Not Predictable

By Jim McVeagh 17/01/2010

The Herald on Sunday contains articles on two extremely misfortunate deaths. The first is Lam Xuan Hu, a 24-year-old Vietnamese student who died when a wheel from a truck, traveling in the opposite direction on the freeway in Auckland, came adrift and crashed through a bus. This unfortunate young man, a recent arrival to New Zealand died the following day in hospital. The article portrays the whole incident as it is: a bizarre accident.

Contrast this with the article on the opposite page. Lynette Coulter, a former stuntwoman, died on 9th January after a near-drowning incident on 1st January from which she was successfully resuscitated. The Herald report clearly thinks something is amiss with the hospital’s treatment as the opening paragraph indicates:

A former television stuntwoman, whom rescuers spent 25 minutes reviving after a near-drowning on New Year’s Day, has died after she was sent home from hospital. [emphasis mine]

While this is a true statement, it is somewhat misleading. She was sent home 48 hours after admission. And in case you though I am just being paranoid, here is the comment from her brother on this issue:

“She was in intensive care one day and released the next. If she was in hospital it’s likely their monitoring would have picked up that she was getting sick,” said Craig.

The implication being that a longer spell in the hospital might have saved this poor woman’s life. While this is superficially true, it should be pointed out that such a delayed onset of symptoms is quite uncommon. Normally a patient with near-drowning who survives the first 48 hours does well. There is nothing untoward or abnormal at all about discharging a near-drowning patient from hospital after 2 days. The time line seems to be:

  • Jan 1   Resuscitated after a near drowning episode – admitted to ICU in the afternoon
  • Jan 3   Moved out of ICU in early hours – discharged from ward in the afternoon
  • Jan 5   Started to become delirious at home.
  • Jan 8   Readmitted to hospital
  • Jan 9   Died.

At first I thought that perhaps the hospital had not discussed the possible complications of near-drowning and the signs of a late pneumonia, but the family say:

“They released her after talking about the risk factors of a near drowning.”

So the discharge was done properly.

Don’t misunderstand here, I am certainly not trying to lay blame on this poor family for not recognising subtle signs of pneumonia. But the hospital did everything that it should have done, as far as I can tell from the Herald article. This unfortunate woman’s death is almost certainly due to a set of circumstances as rare as those that killed Lam Xuan Hu, yet, because it is a medical death, everyone automatically looks to blame someone – usually the hospital.

The problem with this “medical blame syndrome” is that it often results in bizarre policies from the hospital administration and even more bizarre policies from the government. In this case, I would envisage a hospital policy of a minimum length of stay of 4 days for near drowning or, possibly an extremely detailed, unwieldy discharge process. Government may insist that no-one is discharged within 48 hours of being transferred from ICU. Hopefully, any problems at hospital level will be dealt with by sensible changes of process, rather than blanket diktats.

It should have been clear from the time line that this was unlikely to be a hospital based cock-up. Once again the MSM prefer sensational innuendo rather than common sense. But the price for their page three sensationalism may be increased costs and compliance in an already stretched hospital system.


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