Truth and Consequences?

Posted by Kendall Harmon

Howe had been drinking in Denver with friends. At 2:30 a.m. she was riding in a "rickshaw" in LoDo, stood up, fell backward and tumbled to the sidewalk, hitting her head. The 34-year-old mother of two lost consciousness. A Denver Health Medical Center ambulance was sent to 20th and Wazee streets.

Howe, who had cut the back of her head, was "acutely intoxicated," according to hospital records, with a breath alcohol level measured at 0.216. The reports show Howe was uncooperative with emergency department personnel and was tied down.

But according to Howe's complaint, she was not seen by a doctor until 7:50 a.m., more than five hours after she arrived. She was eventually examined by Sooch, but Howe says the doctor did not order X-rays, an MRI or a CT scan of her head, nor was she admitted to the hospital. Sooch treated the cut on her head and in his discharge instructions, prescribed Tylenol, facts verified by medical records. Dr. Sooch, on the hospital discharge sheet, had these instructions for Howe:

"Do not abuse alcohol. Do not get drunk and fall causing harm to your head or body. Apologize to your family, friends and ED (emergency department) faculty for your extremely inappropriate behavior and rudeness while intoxicated. Be a great mother to your kids."

The instructions were "intentionally cruel and hurtful," according to Dr. Greg Kane, who was asked by Howe's lawyer to evaluate her care. "The written discharge instructions . . . served no medical purpose, but were instead cruel and snidely vicious - intended only to humiliate and cause psychological injury."

Read it alll.

Filed under: * Culture-WatchHealth & Medicine

30 Comments
Posted May 29, 2007 at 5:01 am [Printer Friendly] [Print w/ comments]



1. Tom Roberts wrote:

That is the type of article in which a photo of the subject “victim”, and presumeably the resulting scar, would be great to see. Interesting fact is that the word “sutures” is nowhere mentioned. I’d also like to see the trauma center’s list of other patients that night. I’d suspect the usual list of near death experiences which would make this hoyden a less than critical case.

May 29, 6:54 am | [comment link]
2. Larry Morse wrote:

Inntentionally cruel and hurtful.
Naughty Dr. Sooch. You bad person, Dr. Sooch. Telling this drunk such hurtful things. Oh naughty,. naughty, insensitive Dr. Sooch!  LM

May 29, 7:21 am | [comment link]
3. Paula Loughlin wrote:

Any head injury should be treated as a serious one.  According to the report no xrays, ct or MRI was given.  It does not say if they tried to do a basic neuro exam but given the patients condition I doubt she would have cooperated with one.  Making it especially important for her to have at least an Xray.  Waiting 5 hours to see a doctor is typical but inexcusable.  (Hint if you go to the ER even if you have a bone sticking out claim you have a history of heart trouble and are having chest pains- you might get seen STAT)

The discharge instructions to not abuse alcohol are legitimate since alcohol abuse is I think a valid diagnosis.  As for asking for an apology for belligerent behavior it would have been better to refer her to a therapist or pscyhologist.  The discharge notes should reflect legitimate medical concerns. 

All patients are have the right to the same standard of care.  Even when it takes extraordinary measures such as tying the patient down or sedating them. 
The doctor erred but it sure is not an error worth a suit.  But the hospital should make all providers aware of the dangers of adding personal remarks to patient records.

May 29, 8:46 am | [comment link]
4. Summersnow wrote:

Sometime I find it most helpful to read the original article:

Howe went to an urgent care clinic two days later where doctors transferred her to Littleton Adventist Hospital. The diagnosis included a hairline skull fracture, closed head injury, and possible traumatic brain injury. She spent two days in the hospital.

Drunk and beligerant or not, the woman was seriously injured and needed care.  The Dr.‘s bias (justified or not) got in the way of good medical care.  The proof is in the way the hospital in question so quickly decided to settle the intent to sue with the patient.  Obviously upon review, the hospital decided that the patient had a good case.  I only hope Dr. Sooch was also advised that his diagnosis and remarks, while heartfelt, were not good medicine.

s.j.engelhardt

May 29, 8:47 am | [comment link]
5. RoyIII wrote:

Sounds like she is a garden variety drunk blaming others for the “bad luck” she has while drunk.  Sounds like they treated her adequately.  That is actually good medical advice.  Alcoholism is a disease, and this woman needs treatment for it.  What is wrong with her head today?  She will not admit she’s powerless over alcohol and that her life has become unmanageable, that’s all.  God bless her and heal her spiritual disease.

