Thursday, June 11, 2009

1979: The quality of NAF care falls short

On June 11, 1979, 19-year-old Angela Scott died at Grady Memorial Hospital. The events that led to her death -- and also claimed the life of another teen -- began on June 2.

Angela was in the recovery room after her safe, legal abortion at National Abortion Federation member Atlanta Women's Pavillion. Somebody noticed that she wasn't breathing.

A nurse-anesthetist was administering anesthesia to 14-year-old Delores Smith while Dr. Jacob Adams was performing her abortion. The nurse-anesthetist ran to assist in efforts to revive Angela, leaving Delores unattended with her anesthesia drip still running.

After staff had resuscitated Angela and loaded her into an ambulance, they returned their attention to Delores, who had gone into cardio-respiratory arrest. Adams had accompanied Angela to the hospital, and staff refused to release Dolores to an ambulance until the physician had returned to discharge her. This resulted in a 30-minute delay, during which the ambulance crew was unable to attend to Delores or begin transporting her.

Angela lingered for a week in a coma before dying on June 11. Delores never regained consciousness and eventually was admitted to a nursing home, where she died of adult respiratory distress syndrome on October 24, 1979, some time after her fifteenth birthday.

13 comments:

Subvet said...

As a nonmedical type I'll ask what may be a stupid question. Aren't medical facilities generally required to have enough staff on hand so a nurse-anesthetist tending to one patient doesn't find it necessary to hightail it over to another when things go awry?

Hey, why not just strap 'em all on a conveyor belt? That'd help up the quantity of abortions done!

GrannyGrump said...

You nailed it, subvert.

But hey, at least they had a nurse-anesthetist and not a janitor or receptionist like some places.

SegaMon said...

Yes, Subvet, you are correct. As a nurse myself, it was explained that when a patient is under general anesthesia, either a anesthesiologist or nurse-anesthetist must be present at the head of the patient at all times. This is so that the patient can be monitored at all times to ensure that if ill-effects happen to the patient (as happened hear) that an immediate response can be provided.

Christina, do you know the name of this nurse-anesthetist? I wonder if the state board of Georgia was able to take punitive action.

GrannyGrump said...

From my notes:

Articles regarding Delores Smith, age 15, alleged: left unattended by nurse-anesthetist who forgot to turn off her anesthesia when she went to attend to Angela Scott; went into cardiac arrest, kept at facility by nurse who attempted to revive patient with oxygen and intravenous fluid but would not release Delores to ambulance until facility doctor arrived, resulting in 30-minute delay; hospitalized in coma; believed to have overdosed on Brevital. (Atlanta Journal 6-27-79, Atlanta Constitution 6-28-79) Deloris Smith Scheduled for an abortion at Atlanta Women’s Pavilion on the same day as Angela Scott, 14-year-old Delores had no idea how their lives and deaths would intermingle. On June 2, 1979, both girls were at the clinic for an abortion to be performed by Dr. Jacob Adams. Angela had her abortion first then went to recovery. During the abortion on Delores, Angela stopped breathing, and the nurse who was monitoring Delores left to go help Angela. This left Delores unattended and unfortunately, she began having breathing problems herself. Both girls were taken to Grady Memorial Hospital where Angela died a week later. Delores would remain comatose until her death on October 24, 1979. It was later discovered that the nurse-anesthetist who attended to both girls was not technically certified under Georgia law at that time. (Georgia Certificate of Death, # 042928; “Girl, 15, dies after being in a coma since abortion last June,” Atlanta Constitution, October 25, 1979, p. 2-C; Atlanta Journal 6/27/79; Atlanta Constitution 6/28/79)

Tlaloc said...

"As a nurse myself, it was explained that when a patient is under general anesthesia, either a anesthesiologist or nurse-anesthetist must be present at the head of the patient at all times."

And was that rule in place thirty years ago when this incident occurred?

GrannyGrump said...

Tlaloc, I'm sure that 30 years ago, the standard of care was to leave anesthetized patients totally unattended with the anesthesia drip running. After all, an ABORTION CLINIC NURSE did it, so it MUST have been the standard of care!

Tlaloc said...

"Tlaloc, I'm sure that 30 years ago, the standard of care was to leave anesthetized patients totally unattended with the anesthesia drip running. After all, an ABORTION CLINIC NURSE did it, so it MUST have been the standard of care!"

