FD: This is tragic. If he had health insurance, he could have gone to a better hospital in the area... but Parkland is the only facility that takes EVERYONE. I know. I have been there with my family for the past three years.
Long waits. When it costs NOTHING: TIME IS YOUR MONEY.
When you have universal or affordable healthcare paid with your tax dollars, then you can go to any hospital and maybe he would not be dead today.
Why do you pay taxes? Why not for healthcare?
Every major manufacturing country of OUR standard of living has universal or affordable healthcare for its workers, its children and mothers, and the elderly. We don't. We don't care enough to make it happen.
May that should CHANGE!
Long wait in Parkland hospital ER
may have cost ex-restaurateur his life
09:21 AM CDT on Sunday, October 5, 2008
By STEVE THOMPSON / The Dallas Morning News
stevethompson@dallasnews.com
Mike Herrera's pain was growing as he walked into the emergency department of Parkland Memorial Hospital on a recent Friday evening.
He checked himself in and told a nurse about the stabbing sensation in his abdomen.
Then he took a chair and began to wait.
One hour passed. Then another. The sun set and rose while he sat, waiting.
It wasn't until the 58-year-old collapsed in an exam room – 19 hours after he was admitted – that the staff seemed to spring into action, his family says.
But it was too late. He had suffered a cardiac arrest.
"Why did you all leave him there?" a nephew said as doctors tried to revive Mr. Herrera. "You let him die!"
Parkland officials say nurses and doctors did everything possible, but they acknowledge it's a problem when patients with symptoms like Mr. Herrera's must wait so long for care.
"There's nothing you can say except just apologize for this happening," Parkland's president, Ron Anderson, told reporters after the Sept. 20 death.
But had Mr. Herrera been seen sooner, Dr. Anderson said, he may have been treated and sent home – with the same final result.
Mr. Herrera's death follows years of warnings about excessive wait times in the emergency department of Dallas County's charity hospital, which serves the indigent and others without health insurance.
A 2004 study on the hospital – which noted two previous consultant reports – said wait times in Parkland's ER were so excessive that more than one in 10 patients left the hospital before seeing a doctor.
Since then, that ratio has increased to one in five. Officials say the hospital simply has too few beds for the crush of people needing care. The emergency department, where 81 percent of the hospital's patients are admitted, is a perpetual logjam.
Last year, patients admitted to the hospital through the ER waited an average of 12 hours and 42 minutes for an inpatient bed. This year, the hospital has shaved an hour from that time.
That is little consolation for Mr. Herrera's family.
"Why didn't you all help him sooner?" Rebecca Marquez asked a nurse, as her brother lay dying.
Severe pain
Mr. Herrera, who helped his family start a popular chain of restaurants that bears their name, struggled for years with diabetes, heart trouble and painful hernias. His family says he had fallen on hard times and did not have health insurance. He'd been to Parkland's ER for the hernias before.
On that Friday, Sept. 19, the former restaurateur checked himself into the ER at 5:17 p.m. using a touch-screen computer kiosk. There were 164 people there ahead of him.
MICHAEL AINSWORTH/DMN Mike Herrera, 58, died last Saturday after spending 19 hours waiting to be treated for four hernias at Parkland Hospital. His family (left to right) includes brother Jimmy Herrera, great niece Evan Marquez, nephew Edward Marquez, niece Cynthia Bonifaz, sister Rebecca Marquez and niece Elysia Marquez.
View larger More photos Photo store
At 6:13 p.m., he saw a nurse and described the pain in his abdomen as a 10 on a scale of 1 to 10. The nurse took his vital signs, which were normal, and labeled him "urgent" – a 3 on an emergency severity scale of 5.
Hospital staffers could not give him pain medicine until he was seen by a doctor, so Mr. Herrera's great-niece brought him some.
About 10 p.m., Mr. Herrera's brother and sister-in-law arrived and found him nearly asleep. He had half a bottle of water.
"Do you want me to get you another water so you'll have it?" asked his sister-in-law, Kathy Herrera.
"No," he said. "It hurts to drink it."
He told them they should go home.
"There's nothing you can do for me," he said. "I'll call you as soon as the doctor sees me."
The hours passed, and Mr. Herrera waited in his chair, according to his family and a surveillance video obtained by The Dallas Morning News . About 180 new patients came in – many with relatively minor problems like coughs and headaches.
Others arrived by ambulance and helicopter, including 17 in critical condition, more than double that of an ordinary Friday night, hospital officials say.
Victims of car crashes, heart attacks and a stabbing.
