Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Further Details on ‘Ambulance Mistake Killed Teen After Skateboard Accident’


Image credit.
 

Thank you to Michael Berrier for providing a link to a much more detailed account of what I wrote about in Ambulance Mistake Killed Teen After Skateboard Accident.
 

It (the law suit) alleges the hospital and/or it employees: “failed to keep Drew Hughes properly sedated and restrained; failed to properly re-intubate Andrew Davis Hughes during the transport; failed to perform standard objective tests to verify proper placement of the endotracheal tube; failed to recognize clear signs and symptoms of an esophageal intubation and respond to those signs; attempted to falsify the medical records to cover up their negligence; failed to use their best judgment in the treatment of Drew Hughes; failed to use reasonable care and diligence in the treatment of Drew Hughes and in the application of their knowledge and skill to the care of Drew Hughes; failed to possess the required skill and learning to treat Drew Hughes; failed to practice within the standard of care for respiratory therapists, nurses and/or paramedics in the same or similar communities; and were negligent in such other respects as may be shown at trial.”[1]

 

I mentioned almost all of those problems in what I wrote based on the much more limited information in the article[2] I had read. I missed attempted to falsify the medical records to cover up their negligence; and several of the comments mentioned physical restraints (which I did not mention) in addition to chemical restraint.

Was I so accurate because I am psychic?

No.

Airway disasters happen in predictable ways.

When people fail to recognize an esophageal intubation, it is not difficult to figure out why it happened.

If I were to write about a ball rolling to the edge of a table and falling due to gravity, it would be a similarly predictable scenario.

Airway disasters happen in predictable ways.

There was a failure of assessment, which is also a major part of how the tube was removed in the first place. Proper assessment should have prevented the need for re-intubation.
 

Going back to the beginning, a series of choices led up to the apparently very preventable death of a child.
 

A CT of the head was normal but doctors suspected a possible basilar skull fracture,[1]

 

Intubation seems extreme as prophylaxis for a possible basilar skull fracture without evidence of injury by CT (Competerized Tomographic scan), but there may have been a good reason.

The gold standard for airway protection is not intubation, but the patient protecting his own airway.

Was there some reason to believe that the patient would not be able to protect his airway for the entire trip to the trauma center?
 

The article mentions that the respiratory therapist . . .
 

. . . had been licensed for less than a year at this time and was not properly trained or adequately experienced in intubating a patient outside of a hospital setting.[1]

 

The next paragraph mentions stopping to pick up a paramedic, who then drove the ambulance.

Was the paramedic supposed to handle intubation?

Was the paramedic supposed to handle intubation while driving?

That would indicate great skill, but incredibly bad judgment.

Here is the timeline –
 

11:10                   Ambulance leaves the hospital.

??:??                   Paramedic is picked up.

11:15                   Sedation wears off and tube is pulled out.
 

Did the crew change distract everyone from recognizing the signs of lack of sedation?

Was the patient on a drip, which should have been adjusted up for the increased stimulation of an ambulance ride bouncing down the road in a truck?

Did the hospital just discontinue sedation because they have failed to consider the patient’s needs once the patient is out of their bed?

Was the crew supposed to provide bolus sedation en route?

Were they provided with broad enough orders and enough sedative for the ride?
 

And –

They were within 5 minutes of the sending hospital.

Why didn’t they turn around and head back?

If there are complications, the hospital has more resources to deal with those complications.

Clearly, the plan they were following was not remotely a success.

They had left the hospital, stopped to switch crew members and drivers, and the patient had burned through his sedative and pulled his tube out.

They should still have been able to see the hospital, unless there were a lot of trees, buildings, or something else blocking their view.

What were they thinking?

Things can only get better?

Things did not get better.
 

11:43                   They arrived at the trauma center. Late entry 04:10 11/15/2013 – They diverted to a closer hospital. They did not reach the trauma center until much later.
 

