. This is especially true if the patient has an odor of ETOH about him/her.

In this instance the EMS responders, starting with FD, made a few errors in judgement which may or may not have led to the patients demise. The presumption that the patient was a drunk, although incorrect, doesn't automatically make the crew wrong so long as he/she was treated in accordance to local protocol for AMS. The fact that the patient was transported to a facility which was "more distant" probably had little to do with the end result, however does demonstrate the degree to which this crew ignored the needs of the patient and underscores the point that this is a problem of attitude not skill.

NOW TO MY POINT... I believe that the report given to the ED staff by the EMS crew DID likely cause his care to be affected negatively. Not having been present I must simply speculate that thier report went something like "He's drunk" which could understandably lower a nurse or doctor's index of suspicion for any life threatening injuries. Had a report of altered mental status of unknown eitiology been given as the field impression then perhaps a CT scan would have been immidiately ordered by the ER doc.

It's easy to assume that people are drunk, but intil we have field ETOH meters that work like glucometers we can't take the risk, either for ourselvs or our patients, that their only problem is intoxication. (and even then I wouldn't be comfortable labeling people as drunk)