May 29, 9:00 am | [comment link]
6. hyacinth wrote:

Truth?  Consequences?
Is there a subtle or perhaps not so subtle message in this title?

Fact:  The patient’s drunken status in NO WAY diminishes the doctor and hospital’s duty to treat the patient with respect and dignity, offering her the appropriate medical care. 

The doctor and staff’s personal biases interfered in their judgement to provide prompt and appropriate care, evaluating the patient’s head injury and assessing the possibility of an underlying and more serious injury.  They failed in that duty.

In my state, this would go to the office of professional misconduct as well as the department of health and be deemed negligence and substandard care endangering the life of a patient.

While healthcare providers are tested and tried in many ways in emergency rooms by both major and minor complaints (70% of ER visits are for non-emergency problems, crowding and overburdening a frail system) their duty is to properly diagnose and treat the medical condition which brought the patient to them. 

This hospital and its staff failed miserably at fulfilling this duty.  It is why they promptly settled.  Kudos to the patient and her attorney who recognized that this case would have burdened an already overburdened court system and agreed to settle.

Consequences:  Hopefully other patients seeking care from Denver hospitals will know that despite any issues which might raise bias and the impulse to deliver substandard medical care as a meter of judgement will not be tolerated in Denver.  I applaud this patient for what she did. 

Truth and consequences?  Are we supposed to excuse the inappropriate behaviour of the medical personnel because the patient brought her injury upon herself by her excessive drinking?  I would suggest we should all receive the same metering for other medical conditions brought upon us by our poor choices in health habits. 

Yes many medical conditions are brought upon us by our inappropriate choices.  Few could be so poignant as this patient’s case.  It does not, however, give license to healthcare provider to ignore their duty to care or respect. 

Slightly edited by elf.

May 29, 9:00 am | [comment link]
7. robroy wrote:

s.j. englehardt, I disagree with your diagnosis. The article’s medical “facts” are from the client’s lawyers. Possible close head injury is just what you write to justify admission. I am skeptical of the “hair-line” skull fracture diagnosis as well. Having read many skull plain films and head CT scans, there are always linear opacities. Unfortunately, one can find radiologists to call them “hair-line skull fractures” in a court of law. The standard of care for intoxicated patients is to check for signs of trauma, let them sleep it off, give them a neuro exam, then let them go. Not all drunks need head CTs.

That being said, the nature of trauma medicine is delayed diagnosis. After the patient you have repaired taken the bullet out of the chest and sewn up the myocardium and spent a week on the vent, the patient wakes up and complains of a hurting wrist and you diagnose the wrist fracture.

Did the patient suffer from not diagnosing “possible CHI and TBI”? No. Hairline fracture? No. Being told to be a good mom? Obviously, yes!

The fact that the hospital settled shows how very much in favor the legal climate is towards inappropriate lawsuits, not that “bad medicine” was practiced.

May 29, 9:40 am | [comment link]
8. Summersnow wrote:

Robroy,
I again refer to the original article.  The “diagnosis” was made by Littleton Adventist Hospital—not Ms. Howe’s lawyer.  I assume that Littleton Adventist Hospital is an excellent medical establishment.  It seems that they performed the tests necessary to make the correct diagnosis.  I fully agree that Ms. Howe was drunk and, according to the article was uncooperative.  Having worked as an intake technician for a Drug/Alcohol treatment facility I fully understand, firsthand, how uncooperative a drunk can be.  Nevertheless, the original doctor failed in his duty to at a minimum to perform simple tests that may have lead to a different diagnosis.  Instead, it appears that he worked from assumptions and bias and sent her off with a written scolding.  Unfortunately while it may have given him a momment’s satisfaction, it caused his good name to have a professional mark against it while giving the patient cause to file charges against the hospital.

s.j.engelhardt

May 29, 10:18 am | [comment link]
9. Jim the Puritan wrote:

In the old days they would throw you in the county jail to sleep it off.  Now they send you to emergency and let you sue when your feelings are hurt.