It appears that they could have taken the patient out of the ambulance and pushed the patient back to the sending hospital in less time – without decreasing the quality of care provided.
 

(The paramedic) pulled the ambulance off the road and, according to the ambulance report, all four crew members worked to suction and re-intubate Drew with (the respiratory therapist) being primarily responsible for the attempted re-intubation,” the complaint continues. “Drew was given paralytics and sedatives, which meant he could not breathe on his own. He was completely dependent on the oxygen from the endotracheal tube. Drew was intubated into his esophagus rather than his trachea and was not receiving oxygen and could no longer breathe on his own. At the time of the re-intubation, Drew’s parents were parked in their car immediately behind the ambulance.[1]

 

Within 5 minutes of the hospital.
 

“The crew never used objective testing, such as colormetric testing or capnography, to verify that the endotracheal tube was in his lungs and not his esophagus.[1]

 

Why is anyone still using colorimetry?

It is litmus paper that provides false positive and false negative results that many users fail to recognize as erroneous.

Moisture ruins it and there is moisture in every breath exhaled from human lungs.

Exhalation of moisture is the reason some people use moisture in the tube as an indication of proper tube placement. What they fail to realize is that moisture can also come out of the esophagus, so this is not of much help in confirming tube placement.

The only justification for the colorimetry litmus paper is if there is a malfunction of the waveform capnography that prevents the use of waveform capnography.

According to the article, the crew did not even try to use that inadequate method of tube confirmation.
 

In the comments to my original post, Christopher Watford points out –
 

In NC (this happened in North Carolina), waveform capnography is required on all RSI’s

 

RSI is Rapid Sequence Induction/Intubation – an intubation involving the use of sedatives and paralytics. The intubation in the ambulance is described as using both.

Required, but not used.
 

“Almost as soon as the attempted re-intubation was done, Drew’s heart rate began to drop and they could not find a pulse.[1]

 

What does PALS (Pediatric Advanced Life Support) state about the sudden deterioration of an intubated patient?
 

Reevaluate tracheal tube position and patency in patients who remain agitated despite effective mechanical ventilatory support and each time the patient is moved, such as into or out of a transport vehicle. If the condition of an intubated patient deteriorates, consider several possibilities that can be recalled by the mnemonic DOPE: Displacement of the tube from the trachea, Obstruction of the tube, Pneumothorax, and Equipment failure. If tracheal tube position and patency are confirmed and mechanical ventilation failure and pneumothorax are ruled out, the presence of agitation may require analgesia for pain control (eg, fentanyl or morphine) and/or sedation for confusion, anxiety, or agitation (eg, lorazepam, midazolam, or ketamine).[3]

 

The response should be very simple and obvious –

Pull the tube and ventilate with a BVM.
 


 

If deterioration is due to Displacement, the patient should improve.

If deterioration is due to Obstruction, the patient should improve.

If deterioration is due to Equipment failure, the patient should improve.

If the patient does not improve, that leaves Pneumothorax and the patient should have large bore needles of adequate length to reach the lungs stuck into both sides of the chest to decompress the apparent tension Pneumothorax.

If things deteriorate, we need to become very aggressive very quickly. This is one reason why a prophylactic intubation for transport may be a bad idea.
 

According to the ambulance records, at approximately 11:25 p.m., Andrew’s heart rate is in the 30s and he has no pulse. CPR was started and epinephrine was given.[1]

 

Pediatric bradycardia should automatically suggest one problem much more than any other problem.

Epinephrine does not treat hypoxia. The problem was not a lack of epinephrine.
 

In general, pediatric out-of-hospital arrest is characterized by a progression from hypoxia and hypercarbia to respiratory arrest and bradycardia and then to asystolic cardiac arrest.2 17 18 Therefore, a focus on immediate ventilation and compressions, rather than the “adult” approach of immediate EMS activation or defibrillation, appears to be warranted. In this age group, early effective ventilation and oxygenation must be established as quickly as possible.[3]

 

Four people in the back of the ambulance. Three of them should have taken PALS, or been familiar with the material covered in PALS.

