The Doctor Weighs In

Photo by Mark Boster, LA TimesThis story, from the Los Angeles Times,  is so outrageous I have to take a few deep breaths before I tell it.

Edith Rodriguez died in the ER…not on a gurney surrounded by doctors and nurses desperately trying to save her life. She died on the floor of the lobby, lying in her own blood as a janitor mopped up around her.

Jose Prado, her partner, tried to get the attention of Los Angeles’ King-Harbor ER staff, but he was ignored even though Edith was writhing in pain and spitting up blood as she lay on the floor. He called 911 from a pay phone only to be told “Paramedics are not going to pick…his wife up, from a hospital, because she’s already at one.”

An unidentified woman, perhaps another patient, jumped in to help. She also called 911. According to the LA Times, here is what took place:

“After a short debate about whether the call was an emergency, the dispatcher scolded her and insisted that it was not. The 2-1/2 minute call ended on a hostile note. ‘May God strike you too for acting the way you just acted,’ the frustrated caller told the dispatcher, just before 2 am on May 9. ‘Negative ma’am, you’re the one,’ the dispatcher responded before disconnecting.”

Edith Isabel Rodriguez died 17 minutes later. She died of a perforated bowel.

Ms. Rodriguez had sought care at the King-Harbor emergency room three times in the days leading up to her death. A perforated bowel leads to peritonitis one of the most painful conditions known to man. Each time, after she was seen, she was discharged from the ER with a prescription for painkillers. As an emergency physician, I am appalled that this diagnosis was missed – not once, not twice, but three times.

On the day before her death, rather than leave the hospital, she lay down on one of the benches in front of the main entrance. The police found her there and helped escort her back to the Emergency Room where she was summarily dismissed:

“A triage nurse told Rodriguez that nothing could be done to help her.”

I think what the nurse was really trying to say was that nothing would be done to help her.

This story shows a failure, not just of King-Drew hospital, but of the entire health care system. This story
King Harbor Hospitalhappens to be about a hospital in Los Angeles with a troubled history: The US Centers for Medicare and Medicaid Services has repeatedly found Martin Luther King Jr.-Harbor Hospital out of compliance with its minimum standards. In September of 2006, the hospital was informed that it had failed a critical inspection and that it would lose annual funding of about $200 million (more than half of its budget).

Rather, the failures here are much larger than any one hospital. It starts with our country’s refusal to enact universal health care coverage. Although it may seem like it saves money, at least in the short run, by not providing care to poor people, it does not. An analysis by the New America Foundation, in support of Governor Schwarzenegger’s universal health care proposal, shows that costs actually increase when large numbers of people are uninsured. That is because, most of the time, we don’t let people die - untreated - on the floor. Instead, we provide the care and shift the costs onto insured people – raising costs for companies and public entities that provide health insurance.

Then, there is the callous disregard for human suffering shown by the individuals manning the phones at the 911 station. I know these jobs are stressful, but arguing with desperate callers about what is and is not an emergency is dismaying.  But, missing the diagnosis of a treatable condition on three different occasions is inexcusable. Perforated bowel and peritonitis are not subtle conditions. Even in the busy, overworked and understaffed conditions of a county hospital, surely someone could have recognized that this woman was really sick.

And, finally, letting a woman die in a pool of blood in the lobby of an emergency department is nothing short of criminal. What did they think?…she was faking her symptoms?

If I had told you that this took place in the inner city of some third-world country, you probably would have clucked your tongue and thought to yourself: “How lucky I am to live in America.”

But, guys, this is America. This happened in Los Angeles, home to the rich and famous. This is a story that ought not to die. It should be cited repeatedly in the next months and years as we debate how we are going to -- finally --  reform health care in this country.

Edmundo Rodriguez, Edith’s 25-year-old son is quoted as saying “We know we have the responsibility to make sure justice is done for our mother. We just don’t want this to happen again.”

I say, the responsibility should not rest solely with Edith’s loved ones. It needs to belong to all of us. We all helped create the environment that led to this tragedy. And, so we all need to tell this story to our politicians and policy makers, over and over again.  We should not -- must not -- stop talking about Edith Isabel Rodriguez until we have fixed this terribly broken “system.”

Pat Salber, MD

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