You’re in ICU – who decides if you live or die?

Having recently spent time in an ICU, still struggling with some issues, and facing surgery soon, news articles about health, especially those with terrible outcomes, seem to catch my attention more and more these days. I expect it’s a function of my recent experiences and just plain getting older. But an article about a tragic outcome for a young man caught my eye and I thought you might find this discussion interesting.


In the not too distant past, I used to think that insurance companies were to blame for many things related to our failing medical system. Then artificial intelligence (“AI”) came rushing to the forefront of every single thing in our lives, from students cheating on exams or using AI to completely write their essays, to the voice I talk to on a customer help line, to prescribing medication, to making diagnoses in place of doctors. So, I became worried that some AI algorithm was going to be the death of me at some point. Based on the article I read, what may be the death of me comes down to the oldest reason in the world – pure greed.


So, what about that article caught my attention? A young man in Connecticut, described as a gifted student and athlete, died in what seems to me and his parents pure neglect. This young man played Division I hockey, earned a black belt in Tae Kwon Do, ran a half marathon, and graduated near the top of his class in high school. He planned to become a dentist like his two parents and was set to enter dental school. But a few days before he started dental school, he started vomiting, complaining of abdominal pains, and was unable to keep food down. He called his father at work and asked for a ride to the hospital. Everyone thought he had a stomach virus. For full disclosure, the young man did have a history of alcohol abuse, including prior treatment for alcohol withdrawal (sad for someone so young). His father took him to Bridgeport’s Milford campus hospital. His father took him to Milford because it is a bit smaller than the Yale New Haven main hospital and he thought his son would be seen quicker. I won’t bore you with all of the details of his treatment or lack thereof but his parents left him at 7 p.m. because no one believed his condition was life-threatening. The plan when they left was that their son would be rehydrated and put in a room. The parents were more concerned about whether their son could pick up his college parking pass the next day or if one of them would have to do it. They received a call at 4:45 a.m. to come to the hospital, their son was being administered CPR. They did not know that their son had been transferred to the ICU at midnight – no one thought to inform them. By the time they arrived at the hospital, he was for all intents and purposes already dead. From the time he was admitted to ICU at 12:38 a.m. until he went into cardiac arrest at 4:33 a.m., the only person present at his bedside was a nurse. In fact, it appears that no intensive care physician was ever at his bedside. The intensive care physician was leading the medical team via a TV screen – he wasn’t even located at the hospital and never put his hands on this young man or was at his bedside. The doctor at the hospital (a generalist) did not see this young man because the tele-ICU doctor was in charge of the patient. In fact, at 4:45 a.m., when this young man’s eyes rolled back in his head and he became unresponsive and showed seizure activity, he needed to be intubated. But the “generalist” doctor did not know how to do it and the Emergency Room doctor on duty who could do it did not know the way to ICU and had to ask directions and be escorted to ICU, so he was delayed by about 10 minutes. The young man was not intubated for 20+ minutes. As a father, I cannot imagine the horror these parents did and are enduring, having witnessed their son dying while a TV-screen doctor at Yale New Haven Health was in charge and ultimately pronounced their son dead. By the way, the distance from the Milford hospital to Yale New Haven Health is 8.8 miles.


Apparently, “tele-ICU” has become very popular, from rural and remote hospitals (where I can see an actual need) to large and small hospitals in big and small cities and towns. Yale’s objective for tele-health was not to replace bedside care but to allow the “best of the best,” who are concentrated at flagship hospitals, to monitor patients at smaller community hospitals. I’m sorry, it doesn’t appear to me that the best-of-the-best did all they could to save this young man. Is it just me that thinks these tele-health models in larger towns and cities are implemented to make as much money for these hospitals as possible? You know, rather than hiring an ICU doctor to actually be on-site at a hospital and at the bedside of critically ill patients, they would rather increase their bottom line. Hire one doctor and let them handle multiple locations and patients via TV screens. What happened to the Hippocratic Oath of “do no harm”? Dr. Keith Corl, an emergency physician and intensivist (an ICU specialist), who has worked both at the bedside and as a tele-ICU doctor, believes tele-critical care has a very important role in rural hospitals where the alternative is no ICU doctor but, in large health systems, tele-ICU has increasingly become a cost-cutting measure. This same doctor reported that for several years the most common comment nurses wrote in annual surveys at one hospital he worked at was that they would not want to be patients in their own tele-ICU. What does that say about the care being received by ICU patients through a TV screen at that hospital? I think if the parents of the young man who died knew there was no doctor in the ICU, they would have driven the extra nine miles to ensure an actual doctor saw their son and not a TV screen doctor.


I can be seen at the local VA clinic in Pahrump but I choose to drive into Las Vegas because the Pahrump VA clinic only offers tele-health with an actual doctor. I want my doctor to be able to put his or her hands on me or, at least, be in the same room with me when I have issues. After I was transferred from the Emergency Room in Pahrump to a hospital in Las Vegas, I was placed in ICU and the ICU doctors were bedside with me. Various ICU doctors saw me that night and the next day in ICU and I received excellent care. That is how it should be.


I write this as a cautionary note to those seeking medical care. While you may not have a choice in the Emergency Room or ICU that takes you in for care, your family members and/or loved ones should ensure there is an actual doctor taking care of you and not a TV screen.


Jerry Hashimura
Pahrump, NV   

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