title: Emergency department crowding and loss of medical licensure: a new risk of patient care in hallways.
abstract: We report the case of a 32-year-old male recently diagnosed with type 2 diabetes treated at an urban university emergency department (ED) crowded to 250% over capacity. His initial symptoms of shortness of breath and feeling ill for several days were evaluated with chest radiograph, electrocardiogram (EKG), and laboratory studies, which suggested mild diabetic ketoacidosis. His medical care in the ED was conducted in a crowded hallway. After correction of his metabolic abnormalities he felt improved and was discharged with arrangements made for outpatient follow-up. Two days later he returned in cardiac arrest, and resuscitation efforts failed. The autopsy was significant for multiple acute and chronic pulmonary emboli but no coronary artery disease. The hospital settled the case for $1 million and allocated major responsibility to the treating emergency physician (EP). As a result the state medical board named the EP in a disciplinary action, claiming negligence because the EKG had not been personally interpreted by that physician. A formal hearing was conducted with the EP's medical license placed in jeopardy. This case illustrates the risk to EPs who treat patients in crowded hallways, where it is difficult to provide the highest level of care. This case also demonstrates the failure of hospital administration to accept responsibility and provide resources to the ED to ensure patient safety.
authors.affiliation: University of California Davis Medical Center, Department of Emergency Medicine, Sacramento, California.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Derlet
authors.affiliation: Temple University School of Medicine, Department of Emergency Medicine, Philadelphia, Pennsylvania.
authors.forename: Robert M
authors.initials: RM
authors.lastname: McNamara
authors.affiliation: American University of Beirut, Department of Emergency Medicine, Beirut, Lebanon.
authors.forename: Amin Antoine
authors.initials: AA
authors.lastname: Kazzi
authors.affiliation: University of California Davis Medical Center, Department of Emergency Medicine, Sacramento, California.
authors.forename: John R
authors.initials: JR
authors.lastname: Richards
mesh_terms: D000328:Adult; D003441:Crowding; D004636:Emergency Service, Hospital / Q000592:standards; D017809:Fatal Outcome; D006801:Humans; D008006:Licensure, Hospital; D008297:Male; D008318:Malpractice; D019300:Medical Errors; D058687:Out-of-Hospital Cardiac Arrest / Q000209:etiology; D011655:Pulmonary Embolism / Q000150:complications / Q000175:diagnosis*; D011787:Quality of Health Care