May 29, 10:47 am | [comment link]
10. Anonymous Layperson wrote:

Speaking as someone who works in the medical field- the discharge instructions were simply embarrassing.  However one may feel about the value of the “advice” given, it was unprofessional.  A lecture to the patient has no place in discharge instructions.  The patient perhaps deserved an apology but certainly no monetary damages were warranted.

May 29, 11:26 am | [comment link]
11. Irenaeus wrote:

Sounds like the emergency room doctor did poor diagnosis here and let his disapproval of Howe’s intoxication color his medical judgment.

At this point we don’t know the number and seriousness of the other trauma cases the doctor had to deal with. Nor do we know whether Howe’s intoxication and demeanor might reasonably have affected the priority she received relative to other patients.

But the assertion that the discharge instructions were “intended only to humiliate and cause psychological injury” is implausible.

May 29, 12:27 pm | [comment link]
12. robroy wrote:

As I said, not every drunk needs a CT scan. Yes, it is a “simple test” but an expensive one about $500. There are alot of drunks in the ERs, especially at Denver General. With reasoning like s.j.‘s, it will become the standard of care (read defensive, CYA medicine) for all drunks to get a CT, and we will all foot the bill.

Also, as I said, “possible CHI and TBI” is non-diagnosis diagnosis. It is what I write on a admission form or CT request form. The patient did not have them or presumably the lawyer would be crying to the hills.

Please re-read the discharge instructions. That is a verbal scolding??? I can’t imagine it being more innocuous.

May 29, 12:38 pm | [comment link]
13. Irenaeus wrote:

Sounds like the emergency room doctor did poor diagnosis and let his disapproval of Howe’s intoxication color his medical judgment.

But at this point we don’t know the number and seriousness of the other trauma cases the doctor had to deal with. Nor do we know whether Howe’s intoxication and demeanor might reasonably have affected the priority she received relative to other patients.

In any event, the assertion that the discharge instructions were “intended only to humiliate and cause psychological injury” is implausible. Someone with 0.22% blood alcohol is (as I understand it) drunk as a skunk and should be admonished not to abuse alcohol. And if Howe did behave in such a disorderly manner that the emergency room personnel needed to physically restrain her, she owed them an apology (even if the doctor’s discharge instructions were not the place to make the point).

(BTW, I wonder whether the doctor’s cultural background will, overtly or covertly, become an issue in this case.)

May 29, 12:44 pm | [comment link]
14. RoyIII wrote:

Well, we certainly do not want to hurt thhe drunk’s feelings.

May 29, 1:52 pm | [comment link]
15. hyacinth wrote:

Robroy said:
“Sounds like she is a garden variety drunk blaming others for the “bad luck” she has while drunk.”

Robroy, I would suggest your bias colors your read of the facts.  Assuming your read of the medical events are as you present them, the ER doc behaviour (not medical judgement) was inappropriate.  Again in many states, state review boards would raise questions regarding whether or not the acceptable standard of care was met.  I would suggest most review board would say it was not.  The fact that the patient did or did not have a hairline fracture is irrelevant to a review board as opposed to a court of law. 

This hospital knew the behaviour of this doctor was inappropriate and promptly settled the suit.  This physician’s behaviour is embarrassing to the profession.  I recognize the profession takes a lot of abuse from ungrateful members of the public.  THIS is not the physician behind which you want to be rallying that flag.  I too would have advised a quick settlement.   

For those with little sympathy for the patient, think of the foolish things many of our kids do on prom nights.  Irregardless of the silly drunken stupor a son or daughter may be in, if this had occurred to my child, I would expect the same standard of care for my child as that used for a sober one.

May 29, 1:53 pm | [comment link]
16. Anonymous Layperson wrote:

Apologize to your family, friends and ED (emergency department) faculty for your extremely inappropriate behavior

I’m rather shocked that some feel the above order to apologize is appropriate for discharge instructions.  I have no problem with the ER doctor telling the patient she owes an apology for her behavior, but to put it in the medical record as “instructions” is not kosher- as the hospital quickly agreed.

