Waiting on a mule deer crossing…
Editor: In his letter in the July issue (“ED Death Not a Homicide,” EMN 2007;29[7]:33), Dr. Michael LoGuidice assumed that I am a pathologist, but in fact, as stated in my previous letter (“Death Due to Negligence is a Homicide,” EMN 2007;29[5]:35), I am a board certified and practicing emergency physician who also happens to be the Aspen/Pitkin County coroner. In contrast to Dr. LoGuidice's understanding, I am not ignorant of the issues facing emergency physicians, and I am fully aware of the difficulties in evaluating patients with chest pain. The original article I responded to was about a patient with a classic cardiac presentation being sent to the waiting room where she died. It was not an atypical presentation. The legal definition of criminal negligence in Colorado is the failure to do what a reasonable person would do in a similar circumstance. If that failure to do the right thing results in death, then that would constitute criminally negligent homicide. So if Dr. LoGuidice or someone he cares about presents to an ED with complaints of substernal chest pain and pressure with diaphoresis, dyspnea, etc., is triaged to a waiting room, would he think a medically trained triage person had acted reasonably? Of course not, and that is all I was trying to point out. For an ED to miss a classic cardiac presentation like the one in question would be like a pilot taking off on the wrong runway and crashing. It's not just a mistake; it is negligence. As medical professionals, we are expected to act reasonably, not miraculously. There is and should be, however, an expectation that we will not miss the obvious. If we fail to act reasonably in something as obvious as this case, then we may very well step over the line from a mistake to criminal negligence. J. Steve Ayers, DO Aspen, CO Dr. Ayers is also the chief of staff at Aspen Valley Hospital.
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