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Seen by a PA, presumed ingestion and missed meningitis. Reserving any judgements as details are unknown. Lawsuit filed by family.

 

 

The husband of a Brooklyn woman who died of an untreated form of meningitis, slammed Coney Island Hospital with a lawsuit Thursday alleging that his wife was misdiagnosed as emotionally disturbed or suffering from an illegal drug reaction by "careless" and "negligent" medical staff.

 

Grisel Soto, 47, spent her last hours alive strapped to a gurney and prescribed anti-psychotic medication, while the lethal infection raged in her brain.

 

After she arrived in the emergency room last January, Soto was seen only by a nurse and a physician's assistant until she went into cardiac arrest several hours later, according to lawyer Sanford Rubenstein who filed the suit in Brooklyn Supreme Court on behalf of widower Jorge Matos.

 

http://www.nydailynews.com/new-york/brooklyn/coney-island-hospital-hit-wrongful-death-lawsuit-article-1.2659362

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It sounds like this is a case of the PA hearing the nurse's assumption and then adopting a confirmation bias toward the patient.  This is a classic medical blunder.  It's one I struggle with very often - nurse says, "Looks like shingles," so you walk into the room and expect to see shingles rash.  PAs, NPs, MDs, DOs cannot fall victim to this as evidenced in this case - it harms the patient. 

 

I've seen this many times and was thankfully taught by one doc through his fine example of resisting it even when it makes you unpopular. 

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Related, and I think but by the grace of God, when I was working in a busy Air Force ER, a patient was signed in as "migraine," The med-tech guy had done her vitals and all normal (temp 98.6 F),  When I went in to see the patient, she quickly stated, "Its one of my usual migraines but I have not had one this bad in years."  When I was doing her ophthalmological exam and had my hand on her forehead . . .  I noticed that she felt very warm. I went to the triage room and got the thermometer and took her temp (it was 40 C). She had meningitis (later proven by labs and LP) and I could have easily missed it because we were so busy and the diagnosis had "preceded" her via her own comments and those of the triage. I learned my lesson from that near miss and from then on, every time I see an acute headache (and I do this all the time) I certainly do an exam and temp even if they insist it is a typical migraine for them.

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I wonder what other clues were available?  I've seen several cases of acute psychosis from synthetic drugs from head shops like bath salts and such.  We had to take them down with haldol and ativan.  If the person really had illegally smoked synthetic drugs and that was given to me in the history, that is the horse I'm hearing hoof beats for, not meningitis the zebra.  Now if there was a nice 103 degree fever and a 20k white count, then that PA is toast, even though those can happen albeit rarely with the acute psychosis, you can't dismiss them.

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Anyone can miss meningitis.....anyone.  Heck, half the people who present with flu like symptoms could have it....gonna tap them all?   Fact is, that PA drew the short straw.  It's the straw that says....your fooked, the zebra is walking into your office today.  Just ask the doc who drew that same straw the day he went to work.....at Presby Dallas.....and saw a guy for N/V.......and the guy had Ebola..............................            

 

 

Pray the short straw doesn't come for you.

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Of course we don't know the whole story, but it's horrible to think of this woman in restraints and probably ignored when she was sick and dying. I'm not happy to see anyone being sued over medical malpractice, but it sounds like they have a case, and if it was my wife (and mother of my children) I know I would be mad as hell, too. I know these sentinel events are often the result of a perfect storm of systemic failures, provider overload, etc. - and I appreciate the sentiment above that it could happen to any of us, because it's important to remember the fine lines we sometimes walk - but I can't help but think, "jeez, didn't you guys get some labs?!"

 

Would be interesting to know more. Like, why did they attribute her AMS so readily to substance abuse rather than an organic etiology? Was she known by history to be a user? Was she using at the time, as evidenced by toxicology? Or were they just making assumptions? How long had this nurse and PA been on the job? What was patient volume that day? Too many unknowns to really get on a high horse and assign blame, but definitely a sad case.

 

EDIT: A little more background here. It sounds like the ME hasn't determined an exact cause of death and that she was suffering from some sort of infection and on antibiotics.

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Of course we don't know the whole story, but it's horrible to think of this woman in restraints and probably ignored when she was sick and dying. I'm not happy to see anyone being sued over medical malpractice, but it sounds like they have a case, and it it was my wife (and mother of my children) I know I would be mas as hell, too. I know these sentinel events are often the result of a perfect storm of systemic failures, provider overload, etc. - and I appreciate the sentiment above that it could happen to any of us, because it's important to remember the fine lines we sometimes walk - but I can't help but think, "jeez, didn't you guys get some labs?!"

 

Would be interesting to know more. Like, why did they attribute her AMS so readily to substance abuse rather than an organic etiology? Was she known by history to be a user? Was she using at the time, as evidenced by toxicology? Or were they just making assumptions? How long had this nurse and PA been on the job? What was patient volume that day? Too many unknowns to really get on a high horse and assign blame, but definitely a sad case.

 

EDIT: A little more background here. It sounds like the ME hasn't determined an exact cause of death and that she was suffering from some sort of infection and on antibiotics.

Shouldn't the nurse been equipped with the knowledge of prior infection, ear pain and antibiotic? Rn triage 101. There seems to be a suit here no doubt, but it seems fairly complex. Coney island...doesn't necessarily have the best track record either
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