PALS repeatedly recommends BVM ventilation.

Why?

Hypoxia -> Bradycardia -> Cardiac Arrest – > Brain Death.

BVM ventilation can interrupt that deterioration.

Ventilation can prevent the deterioration to bradycardia.

Ventilation can prevent the deterioration to cardiac arrest.

Ventilation can prevent the deterioration to brain death.
 


 

The tube does not appear to have been removed for BVM ventilation.

What would we expect to see if the patient had been ventilated with a BVM prior to losing pulses?

An increase in heart rate.

What would we expect to see if the patient had been ventilated with a BVM after losing pulses?

An increase in heart rate and ROSC (Return Of Spontaneous Circulation).

These improvements would not always happen, but they are the most likely to happen with ventilation.
 

Things get even worse
 

“According to the records a shock is given with a defibrillator at 11:38 p.m.,” the complaint alleges. “CPR was continued. Drew’s heart rate was in the 40s. More epinephrine was given. During this time, the emergency room physician at Carteret General was called to get permission to give Amiodarone. The emergency room physician told the crew to recheck the tube and suction because the arrest may be respiratory related. The crew again failed to verify the tube placement.”[1]

 

I am calling for orders.

I receive orders to do the most important and most obvious assessment – an assessment I should have done over 20 minutes ago – an assessment that should be continued throughout transport, I but still have not done it.

I ignore the orders.

Panic? Tunnel vision?

I see what I want to see – a cardiac arrest that indicates that it is time to give another drug.

I continue to ignore the reassessment that is part of the algorithm.
 

According to the complaint, “The ambulance was diverted to CarolinaEast in New Bern because Drew’s condition was deteriorating. They arrived at Carolina East at 11:43 p.m. according to the ambulance records.[1]

 

Timeline of events –
 

11:10                   Ambulance leaves the hospital.

??:??                   Paramedic is picked up.

11:15                   Sedation wears off and tube is pulled out.

11:25                   Cardiac arrest (tube probably in esophagus).

11:30                   Still dead (tube probably in esophagus).

11:35                   Still dead (tube probably in esophagus).

11:38                  Medical command contact and diversion to hospital five minutes away (tube probably in esophagus).

11:43             Arrival at hospital and tube is pulled out of esophagus following assessment of tube placement.
 

Why did the doctor pull the tube?
 

Drew had no pulse on arrival. Once at CarolinaEast, the emergency room physician documented that Drew’s color was cyanotic, there was no fogging of the ET tube and Drew had rumbling sounds in his stomach. All of these are classic signs of an esophageal intubation.[1]

 

Apparently, even without waveform capnography, it was obvious that the tube was in the wrong place.

Cyanosis and rumbling breath sounds in the stomach?

How do you assess tube placement, observe these signs of esophageal intubation, and come up with excuses to justify leaving the tube in place?

This appears to be an example of cognitive dissonance.

We believe so strongly that we are doing the right thing, that we ignore abundant evidence to the contrary.

He’s blue.

I should check the tube.

Nah! He just needs some amiodarone (which coincidentally can cause skin to turn blue).

It sounds like I am ventilating his stomach.

I should check the tube.

Nah! He just needs to be defibrillated.

Medical command told me to check the tube.

I should check the tube.

Nah! I saw the tube go through the cords.
 

“A respiratory therapist at CarolinaEast immediately extubated and re-intubated Drew on the first attempt,” the complaint continues. “Within a few minutes his blood oxygen saturation level returned to 100 percent and his vitals improved.[1]

 

It appears to have been an easy intubation.

It appears to have been an easy assessment.

Why did the paramedic, respiratory therapist, nurse, and basic EMT not check placement of the tube?
 