Patients lined the hallways in the ER – on gurneys because there weren't enough exam rooms for them all. Some sat in chairs while doctors examined them.
Not enough room
That cramped scene is not unusual for Parkland's ER. Built in 1954, the hospital as a whole now accommodates twice the patients it was intended to handle. The lack of empty beds forces patients to wait in the ER to be admitted, taking up space and the attention of ER nurses.
"I come in each morning now, and I can tell you there are about 18, 19, 20 patients down in the ER who've been admitted and have been there all night long, because there are no beds upstairs," Dr. Anderson says.
The 2004 study and Parkland officials agree that this problem, called "boarding," is a major culprit in excessive ER wait times. And experts say it is happening in every major city.
When Mr. Herrera checked into Parkland, 21 patients were boarded in the ER, waiting to go upstairs. The department has 78 beds in all.
Hospital officials have worked to ease crowding by moving patients in and out of rooms more efficiently. Another solution would be to build a new Parkland Memorial Hospital, a $1.3 billion plan that will go before voters in a November bond election. The proposed 862-bed hospital would give Parkland 28 percent more beds when completed in 2014.
While a new facility would ease crowding, hospital officials say it won't solve the problem, and they acknowledge that waiting six years to address the issue isn't an option.
But without somehow freeing up beds faster, there's not much the ER can do to ease wait times, says Jennifer Sharpe, Parkland's director of emergency services.
"Which is part of the reason why it's been like this for a while," she says.
'I need help!'
At 9:26 a.m., after sitting in the same chair for more than 13 hours, Mr. Herrera heard his name called. During that time, no hospital staffer had so much as checked his pulse. The hospital has no policy to reassess "urgent" patients.
A physician ordered lab tests and X-rays.
At 11:21 a.m., he told a nurse his pain had faded to a 6 out of 10, perhaps because of the pain medicine.
When his sister arrived at the hospital about noon, she says, she found him in an exam room alone, standing by his bed and throwing up into a trash can. A nurse came in and asked him to lie back down so she could give him an IV.
"I can't," he said. "I'm all cramped up."
Then he collapsed onto the bed and his eyes rolled back. He was in cardiac arrest. His sister screamed.
"I need help!" the nurse yelled. She and a doctor wheeled him to a critical care room.
The staff forced a breathing tube down his throat, shocked him repeatedly with a defibrillator, filled him with medications and pumped on his chest.
They worked for more than two hours, as family members wept. He was pronounced dead at 2:48 p.m.
A few days later, his 10-year-old son was among a dozen pallbearers who carried him to his grave.
Preventable?
The county medical examiner has determined Mr. Herrera's death was caused by clogged arteries, an ailment he'd been treated for at another hospital. Diabetes and morbid obesity were also listed as contributing factors.
Dr. Anderson, Parkland's president, who ran the ER for six years, says that the death may not have been prevented had Mr. Herrera been treated sooner.
"It's easy to be a Monday-morning quarterback," he says. "But in this particular case, as I put myself in that position, I'm not sure I would have done something different."
The family's attorney, Robert Hinton, disagrees.
"The guy wasn't going to die anyway," he says. "And even if he were going to die sometime soon, you shouldn't make him go through that misery, and inflict that misery on the entire family while he dies in front of you."
What is certain is that overcrowding in the country's emergency departments is killing some, says Dr. Arthur Kellermann, a nationally recognized professor of emergency medicine at Emory University in Atlanta.
"My hunch is that it happens several times a week in hospitals around the country and it doesn't make the paper," he says. "And that's just completely and totally wrong."
HERRERA'S FINAL HOURS
5:17 p.m. Sept. 19: Mike Herrera uses the automated kiosk in Parkland's emergency room to check in.
6:13 p.m.: Mr. Herrera is taken to a medical triage room, where a registered nurse takes his vital signs.
8:02 p.m.: Parkland staff visit with Mr. Herrera in the waiting room.
9:32 a.m. Sept. 20: Mr. Herrera is taken to an ER room.
10:00 a.m.: Mr. Herrera is seen by a physician and an exam is performed.
11:31 a.m.: Pain medication is given to Mr. Herrera.
About 12:15 p.m.: Mr. Herrera vomits. A physician and nurse evaluate him and order an IV.
About 12:20 p.m.: A medical technician starts an IV. Mr. Herrera collapses with no pulse or respiration. Resuscitation efforts begin.
2:48 p.m.: Mr. Herrera is declared dead.
SOURCE: Parkland Memorial Hospital
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