0.22% blood alcohol is (as I understand it) drunk as a skunk

The tolerance of chronic alcoholics to alcohol is astonishing.  I recently testified in a court case (I’m a toxicologist) involving someone who came to work with a blood alcohol of 0.35%.  The individual was able to function and suspicion was only raised by the odor of alcohol.  I’m sure I would be in a coma long before reaching that level…

May 29, 2:03 pm | [comment link]
17. Pat Kashtock wrote:

es, I would think that with an obvious head impact, they would have ordered a CT scan to be on the safe side.  I am not sure that head trauma always shows up immediately, though.  Our daughter’s did not always show on the scans the first day.

As for the instructions—as angry as she is over them, they may be the very thing that saves her life in the future, should she allow those words to truly get to her.  That is not being unsympathetic.  She had gone way over the top in alcohol consumption.  Having her actions put down onto paper where she sees them spelled out in the cold light of day may be the one thing that gets to her and cuts through the common denial.  She has children.  I pray she live long enough to see them grow up.  Continuing in the behavior described by the paper could make that less likely.  The doctor’s words are similar to those by some judges I have seen.

May 29, 3:27 pm | [comment link]
18. Larry Morse wrote:

Funy, but Sooch’s remarks struck as exctly what this woman needed. She needed someone to point out to her where she ws going and what she must do. Unprofessional advice? Only if you assume that a doctor never speaks anything but medspeak. I assume that a good doctor will tell the entire truth as he sees it,when the patient’s entire welfare is considered.

The suit’s a different matter. Did someone utter the words “rampant greed”? LM

May 29, 3:52 pm | [comment link]
19. Summersnow wrote:

With reasoning like s.j.’s, it will become the standard of care (read defensive, CYA medicine) for all drunks to get a CT, and we will all foot the bill.

For better or for worse, this standard of care is already in place.  Thank you, Lord that Ms. Howe that was not more seriously injured.  It would not have been found in a timely manner and if more serious damage had occured, you can bet that the family would have sued for far more in damages than was probably settled out of court.

I was taught from the time I was little, that two wrongs do not make a right.  Ms. Howe chose to drink to excess and that lead directly to her injury.  That was her wrong.  Dr. Sooch behaving in a less than professional manner and venting his displeasure in so personal terms was his.  Unfortunately such actions will lead to more “CYA” care, without any help from someone with such little influence on our health care system as myself.

May 29, 4:58 pm | [comment link]
20. hyacinth wrote:

Larry,
No I don’t think anyone uttered “rampant greed”.  I agree with you that the woman needed someone to point out to her recklessness.  Doctors are indeed charged with such moral duties.  Indeed I suspect he did feel that he was telling her the entire truth for her own welfare.  As one who has sat on review boards, I can state this doctor carried out this duty in an unprofessional manner.  Perhaps it seems unfair but the duty of state boards is to assure the public among other things, that when they are treated by healthcare providers, they are entitled to appropriate care without fear that a provider’s personal bias will in ANY way alter the quality of care they deserve. 

This physician’s approach is the very reason why so many patients lie about their behaviour to doctors.  They are fearful that the doctor will judge them rather than help them deal with their problem in doing what’s in their best interest.

May 29, 5:13 pm | [comment link]
21. hyacinth wrote:

Well said, summersnow!

May 29, 5:14 pm | [comment link]
22. Sarah1 wrote:

RE: “This hospital knew the behaviour of this doctor was inappropriate and promptly settled the suit.”

The settlement actually means very little about what the hospital believes about the behavior of the doctor.

Hospitals and insurance companies routinely settle cases regardless of whether they believe the physician at fault—because jury trials are death.  Juries are always willing to give money to the poor person who is injured and needs help, especially if they can take it from the greedy insurance company.

One of my family members who is a physician actually searched long and hard to find an insurance company that did not make it an *automatic* practice to settle claims.

May 29, 6:03 pm | [comment link]
23. Paula Loughlin wrote:

We may dissaprove of this woman’s excess alcohol consumption and her uncoopertive behavior.  I sure do and pray that she gets treatment for her alcohol abuse before she kills herself or someone else.  But she received head trauma which should always be regarded as serious till proven otherwise.