Cognitive dissonance theory explains human behavior by positing that people have a bias to seek consonance between their expectations and reality. According to Festinger, people engage in a process he termed “dissonance reduction,” which can be achieved in one of three ways: lowering the importance of one of the discordant factors, adding consonant elements, or changing one of the dissonant factors.[6] This bias sheds light on otherwise puzzling, irrational, and even destructive behavior.[4]

 

This is one of the reasons we need to constantly look for evidence that we are wrong, rather than evidence that we are right.

We tend to be satisfied with inadequate evidence if we only look for confirmation.

We can talk ourselves into almost anything.

At some point we all probably engage in cognitive dissonance. We need to anticipate this and aggressively seek evidence that contradicts what we want to believe.

Our patients’ lives may depend on our ability to avoid cognitive dissonance.
 


 
This is not just a problem for EMS – See also:

What Does it Take to NOT Kill a Patient – Part I – 4/03/2011

What Does it Take to NOT Kill a Patient – Part II – 4/04/2011

What Does it Take to NOT Kill a Patient – Part III – 5/20/2011

What Does it Take to NOT Kill a Patient – Part IV – 5/23/2011

What Does it Take to NOT Kill a Patient – Part V – 5/30/2011

From EMCrit –

EMCrit Podcast 47 – Failure to Plan for Failure: A Discussion of Airway Disasters – 5/09/2011

From Resus.Me –

Anaesthesia’s dirty laundry – let’s all learn from it – 4/03/2011

 

The paramedic, respiratory therapist, nurse, and basic EMT cannot change the outcome, but they can learn from it and make sure others learn the importance of ventilation for children and the importance of looking for evidence that we are wrong.

The family of Drew Hughes cannot get him back, but maybe a part of the settlement can include some attempt to educate medical personnel, so that fewer other families experience the kind of pain they live with.
&nbsp


 

Footnotes:

[1] Lawsuit filed over death of Emerald Isle youth
Posted: Wednesday, November 6, 2013 9:51 am | Updated: 9:56 am, Wed Nov 6, 2013.
22 comments
By Brad Rich, Tideland News Writer
Tideland News
Article

[2] LAWSUIT: Ambulance Mistake Killed Teen After Skateboard Accident
Updated: Wed 9:14 PM, Nov 06, 2013
WITN.com
Article

[3] Respiratory System
2000 ECC Guidelines
Part 10: Pediatric Advanced Life Support
Postresuscitation Stabilization
Free Full Text from Circulation.

[4] Cognitive dissonance
Wikipedia
Article

.

Comments

  1. Unfortunately, I think that people simply don’t think about the extra stimulus that patients go through in transport. When in the hospital, the goal is to keep the patient sedated appropriately, careful to be just the right amount, neither too much nor too little. While laying in a hospital bed the only stimulation they get is the occasional beep out of a vent, IV pump or monitor. When you add the bumps in the road and occasionally the sirens, they require more sedation to maintain the same level of unconsciousness. It should be part of everyone’s pre transport process to assess how much of the drug being used is left in case more needs to be gotten from the facility, and also talking to the provider overseeing the patient about a contingency for the added agitation.

    There are unfortunately so many things that appear to have gone wrong here, and hopefully they will be excellent learning points for us all. Thanks for the follow up!

  2. I still wish there was more information as to why the patient was intubated in the first place. A possible basilar skull fracture does not justify RSI in a patient who is maintaning their own airway. I couldn’t agree more with the statement, “The gold standard for airway protection is not intubation, but the patient protecting his own airway”. People have got to start questioning the healing powers of plastic in the trachea.

  3. Drew didn’t have to Die.

  4. The only way a nurse or/and a respiratory therapist can operate outside the hospital in North Carolina is if the transport service is a specialty care certified service. This service was not. This means that the nurses and respiratory therapist did not receive specially training in critical care transport medicine. The North Carolina office of emergency services regulates all specialty care transport services in the state. They oversee that the policies and protocols are in place that these individuals are trained appropriately.

