[vanillaface]

There wasn't a specific medical law section, so I hope I'm putting this in the right spot.

I'm doing a report and I'm having some trouble finding some cohesive information. The scenario includes an elderly woman having a heart attack and being ordered to have a procedure done. She has roughly six hours to have it completed for it to be effective. Before she is transferred to the surgical suite, another younger patient comes in suffering a massive heart attack and is ordered a procedure to be done immediately in order to save her life. The doctors realize they have two patients both needing use of the surgical room for similar procedures, and decide on the patient who came second. The procedure took longer than expected, exceeding the first patients 6 hour window, and the first patient dies waiting for treatment.

The parts of my report that I am struggling with are if it was acceptable to treat the second patient out of order of admittance, any ethical and/or legal issues, and whether the physicians should inform the family all of the details that resulted in the patient passing away waiting because another patient they deemed more critical needed the procedure first or give less details.

Any help would be appreciated.

[Fr_Chuck]

There is no requirement for patients to be seen first come/first serve, in case that is not ever the case in hospital ER.

The extent of their injury will be considered.

[DrBill100]

From the standpoint of medical ethics the decision to assign priority to the more critical patient rests on firm ground. It is the duty and responsibility of the physician to make such decisions. Triage.

The legal ramifications I will leave to those more qualified in the law.

[AK lawyer]

...
The legal ramifications I will leave to those more qualified in the law.

We here at the Legal AMHD have certain rules that we are asked to follow. One of them concerns homework. We can critique what you come up with, but cannot do it for you.

In research your answer, you might consider the statutory framework for whatever jurisdiction your hypothetical hospital is in. Pay particular attention to statutes concerning hospitals. I would also explore whether the elderly patient had some sort of a contractual right to "first come, first served" surgery.

[vanillaface]

In research your answer, you might consider the statutory framework for whatever jurisdiction your hypothetical hospital is in. Pay particular attention to statutes concerning hospitals. I would also explore whether the elderly patient had some sort of a contractual right to "first come, first served" surgery.

It was my belief that they had made the right decision in allowing the elderly patients procedure to be postponed since she had a 6 hour time frame, and the other patient needed immediate treatment and would not have been able to survive waiting for the elderly patient to go first. However, I wonder if the hospital could be liable for only having once such surgical suite available? If there was more than one surgical suite set up for angiograms and angioplasties, both patients could have had their procedures done at the same time - assuming the surgeons were available.

I feel that it is likely that the deceased's family could sue for wrongful death, but do not think malpractice would be at play. It's difficult for me to decide because I don't think the physicians were intentionally negligent and denying treatment, but just had to postpone it until the room & surgeon was available. When using the ethical-decision making model, I would have come to the same conclusion that the younger patient would go first.

[AK lawyer]

... However, I wonder if the hospital could be liable for only having once such surgical suite available? ...

Perhaps, if the hospital's certificate of need requires it to have more than one operating room.

In general, however, no. By that reasoning, a hospital would be required to have an infinite number of operating rooms, and operating teams, in the remote possibility that it would have an infinite number of patients needing immediate surgery.

[ScottGem]

Almost every civil suit is based on negligence. The defendant has to be shown to have acted in a negligent manner. So a hospital's not having sufficient facilities could only be shown to be negligent if there were studies that showed more facilities were needed to serve the community.

[J_9]

It was my belief that they had made the right decision in allowing the elderly patients procedure to be postponed since she had a 6 hour time frame, and the other patient needed immediate treatment and would not have been able to survive waiting for the elderly patient to go first.

In the ER we triage a patient in order to determine who is in need of treatment dependent upon severity of their condition. If the elderly person was stable, it is priority to treat the unstable person first.

I wonder if the hospital could be liable for only having once such surgical suite available? If there was more than one surgical suite set up for angiograms and angioplasties, both patients could have had their procedures done at the same time - assuming the surgeons were available.

This is dependent upon the level of care at the hospital involved. Was it a rural hospital or a metro hospital? At my facility we have NO surgical suites available for patients like this and they are shipped off to a hospital with a higher level of care.