Attorney Kay Van Wey Weighs In:
Tele-Doc ICUs: Are They Safe for Patients?
by Kay Van Wey, medical malpractice attorney.
Host of the AdvoKAYte: Holding Healthcare Accountable Podcast
Contact: kvw@vanweymetzler.com
Medical Malpractice Attorney Kay Van Wey
I’m a malpractice attorney with a long and hard-fought career holding our medical system to account. I’ve seen a lot of personal suffering in my professional life, and I have developed a pretty strong stomach when I hear devastating stories about how our medical system sometimes behaves. I don’t often feel surprised, but I honestly was not prepared for how hard this case hit.
Conor Hylton Shouldn't Have Died.
A young man was admitted to an Intensive Care Unit (ICU), a place where the most critically ill patients are treated. In an ICU, patients might deteriorate rapidly or require life-saving interventions. ICUs are typically well-staffed with a very low ratio of practitioners to patients because of this. These units are typically overseen by physicians trained in critical care, often referred to as intensivists.
Tele-Doc ICUs?
That’s not how this ICU worked. This ICU was staffed to be cost-efficient, sharing its Intensivist with other ICUs using telemedicine. A tele-doctor is, for practical purposes, a camera attached to a screen. Intensive care was managed through a remote monitoring model.
An intensivist, also known as a critical care doctor, is a medical practitioner who specializes in the care of critically ill patients, most often in the intensive care unit (ICU)
Sometime after ICU admission, the young man’s condition started to deteriorate, and he required intubation to allow him to breathe. This is where something that was already wrong became critical. Intubation was stalled because there was an alleged delay in securing the patient’s airway. The young man needed immediate hands-on intervention, but the ICU as run was incapable of delivering it. As a result, the patient, a young man, died.
The ABC's of Critical Care.
There were further allegations that the patient was not even examined by a critical care physician. I am a mother of two sons who are now in their twenties. This is a case I think about when I worry about them. I worry about them all the time.
Every first-year medical student and every medical malpractice lawyer knows the importance of the ABCs. A stands for Airway, B stands for Breathing, and C stands for Circulation
The airways always come first. In an ICU, it is easily foreseeable that a patient’s airway might get blocked or the patient might stop breathing. Lack of oxygen can cause irreversible brain injury within minutes. Intubation is traumatic, but sometimes it is what’s needed to keep an open airway for a patient who can’t breathe.
Intubation is a highly skilled hands-on procedure. Not all physicians are trained to properly intubate a patient, but all ER and ICU doctors are. No matter how well-trained their doctor is, a patient can not be intubated through a screen.
The remote monitoring of ICUs was developed because of a shortage of ICU staff.
Tele-ICU models were developed in part due to a shortage of Intensivists and the need to have that limited number cover several ICUs across multiple hospitals. In theory, tele-ICUs allow Intensivists to oversee a larger number of patients with the support of highly trained nursing teams.
Kay Weighs In.
As an experienced malpractice attorney, I see too many obvious but unanswered questions to see how the tele-ICU model is geared to patient safety.
Was there anyone in the ICU who was qualified to immediately intubate a patient? Was the patient given an appropriate examination after entering the ICU? Was he even properly triaged for this level of care? Was a transfer to a nearby better-staffed ICU considered? Was the young man’s family informed of their options? Were they offered an informed choice?
This wasn’t a small town or rural setting struggling to stretch each dollar. This incident happened in a well-resourced American community literally minutes from other world-class medical facilities. In fact, the young man’s family brought him to the nearest hospital without realizing the hospital’s ICU did not have an in-house Intensivist.
How Can You Protect Yourself from Medical Malpractice?
If you or a loved one are admitted to an ICU, here are a few questions you might want to ask to best advocate for yourself or your loved one.
- Is there a trained ICU physician physically present 24/7?
- Who is responsible at the bedside?
- Is care remote or in person?
- Who has the authority to intervene if things go wrong?
Ask questions early. because later may be too late. Doctors and other health care practitioners are not the enemy. As long as you are honest, polite, and respectful, doctors tend to appreciate that you are asking for good reasons.
Medical Technology Can Be Good for Patients -- With Limits.
Technology and innovation aren’t the enemies either. Tele-health, if staffed responsibly, can make health care accessible to more people for less money. Having tele-health as an option could save countless lives. There are certain times and places, however, where tele-health should not be used as a primary care delivery model. Intensive Care Units are among those places. The need for highly trained authoritative intervention in an ICU is simply too high.