    This unfortunate situation is a glaring example of untrained individuals that did not recognize the most basic indications of an esophageal intubation.

    The transport service should be sanctioned by the office of emergency services for allowing untrained individuals to practice on their truck. The hospital should be sanctioned for improper supervision. The emergency physicians group policie should be examined for intubation of a patient that really did not need intubated. At times the trauma center will want them intubated before transport but it is the decision of the emergency physician at bedside with the patient not be receiving physician that has not laid eyes on the patient

  5. Great comments and blog entry about a preventable tragedy…”if only” applies to this situation so many times over it is shocking. Although, as a medical professional that specializes in pediatric patients, I can see (unfortunately) how it happened. If you aren’t used to taking care of pediatric patients most people under or over sedate and without using skills all the time you lose them. The fact that they tried to change their records troubles me deeply, as it is bad enough they made the mistakes they made, but to try and cover them up is unforgivable. They (EMT, Paramedic, RT and RN) may not take a Hippocratic Oath as physicians do but they still have standards that must be adhered to. A policy and procedure change along with education at many levels should definitely be part of the settlement, although the loss of such a beautiful boy from this earth is something no one can put a price on. This experience should also accentuate the value of Children’s Hospitals across the country, and the assets they bring to every child and family, as Drew’s experience is clearly one that could of been handled by the experts at the Children’s Hospital and Trauma Center, if only he could have gotten there without such damage. If only….indeed.

    • A Grieving Pediatrician in Eastern NC says:

      As a Pediatrician in a rural community I absolutely agree with all your comments. The saddest words…”if only”… . Reading the account I kept thinking “Bag…pull the tube and BAG!” Why did they not call for help sooner? The mistakes these people made are obvious and deplorable. Mistakes and errors in judgement are one thing but to compound the tragedy with deliberate cover up is incomprehensible and sickening. Who can trust them now? I can’t.

      You are absolutely correct – our children who are ill or injured often receive treatment from providers not trained to take care of them. Children are not mini adults. A Children’s Hospital / Trauma Center is not feasible in many communities but we are fortunate in our state to have several of the very best only miles away…and instantly available by phone – if only providers will call. If only…
      Terrifying words for all of us – medical professionals, parents, humans.

    • Their standards are still “Do No Harm” right on down to the the Home Health Aide’s so they know.

  6. As an FNP and as a mother of a boy close to Drew’s age, I am heartbroken and disappointed. Though I don’t know the entire story, it seems so many errors in judgment were made. One thing is for certain, that boy didn’t have to die. I don’t want to comment on specifics but again, this boy didn’t have to die. I am so very sorry for his parents, brothers, other family and friends. I see my boy in his face and it is painful for me. I can’t imagine his parents grief. God bless them.

  7. This was and is a terrible and preventable tragedy. I feel so very sorry for Drew’s parents, family and friends. As an EMT myself, I have repeatedly questioned, “Why wasn’t breath sounds listened for (stethoscopes are on all ems units)? Could the 4 people in the back of that unit, at the time of the re-intubation, not SEE rise and fall of the abdomen NOT the chest? Have emergency medical professionals and other medical professionals become so COMPLACENT with technology and machines that we are FORGETTING THE BASIC STEPS of ASSESS, ASSESS, AND RE-ASSESS???” This situation and others similar to it truly SICKEN me to think that our medical professional/health science personnel are becoming so LAZY and IRRESPONSIBLE. God bless the Hughes family and give them strength to continue on with their daily lives and piece it all back together as best as can be.