So in other words you can't show that the rule was in place, you just want to assume so, and want everyone else to do so as well.

GrannyGrump said...

Wouldn't the fact that two patients DIED be somewhat indicative of a screwup?

Oh -- I forgot -- this was an abortion clinic. They don't screw up!

Tlaloc said...

"Wouldn't the fact that two patients DIED be somewhat indicative of a screwup?"

Assuming it was the cause then its certainly an indication that it was a bad practice. That doesn't mean however that it wasn't accepted practice at the time. Medieval barbers aren't evil for having bled their patients, they were just ignorant.



" Oh -- I forgot -- this was an abortion clinic. They don't screw up!"

That kind of hyperbole really doesn't help your cause, Christina. There's a huge gap between "you haven't shown they were at fault" and "they can't be at fault." That you choose to disregard that difference only makes it harder for anyone to take your claims seriously. The boy who cried wolf and all that.

GrannyGrump said...

Tlaloc, if you have a Yahoo ID, why don't you do pose the question and see if some anesthesiologist will say, "Sure! We left them unattended with the drip running all the time! When they died we figured there must have been something wrong with the patient. It didn't start to occur to us until around 1998 that patients under general anesthesia should be monitored."

GrannyGrump said...

And, by the way, Tlaloc, I said the quality of care fell short. Wouldn't you say that if the quality of care leaves a patient dead, it fell short? Or is a dead patient just as acceptable outcome as a live patient? Sort of the way a dead baby is just as acceptable a pregnancy outcome as a live baby?

And have you read the comments? "It was later discovered that the nurse-anesthetist who attended to both girls was not technically certified under Georgia law at that time."

Ah, but was it standard of care at the time that your nurse-anesthetist be certified? Maybe the Georgia law only RECOMMENDED that they be certified.

Hey, Sega -- you're a nurse. Can you ask an anesthesiologist at what point it became the standard of care to monitor patients while they're unconscious?

Tlaloc said...

"Tlaloc, if you have a Yahoo ID, why don't you do pose the question and see if some anesthesiologist will say, "Sure! We left them unattended with the drip running all the time! When they died we figured there must have been something wrong with the patient. It didn't start to occur to us until around 1998 that patients under general anesthesia should be monitored.""

Because honestly I really don't care to debate the merits of a death that happened three decades ago. It just really doesn't seem relevant. My point was just that people are assuming facts not in evidence.

If you really want to have a case you should be the one researching the matter (not that that will really do anything to change the ancient history aspect).



"And, by the way, Tlaloc, I said the quality of care fell short. Wouldn't you say that if the quality of care leaves a patient dead, it fell short?"

Of course not, because that's ridiculous. It assumes that no one would ever die if only the care were good enough but obviously medical science is no where near that advanced. The care can be perfect and patients will still die.



"And have you read the comments? "It was later discovered that the nurse-anesthetist who attended to both girls was not technically certified under Georgia law at that time."
Ah, but was it standard of care at the time that your nurse-anesthetist be certified?"

Assuming the comment is correct (a dangerous thing under the circumstances, clearly) then that certainly sounds like a serious violation. Seems unlikely that GA would have a process for certification but not require it (I suppose its possible but seems unlikely).

SegaMon said...

Christina: "Hey, Sega -- you're a nurse. Can you ask an anesthesiologist at what point it became the standard of care to monitor patients while they're unconscious?"

I do not work in the OR. I work as a Med/Surg nurse. Thus, I don't usually talk to anesthesiologists. I will certainly have more of an opportunity to talk to anesthesiologists (and nurse-anesthetists) when I go back to school in September and when I look for an OR job early next year. I still have lots to learn. :)

As far as I know, it would make sense to never leave a currently anesthetized patient alone.

The reason why it would be hard to show that it was once acceptable to leave an anesthetized patient unattended is because of numerous reasons. The most important reason is that the patient has to be intubated!!! If the airway is not monitored and maintained, then the patient runs the risk of great injury and even death.

This is one reason why many ICUs have patient-nurse ratios of 2 to 1 and 1 to 1. Even with the 2 to 1 ratio, patient vital signs are monitored at every moment.

I can cite specific resources in a couple of my current Nursing textbooks if needed.

Thus, even 30 years ago, it would ALWAYS be idiotic to leave a fully anesthetized patient alone.