The liver donor tragedy,
a case of post surgical negligence
Another striking illustration of this point is the recently publicized case of a fifty-four-year-old man who allegedly died because of post surgical negligence at a prestigious medical center in New York City. His wife charged that the people in control of the victim's post operative care "showed a depraved indifference to human life." The New York State Health Department investigated the matter and cited the hospital for the post surgical care, characterizing it as "inadequate and fragmented at best."
The man had been in good health when he went into the hospital to donate a portion of his liver to his younger brother. The next day he was dead. The wife related that her husband was exhibiting hiccups and nausea with increasing frequency and intensity. Then he vomited blood. There were a number of delayed responses from the nurses and one resident who allegedly did not seem concerned and did not appreciate the severity of the situation. Hiccups, nausea, and vomiting blood are classic signs of rupturing esophageal verices (varicose veins in the esophagus [food pipe]). There is increased pressure against the phrenic nerve, resulting in the uncontrollable hiccups. The usual cause is congestion in the portal vein (large vein drawing blood away from the liver). In any case, these symptoms were critical given that the surgeons had removed a portion of the patient's liver only a few hours earlier.
One remarkable aspect of this tragedy is the reported comment of the chief of staff. The Newsday reporter quoted him as having said, "We did what any ethical organization would do. We admitted that the post operative care was not optimal in this case and we have fixed it. . . . This is a quality institution. . . . I don't believe we should be measured by a single case in a single point in time." The problem with this statement is that even a single case of neglect by a contingent of nurses and doctors being apathetic toward a series of life threatening symptoms is exactly how one should measure the performance of a world-renowned hospital. It is highly unlikely that this apathy was an isolated incident that accidentally fell upon this poor fellow like a brick tumbling from a high-rise construction site. This endemic indifference and/or lack of basic knowledge was an indication of a deep-seated management infrastructure deficiency. The scariest part of the executive's quoted statement was "we have fixed it." This hospital manager seems to have missed the point in his zeal for protecting the reputation of a fine institution that pays him a six-figure salary. A young healthy man lost his life. He is gone forever. How does that get "fixed"? Moreover, this medical center had fifty-one malpractice cases pending against it on the New York State Supreme Court calendar as of May 30, 2002 (this does not include cases in discovery and those recently settled). Thus it was disingenuous to say that this was "a single case in a single point in time." This is an example of a hospital senior manager glossing over the real cause of the scandalous events in attempting to "fix" the institution's public image.
Despite that example, for the most part, hospital managers are well-educated, law-abiding, well-intentioned individuals. On the other hand, hospitals have evolved from a charitable institution type of structure relying heavily on donations to a cash-flow corporate culture relying almost exclusively on service revenues. Although profit motivation is not necessarily bad, the negative pressure of institutional budget deficits will send executives scrambling to cut costs and admit patients beyond total bed capacity. The overriding concern is that most hospitals experience cycles of cash-flow deficit because reimbursement does not keep up with overhead. This information, however, will only be useful if it teaches you how to differentiate a well-run hospital from one that should have a danger sign on the front door.