  8. The ambulance (not a Critical Care Truck-not even close) did not even use end tidal CO2. The hospital respiratory staff does not embrace ETCo2. Unbelievable. Not even on a vent?
    The ambulance stopped in Newport, NC which is six miles from the hospital. Newport Fire has very experienced Medics and ETCO2 monitoring.
    Not that it would have made a difference because of arrogance or ignorance, they were not called.
    Then the cover up by multiple parties? NCOEMS has requirements for a difficult airway form, IT IS REQUIRED on all RSI’s. Not only that but the Carteret County EMS QRV medics assisted with the transport. It is also a County hospital. So why was the form omitted? Then there is QA/QI- didn’t come to the light of day?
    I have been a critical care medic, fire medic, air medic and administrator for over 25 years. This tragedy should have never happened. I have seen and intervened on several misguided RSI and conscious sedation attempts and whole heartedly agree with the above poster on all points. This is a low frequency high risk event that was left to amateurs. The train wreck started in the ED with negligence and incompetence and rolled downhill on the EMT’s. A runaway freight train of poor choices and lack of critical decision making skills resulted in a needless death.

  9. If he was an esophageal intubation why did the article not include that he also had abdominal distention? With a severe head injury, since he wasn’t wearing a helmet, there could be more reasons for the way events turned out other than respiratory complications. Why for example did the ED physician treat him as an adult since he was too tall to fit on braslow tape, then all of you want to call him a pediatric patient only due to his age…Instead of only going off what you read 85 the paper, biased as it is, take the blinders off and think. After the trial the family won’t be able to bash anyone once they get their money, even in grief we still want to blame someone.

    • anonymous,

      all of you want to call him a pediatric patient only due to his age

      What would be different about this if he were an adult?

      He died at 13 years old.

      What age do you consider to be adult?

      .

      • NCOEMS age for pediatric airway is Less than age 11.. so as far as his airway.. it is adult

        • A 13 year old patient is a pediatric patient.

          A pediatric patient with an airway large enough to take an adult endotracheal tube should be intubated with an adult endotracheal tube.

          Using one particular age to make that determination is a matter of trying to make the protocol simple – perhaps to decrease the stress of the situation by providing a simple answer – an answer that doesn’t help.

          The protocol should make it clear that an intubated patient should be intubated with the right size of endotracheal tube, regardless of the patient’s age.

          We should be treating the patient, not the protocol.

          .

    • The head injury wasn’t that bad. Anonymous, did you read the article? Did you see the part about the CT scan? The paper is based on the Complaint which is taken from the medical records. It is not some made up story. No matter how tall Drew was he was 13 and developmentally there is a difference. How you treat and how a 13 year old behaves are different than an adult. Educate yourself!

    • Based on the reports, it is a confirmed fact that the ETT was in the patient’s esophagus on arrival at the receiving facility. In theory, it could have been properly placed initially and been dislodged during movement of the patient, but in that case, there should be documentation of waveform capnography used to confirm that tube placement was correct up to that point .. Which there isn’t.

      Failed intubation attempts happen, but there is no excuse for not recognizing esophageal intubation. If there is any doubt, pull the tube and bag the patient.

      I agree that giving the family monetary compensation his death won’t bring their son back, but in this case an avoidable error was clearly made which led to his death. The kid’s age is irrelevant.

      • Hopefully the outcome of this will be more along the lines of what happened with David Rosenbaum where it resulted in an overhaul of the systems that failed, not a load of money alone.

        • One only need look at the current state of EMS in the District of Columbia to know that there was no “overhaul of the system”. A few of the Titanic’s deck chairs were re-arranged, but nothing more.

          If I were the Rosenbaums I would petition the court to find the District in violation of the settlement. They gave up a lot of money on the promise that the system would be fixed. My humble opinion would be that an injured police officer lying in the street for 20 minutes, and a cardiac arrest not receiving an ambulance for 45 minutes, provide all the proof anyone should need that the Rosenbaums were cheated.

    • He did NOT have a “severe” head injury. And the lawsuit was never about money. It was about education and ensuring that this will not happen to someone else’s child.

  10. Believe me, the family wants change to happen and care to be improved in their community. The problem with Carteret General Hospital is that patient care has taken a back seat for too long and making a profit has become a main priority, however they can do it.

