A Death in the E.R. Raises Questions of Racial Disparity
FARAI CHIDEYA, host:
From NPR News, this is News & Notes. I'm Farai Chideya.
Forty-nine-year-old Beatrice Vance of Lake County, Illinois, visited her local emergency room in July. She had classic symptoms of a heart attack but she had to wait two hours for care. She died before her name was called. This month a coroner's jury didn't just cite the hospital, Vista Medical Center, it declared Ms. Vance's death a homicide. Lake County Coroner Dr. Richard Keller says he wasn't surprised by the verdict. He argues Ms. Vance should've been seen immediately.
Dr. RICHARD KELLER (County Coroner, Lake County, Illinois): They arrived in the emergency department at about 10:15. She was not called back, as they say, until about 12:25, so about two hours. Her daughter is indeed an LPN and was becoming increasingly frustrated as they sat there and she saw her mother appearing to get more and more ill. The daughter went to the staff at least five times that she recalls and asked for them to pay attention to her mother and to get her mother back and to get her mother care. And she did get frustrated enough that she really considered calling 911 to see if that would make an impact.
CHIDEYA: You were an emergency room doctor for more than 20 years. First of all, do you think that her life would have been saved by intervention if she had been seen 10, 20 minutes of walking in? And should she have been seen, would you, if you were there in that situation, immediately take care of the patient who was in condition like hers?
Dr. KELLER: Well, she certainly needed immediate care. There's no doubt about it. She should have had at least an electrocardiogram, a heart tracing, done within 10 minutes or so of her arrival. She presented with the classic symptoms. You know, at times it's not too difficult to shuffle someone with a-typical signs. You know, those complaints that don't necessarily only go with a heart attack.
But certainly somebody presenting with the story that she did should have been seen emergently, which is within 10 minutes. She also died of a heart attack that the clot-dissolving drugs were made for. She had a blood clot in the middle of her vessel, and had she been given those life-saving drugs, those clot-dissolving drugs would have saved her life. There's no doubt about it.
CHIDEYA: In this case a jury has charged hospital officials with homicide. Did you expect that outcome when you presented your report?
Dr. KELLER: It was certainly an option that we had considered. The case did meet the definition that we give to the jury in their instructions as to what a homicide is. But I think that it would have been equally as easy, if you will, for the jury to make an undetermined determination, which was one of the options that was available. You know, citing that they really weren't sure if the hospital, you know, should have been taken to task for this.
CHIDEYA: Explain to us exactly what those factors are that makes something a homicide that they were ruling on.
Dr. KELLER: The death occurs because of an intentional act or because of a reckless act by somebody else. And that can be either an overt action or the lack of action that results in somebody's death.
CHIDEYA: Now I personally haven't heard of a coroner's jury before. What exactly is that and how does it differ from, you know, I mean there's criminal cases, there's civil cases. What's a coroner's jury?
Dr. KELLER: The coroner system is a separate justice system from the civil and criminal court system. We do indeed hold inquests, which are trials with a jury of six. A case presented with testimony laying out the death investigation, all the information that was uncovered, and then the jury deliberates as in any other trial comes to a verdict or decision as to the manner of death.
CHIDEYA: What's going to happen next? Does this open the door, for example, to criminal prosecution and of whom?
Dr. KELLER: Well, we certainly have actually referred the case on now to at least three different entities. We have filed a report with the state's attorney, and the decision will be up to them whether there is criminal prosecution. We've also filed a report with the Illinois Department of Public Health, who oversees and regulates hospitals, as well as with the Joint Commission of Hospital Accreditation.
You know, I don't know that we necessarily want or desire - and actually I know that we don't desire necessarily a criminal prosecution. But obviously the system failed Ms. Vance in this case and we want to make sure that the system doesn't fail anybody else.
CHIDEYA: Let's put this in a larger context. First thing that comes to mind for me was that there was a study that came out a couple of years ago that said that doctors on average did not take the pain of African-American patients as seriously as the pain of white patients when, for example, prescribing pain medication. Is there a chance that those kind of determinations by medical professionals could have figured into this case?
Dr. KELLER: It's certainly possible that she was characterized in such a way that she may not have been taken as seriously as somebody else coming in. She had discussed with her daughter, you know, it was 10:15 at night. She was dressed as if preparing for bed. She was in a baggy T-shirt and some shorts, you know, it was summertime. And she had mentioned to her daughter that perhaps she should change before they go into the hospital.
So unfortunately I think that, you know, some of those things may have happened. Certainly, I've seen the studies that demonstrated that all ethnic minorities, quite frankly, don't necessarily get the same credence given to their story as Caucasian individuals. And unfortunately I think that that needs to be looked at as well. You know, was that a contributing factor?
CHIDEYA: Dr. Richard Keller, thank you so much.
Dr. KELLER: You bet. Thank you very much.
CHIDEYA: Dr. Richard Keller is the coroner for Lake County, Illinois.
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