The treatment she received or,  more to the point, did not receive is inexcusable.  All persons the poor, the drunk, the homeless, the addict, the prostitute, the drug dealer,  the uninsured have a right to at least a minimum standard of care.  No not everyone should have extensive battery of tests or needs to be seen STAT.  But one can not separate the deserving from the undeserving when treating patients in the ER.

She is one of the least of these of whom Christ speaks.  We want to turn away or chastise her with anger not love.  We say thank God I am not like that.  Forgetting all our own follies that could lead to injury or death.  Spiritual or physical.  We do not see ourselves, our children, our spouses,  our family and friends.  We only see a stranger who is no concern of ours.  “Serves her right,  that will show her and stupid drunk are our reaction” 

But who would Jesus see if she came before Him.  If she cam before Him drunk, injured, angry and fighting.  He would see the image of God the very flesh of which He became incarnate.    It is often very difficult for us to do the same.  But that is what Christ calls us to do.  I have failed too often in this,  but with the help of God’s grace pray to avoid doing so in the future.

May 29, 6:25 pm | [comment link]
24. hyacinth wrote:

Sarah,
NO ONE in the industry automatically seeks to settle.  Secondly, 70% of lawsuits against physicians are won by physicians.  When a hospital or physician settles, its because the malpractice carrier has had an independent physician claims reviewer determine that they can not reasonable expect to win the case on the merits of the facts in the record.  This does not always mean the physician or hospital is wrong.  Often, the medical provider has merely done a poor job of documenting the facts which would have saved his/her hide.  In the case presented here, it would have been better for this physician to have done less documenting!

May 29, 6:41 pm | [comment link]
25. Tom Roberts wrote:

To add to #24’s conclusion, the ironic approach which would have been praised by all but the insurance company would have been to keep Howe in the hospital until she was competent to receive proper treatment, and then add test on test and plastic surgery to boot. But all this second guessing what should have happened ignores the simple fact that no material harm came of the treatment Howe received and that the diagnosis of a cranial hairline fracture was the only substantial thing that Sooch missed.
From the article we can only guess what sort of material lack of cooperation led Sooch to miss the need to XRay the patient. Perhaps Howe refused (while tied to the ER gurney) to have that test done until two days later? We don’t know from this article.
But we do know one thing: the second diagnoses were made two days later. So if there was a huge problem, what prevented Howe from sobering up and going in the next day, if matters were “urgent”? But at that point it became in everybody’s interest to treat Howe in the maximum mode, which as I point out above is what Sooch should have done to pad up the bill on the binge night.
My last observation is that Kane is not an unbiased source, being paid by Howe to say what he says. I’m not saying he is wrong, just that he’s a paid expert to augment Howe’s complaint.

May 29, 8:27 pm | [comment link]
26. Rob Eaton+ wrote:

Reading Dr. Sooch’s comments, I immediately thought of the main character of the TV series “House”, as in Dr. House.  I’m thinking that Dr. Sooch has either taken on House as a role model, or Dr. Sooch - and those like him - is the script model for Dr. House!
In a world of gray, people thirst for the “tell it like it is” lifestyle, even if clothed in presumptive arrogance, or arrogant brilliance, or even brilliant bravado.  Even if the need to be such and speak such wanders across moral and ethical boundaries, as with House (and apparently Sooch).  The TV series has held its own by providing script characters who are pushed to the brink of their own personalities attempting to provide balance by holding the rebel House in place.  Lately, as in the last few episodes that I have seen, the whole venture seems to be beginning to spin a bit out of control.  People will finally get tired of hearing the doctor say, “I’m sure this is the problem”,  4 or 5 times in one diagnostic session.  “Tell it like it is” should be more God-like in being all-knowing (one “I’m sure - trust me” should be enough); but suddenly becomes less raw truth and more over-bloated, opinionated problem solving, in order not to reveal serious personal insecurities.
Another season, perhaps.
The problem with doctors like Sooch (and - who knows - this may have been the 20th drunk dealt with on that one shift) is they don’t have script writers, and the people around them rarely become their moral and ethical check-and-balance.  Yes, patients (all of us)  NEED to hear the naked truth about immoral and dangerous beviour, and it’s consequences socially.  And doctors NEED people/patients to challenge their effrontery, and their conclusions.
  If you have found a medical professional (such as I did recently) who chooses to become an advocate in such situations (even if it is a another doctor or a nurse who is a personal friend), then you are blessed.
And let’s get a TV doctor who gets their diagnoses correct AND shares it with a proper professional attitude, working with a professional team that is not considered extra baggage.  But maybe that’s just not exciting enough to keep today’s viewers, or sponsors.