    Patient care has suffered greatly due to the culture the current administration has created.They have yet to even acknowledge that an event occurred on June 28th. It is not just a monetary issue but for this hospital to change it will take hitting them where it hurts. I can’t even imagine how this child’s parents function daily knowing what they know.

    In my opinion they deserve whatever they can get so they can take some time and move on with their lives worry free. I know this family and there are so many good things they want to do in honor of their son. Drew Hughes was a WONDERFUL child and his loss has deeply affected this community. Drew’s father still works at the hospital. I don’t know how he manages to go there everyday.

  11. No matter what the age..This is a preventable death…
    As a parent and a practicing paramedic I am very upset.He deserved better care..
    Enough said.

  12. A few things.. If the hospital ambulance is not certified for this type of transport..

    Why did they not request Vidant to send thier CCT unit with a Critical Nurse, RT and medic or thier helicopter?

    Why was he intubated if he was talking beforehand?

    Why wasnt he physically restrained along with chemical restraint?

    Why did they change crew members during transport?

    This is a cluster from the first minute. The RT and nurse should have not been in that ambulance and the medic should not have been driving he or she should have been in the back. But ultimately the ER physician and staff made very poor choices on who to transfer the child with. The crew was under trained and under equipped.

    Stay Safe

  13. So, here’s the problem. Those in power don’t want to deal with this systemic problem. It’s not just this service or this county, it’s EMS. Just take the call and it’ll be ok. And if bad things happen find the easiest person to crucify without causing any damage to the organization itself. Until there’s a standard for everyone to be able to say no to these kind of things without fearing for their livelihood this will continue to happen. And people will continue to suffer because we refuse to make it any better all in search of the almighty dollar and the maxim of never daring to question the patient/customer. Until then it won’t get any better.

  14. What I write does not change your protocols. If you do not like a protocol, take it up with the medical director. I have several inadequate protocols, too. I call medical command and attempt to persuade the physician that what I am requesting is in the best interest of the patient. It is rare that I am turned down, but the dose is often inadequate. I call back before I need more, so the patient does not have to put up with the On Line Medical Command delay in treatment. Health care providers should be anticipating where the care of the patient is headed – both for good and for bad.

  15. That sound suspiciously like a quote

  16. karma, Cgh deserves whets coming

  17. That hospital cares about nothing but the money they make. Even the charge nurses, most of them, are incompetent. The charge nurse I worked under did not even fill out our renewals for our licenses. I know of several people who lost their schooling, licenses, certs, and JOBS due to the lack of the charge nurse ever filling our our renewals. THIRD MEDICAL FLOOR CHARGE NURSE PAT, A WOMAN WHO IS NO LONGER THE CHARGE NURSE THERE BUT STILL WORKS IN THAT HOSPITAL. We were always understaffed and never had anyone to go to about it because she was never on floor. Our patients got the best care we could give them and that resulted in us being rushed and late ending shift some but we did what we had to. I had started applying for other jobs a few mrhs in because I was never slated for my CPR class, as everyone knows you have to be current and keep current. The charge nurse was never there and I reminded her daily of my need of my BLS CPT & First Aid. NEVER did I get it. I lost my license before I ever got it when renewal time came around I gave Pat . The charge nurse, my renewal forms and she sat on them as I learned from many others they were working new places BC she failed to renew their licenses and certs too. DREW DID NOT HAVE TO DIE. THAT HOSPITALS ICOMPETENT WORKERS DUE TO THEIR LACK OF STANDARDS AND MONEY HUNGRY PEOPLE RUNNING THAT HOSPITAL ARE USELESS AS ARE MOST OF THEIR ER PHYSICIANS. Its scary that people of Carteret County have only that horrible hospital to be taken to. if I lived in Carteret County I would derive right on up to Carolina East. At least they actually care about their hospital, patients, and workers. God bless Drew’s family. And Drew you are missed. And yes my son knew Drew. That hospital needs COMPLETE RESTRUCTURE FROM THE TOP DOWN!

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