ITHACA, N.Y. — Cayuga Medical Center officials said that a patient who died in the hospital's emergency room waiting area on Jan. 19 resulted in procedural changes within the hospital and the termination of a nurse's contract. They say the nurse falsified and never checked the patient's vital signs.
The death of the 52-year-old man happened after the Ithaca Police Department and Bangs Ambulance were called to a convenience store where the man was reportedly sleeping. He initially declined treatment but eventually consented to be transported to Cayuga Medical Center where he arrived around 6:07 p.m, hospital officials said.
When he arrived at the hospital, however, he was triaged at a level 4.
Doctor David Evelyn, Vice President of Medical Affairs at CMC, said all patients who are admitted into the emergency room are triaged on a scale of 1 - 5, with a level 1 being given to a person with the most severe symptoms. A person suffering from a heart attack, for instance, would be triaged as a level 1. A person with a sprained ankle might be triaged as a level 5.
Part of the triage evaluation includes recording one's vital signs, noting complaints from the patient and evaluating physical symptoms.
John Turner, Vice President of Public Relations at CMC, said patients have the right to refuse to have their vital signs checked and nurses are supposed to note that issue. The patient, officials said, is already alleged to have declined treatment from emergency personnel who responded to the convenience store.
Whether the nurse followed the procedure to record the man's vital signs is being contested.
Evelyn said the patient can be seen in surveillance videos being wheeled into the waiting area around 6:10 or 6:11 p.m. He would have been in a private area — which is not under video surveillance — with the now-fired nurse for about three minutes. During that time an eyewitness said the nurse did not check the man's vital signs. She also does not check his vital signs in the emergency room or take him to the private triage area again, the video allegedly shows.
Evelyn said the man was able to stand from a wheelchair and transition into a seat in the waiting area of the emergency room. Then, at 8:23 p.m., the nurse went to take him to the back area. He did not have a pulse and efforts to resuscitate him were unsuccessful. He died in the emergency room.
For a person to die in the waiting room of a hospital is rare, officials said.
"It hasn't happened here in probably, ever, that we know of," Evelyn said, though he said people with critical medical conditions or injuries sometimes die at the hospital or on a gurney while they are rushed into the emergency room.
An investigation was launched into the incident. Hospital officials interviewed the ambulance crew, nurses (There were about eight on duty the night of the death.), patients who were in the emergency room at the time, and the surveillance cameras in the emergency room were reviewed. When the timeline of the incident was pieced together, officials became suspicious of the primary nurse's account of the incident.
"It appeared to us that there was a discrepancy between that story that the triage nurse was giving us and what we can see on the tapes," Evelyn said. "We were able to determine that the triage nurse did not take vital signs, even though there were vital signs in the record."
In addition to no video evidence showing that vital signs were taken, the machines used to take vital signs automatically upload the information to "the cloud" where it's loaded into medical records. Hospital officials said there is no record of the digital recording either.
Taking a patient's vital sign when he or she is admitted to an emergency room is considered standard care and would be expected at any hospital, said Deb Raupers, vice president of Patient Care Services at CMC.
The nurse -- who is a travel nurse and not a full-time nurse at Cayuga Medical Center -- was placed on suspension while officials investigated. Then, her contract was terminated after hospital officials determined that she falsified the man's medical records.
Raupers said there is no evidence, thus far, indicating that the nurse falsified other medical records in the past.
In addition to the internal investigation, Evelyn said the death was reported to the Department of Health and the Office of Professional Discipline, an investigative arm for nursing licensing.
Speaking in broad terms and not about this case specifically, Evelyn said the Office of Professional Discipline can instate one of three options if they find that the nurse behaved inappropriately. The agency can suspend her license, revoke her license, or suspend her license but allow the nurse to practice under very controlled circumstances.
John Rudd, President and CEO at CMC, said, "This is kind of a defining moment for us and I view it as: there were clearly decisions made at the individual level that were very inappropriate and reckless. But we also have to look and say, 'What are some the systems issues could have allowed that to happen?'"
He and Raupers said long-and-short-term changes have been put in place to improve the way the Emergency Department (ED) operates.
Some of the changes include:
- Nurses were "re-educated" about the CMC triage policy
- An assigned triage nurse will cover the triage area at all times.
- Periodic monitoring and reassessment of patients in the emergency room waiting area.
- Group "huddles" which are now used as communication techniques between Emergency Department nurses to evaluate the needs of patients the ED.
- CMC will work with regional EMS to ensure that patients are properly admitted into the ED and that all procedures are followed.
- Four work teams new work teams were created to target the different needs of the ED.
- An escalation procedure that determines how nurses should handle high-volume situations in the ED.
- An external consultant will be hired to evaluate the Emergency Department and determine if additional improvements should be made.
Previously, Cayuga Medical Center has been involved in a dispute with several nurses, some of whom say that the Emergency Department is understaffed to the point of being unsafe. CMC has denied these claims and hospital officials said the number of nurses on duty is not at all related to the man's death.
"A nurse that falsified documentation and said she cared for a patient is why this patient died," Raupers said.
Hospital officials said they are not making the surveillance video available to the public or for reporters to view, but said the Department of Health has the video as part of their investigation into the death.
The name of the nurse and patient are not being released.