Deadly hazards of “urgent care”

Emergency medical transportation and urgent care were some of the great public health achievements of the 20th century. And they saved the lives of many otherwise healthy young people who still had years ahead of them. But today, hospital urgent care has been transformed into a frantically overloaded, assembly-line for too many routine “non-emergencies” that can crowd out the genuine crises.

Rory Staunton is a perfect example of this tragic state of affairs

One day last spring, 12-year-old Rory fell while in the school gym and scraped his elbow. No one, including Rory, thought anything more of the minor mishap. Later that night, Rory came down with what appeared to be a stomach bug. But his major complaint was of severe pain in his leg. Not knowing what to make of it, Rory’s mother did her best to soothe him. But the next morning, when Rory spiked a 104 degree fever, she took him to see his pediatrician. 

Despite a confluence of symptoms that should have raised a red flag (severe leg pain, blotchy skin, rapid breathing), his pediatrician somehow assumed it was nothing more than an intestinal bug. Nonetheless, she sent him to the NYU Langone Medical Center emergency room.

The E.R. doctors ordered lab tests. Which showed an alarming elevation in white blood cell count, the cardinal sign of a raging infection, not just an intestinal bug.  

In a child of his age, this finding might well be a sign of appendicitis and not an unusual super-bug. But either way, it indicated a serious problem that demanded immediate attention. Yet when these results came back, the E.R. doctors completely ignored them. In fact, they promptly sent Rory home with nothing more than a prescription for an anti-nausea drug.

Two critical days later, during which a swift dose of antibiotics may very well have been all the young boy needed, Rory’s body had become covered with blue streaks, and the barest touch made him scream in pain. The pediatrician advised going back to the E.R. where Rory was finally admitted to intensive care.

Then, and only then, did doctors finally realize that Rory was suffering from septic shock. Brought on by streptococcus bacteria. Which had entered his bloodstream when he fell and cut his elbow on the gym floor.

Doctors in the intensive care unit heroically tried to save his life. But the damage was done. And just two days after what should have been a minor tumble, Rory was dead.

Captain Cheslea “Sully” Sullenberger, the hero of the Hudson, was one of Rory’s idols. He read Sully’s memoir over and over again, and hoped to be a pilot himself someday. And perhaps the most poignant message to arise from this tragedy came from Sully Sullenberger himself.

“If something good comes from Rory’s death, it will be that we realize we have a broken system,” Sullenberger commented in The New York Times. “Patient care is so fragmented. For the most part, medical professionals aren’t taught these human skills that some deride as ‘soft skills.’ So there’s insufficient sharing of information and ineffective communication. Some in the medical field look upon these deaths as an unavoidable consequence of giving care. But they’re inexcusable and unthinkable.”

Very true. But, unfortunately, they’re not unusual.

From my work as a Medical Examiner, I can tell you that sending children home from the emergency room with fatal infections is far from a rare occurrence.

Pilot Sullenberger got it right that Rory’s death is “inexcusable and unthinkable.” But the cause is not just a “failure to communicate.” It’s also the dictates of “third party” insurance and government “guidelines” that now rule medical practice in this country. Which help load emergency rooms with routine matters, crowding out truly urgent medical crises. Mandates that effectively ration medical care—and can keep it from those who need it most.