RGEaton

May 29, 8:36 pm | [comment link]
27. Capn Jack Sparrow wrote:

Hyacinth,

Perhaps Sarah is confused about the difference between an insurance company automatically settling OR an insurance company arbitrarily imposing a settlement on an accused physician simply because it would cost them less to settle for a small amount than it would cost to hire a lawyer to defend the doc. Most people don’t realize that if a doc is sued successfully more than a few times or if several cases are settled, regardless of merit, he is essentially uninsurable and out of business. In high risk fields like OB, emergency medicine, neurosurgery or interventional cardiology, multiple lawsuits are inevitable and if a community wants to keep its specialists, there better be a strong defense for them.

Sure, once in a while a doc is really guilty of malpractice. But usually it is the right thing to fight all the way to the top. After all, you can’t negotiate with terrorists or shakedown artists, and let’s face it, most lawsuits against docs are just that.

Regarding the issue of malpractice, let’s not forget that to prove malpractice not only does the standard of care have to be breached, but the patient has to prove that she suffered a bad outcome BECAUSE the standard was breached. It’s not enough if the doc breached standard of care AND the patient had a bad outcome. This patient didn’t suffer any more than she would have had the supposed hairline fracture been discovered on the night of the accident. She should not get ANY money.

Perhaps the doctor should be counselled to avoid writing things in the chart that would inflame a jury IF he had committed malpractice; which he didn’t BTW. After all, you can’t give the terrorists any ammunition to shoot back at you with.

May 29, 10:14 pm | [comment link]
28. Larry Morse wrote:

#20. No, no one actually said “rampant greed.” This was mere sarcasm since the suit was clearly stimulated by tht old American Dream: Sue anyone you can for any reason whatsoever; if you get the right jury you will walk away filthy rich.

As to her wait in the ER, for most of us who have been to ER’s, the five hour wait was a drop in the bucket. And $250 just for the privilege of waiting.

AS to Sooch’s advice, it went too far, perhaps. Perhaps. Unprofessional? No, indeed. He was telling her something she needed to know. Perhaps she would listen to a doctor who -  Oh great professional ones - should do something other than merely treat a medical condition. Something about treating the whole patient?

Of course they settled the suit. I worked in the Casualty Dept of an insurance company, and we ALWAYS settled a med suit as quickly as possible because juries give away the farm in these cases.
Liability isn’t the issue. The issue is $250,000 to settle on the court house steps or twice that as an award from the jury. (I might add that if this were a male drunk, the case would change entirely. Women always get sympathy, men very rarely.) LM

May 29, 11:56 pm | [comment link]
29. Country Doc wrote:

With 43 years experience as a physician much of it in ER’s I can confidently say that the good doctor’s written advice was just what she needed and was good medicine.  Suites are frequently settled to avoid additional cost and are not related to truth.  A wild, combative and abusive drunk will not get test that require cooperation if for no other reason then that doctors can’t do anything without your consent.  She suffered no harm and the so called errors were unavoidable except to omniscient omnipotent physicians.  You can be sure that at Denver General now drunks will get more expensive unnecessary tests and the waiting time for the other patients will get longer.  Also, more doctors will continue to increasingly retire earlier.  Enjoy.

May 30, 12:43 am | [comment link]
30. Sarah1 wrote:

RE: “NO ONE in the industry automatically seeks to settle.”

And I did not say that they did “automatically” seek to settle.  I said that they routinely settle.  And that is the case.  The reasons are well articulated by Cap’n Jack Sparrow . . .

Thanks Cap’n Jack!

May 30, 9:49 am | [comment link]
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