A MEDICAL MISHAP
by Dr Michael Ellis

At the beginning of December 2001, while at home Dr Logan picked on a scab on the top of her foot to ensure that this wound was healing. Unfortunately she started to lose a copious amount of blood. She saw that she was hemorrhaging and called the ambulance before she fainted. She subsequently recovered consciousness in the ambulance to find that a tube had been placed in her mouth. The ambulance officer told her that she had lost over one litre of blood and that when they had come into the house, she was pulse-less.

She was taken to Monash Hospital Emergency Casualty and placed in a side room. She had persuaded the ambulance officer to take the tube out of her mouth to speak to him about what he had found and she had a drip put up from the time she was in the ambulance.

She saw the emergency doctor two and half hours after she had been admitted to casualty. When she was in her kitchen at home, she slipped on the blood she was losing and hit her eyebrow on the sink. She sat in the blood for some minutes and after losing more blood, she lost consciousness. As a result of this history, the emergency doctor arranged for her to have a CT scan.

While she was in the cubicle in the hospital casualty, she was given nothing to eat or drink and nobody offered to take her to toilet until she had asked three times. She was in the cubicle room in Monash Hospital Emergency from 11:30am - 6:00pm. During this time she had only three lots of observations in which her blood pressure, pulse and temperature were measured.

She was told by the nurse that they would not give her a blood transfusion because she was over the age of 80 and because her haemoglobin was within the normal limits. A hospital administrator came down to see her and told her that she could not be transferred to a private hospital because of the paperwork, laundry and personal care being too expensive for only one to two nights stay.

She says that when you are weak with blood loss, you do not feel like arguing. She says that she told this administrator that she lived alone with a dog and cat and that she wanted to go into hospital to be cared for, for one to two days as she felt so weak. Her comments were totally ignored.

She subsequently went to her daughters house. She had to go out of the hospital to her daughters car and walked out to the car park unaided. She felt so badly treated and cared for she felt she had been 'dumped'.

Dr Logan is very concerned and angry at the crudeness of the approach to her, not just because she is a doctor, but because she is a human being. She feels she was treated in an offensive and crude way. She feels she was treated carelessly and is concerned that other patients will also be treated in this manner.

Dr Logan has atrial fibrillatiion for two and a half years and is on small doses of Warfarin. Her INR is under good control.

Background:
Dr Olive Logan is an 83 year old doctor who has been in medical practice for 58 years having graduated from medicine at Melbourne University in 1943. She was initially in the public service for most of her life until the age of 65. However, since then for the past 19 years, she has been working in general practice. When in the public service, she dealt with mental health, turburculosis, general medical problems, paediatrics, and also worked in the school medical services.

Comment:
Dr Logan experienced extremely uncaring treatment. The differential diagnosis of loss of consciousness in this situation we have to rule out such causes as CVA, heart attack, and cardiac dysrhythmia because she has a history of atrial fibrilliation. That she was put in a cubicle and observed only three times in six and a half hours shows the degree of neglect that is occurring in our hospital system.

The hospital saw her as a liability and was not willing to give her a transfusion because she was too old, according to the nurse. Dr Logan states that she had noted contemporary newspaper comments at that time of a two week shortage of ORH+ blood, which is her group. It was also too inconvenient for the hospital to observe her over the next 48 hours despite the fact that she had lost a great deal of blood and was in a state of weakness and emotional shock. She also had top private health care since 1953.

It is well known that 16% of patients who go into hospital either come out worse or do not come out at all as they die from iatrogenic illness and hospital 'so called treatment'.

The Journal of the American Medical Association has published figures showing that Western healthcare is now the third leading cause of death in America.

But this is not a local problem. The British Medical Journal declares that in America alone, 199,000 A YEAR are being killed by errant medical procedures. In the UK, blunders by doctors are killing 40,000 a year. In Australia, 1 in 5 are being killed by their own healthcare, and in China, bad medicine is killing 200,000 every year, with 60-80% of China's 10 million deaf-mute cases related to the use of inappropriate medicine.

The Quality in Australian Health Care Study (QAHCS), published in the Australian Medical Journal in 1995, reported that 16.6% of hospital admissions were associated with an iatrogenic patient injury, termed an adverse event (AE) This compares with the rate of 3.7% for AEs in the Harvard Medical Practice Study (HMPS), and a rate of 17% in a more recent study with an alternative observational method of determining AEs.

Fifty per cent of the AEs in the QAHCS were judged to have a high preventability score (4 or more on a scale of 1-6 of increasing likelihood of preventability). The disability caused by these adverse events ranged from temporary disability (fully resolved in one month) in 46.6% of AEs, to death in 4.9% of AEs. Although recording AEs emphasises only the "complications" of rather than the benefits derived from healthcare, AEs are of great significance to individual patients as well as to the whole healthcare system.

This global medical catastrophe is growing worse with each passing year, but people are finally beginning to wake up and take action.

Dr Logan is available for confirmation of this story and can be contacted in Australia on (03) 9583 9894.
Medical Renaissance Group
E-mail: mindquest@ozemail.com.au