Young boy dies in hospital waiting room "because he had to wait"

[LannaGuy]

4 minutes ago, mark131v said:

No just from what is written here it sounds potentially like an aortic anurism, some of the indicators are there such as the severe upper abdo pain and this should have been investigated, a few very simple questions and a simple examination should have highlighted this

 

What this does show is there appears to be a fundamental lack of knowledge relating to life threatening symptoms and a failure of the staff to pick up on this and triage the patient, by the way I work as a paramedic and these symptoms as they are reported here would have been picked up whether he could have been saved is questionable but early diagnosis would certainly have offered him a chance

You are right it's possible but we don't know everything. Was the A&E full of a serious car accident and they thought he could wait?  was he just standing there and suddenly collapses?  you know that after an event like this it is easy to say 'this and that' but I doubt those nurses and doctors meant him to die and probably made the call they thought was the correct one.  IF he had been carried in flat out things would have been different I'm sure. Blaming doctors and nurses doesn't really sit easy with me as they are, generally, dedicated to helping people. This is not Barts and we can't expect the same standard.

[Here2008]

8 minutes ago, mark131v said:

No just from what is written here it sounds potentially like an aortic anurism,

That is a problem usually associated with being middle aged/elderly/

 

I have just searched the PubMed and Cochran databases for reports/stats of pediatric case of AA  which resulted in a total of five cases all of which were found in children with serious problems associated with life shortening genetic abnormalities.

Very, very, rare !

[Prbkk]

3 minutes ago, LannaGuy said:

You are right it's possible but we don't know everything. Was the A&E full of a serious car accident and they thought he could wait?  was he just standing there and suddenly collapses?  you know that after an event like this it is easy to say 'this and that' but I doubt those nurses and doctors meant him to die and probably made the call they thought was the correct one.  IF he had been carried in flat out things would have been different I'm sure. Blaming doctors and nurses doesn't really sit easy with me as they are, generally, dedicated to helping people. This is not Barts and we can't expect the same standard.

Agree with that but for the description of severe pain in the article. IE, not just pain, not moderate, not strong...but SEVERE, indicating urgency, priority, immediacy. Who would leave a child in that state in a waiting room? 

I'm sure they didnt want him to die but the fact remains, admittedly at first glance and without all the facts, that a child died in the waiting room when he should have been assessed as an urgent case.

Sometimes the system doesn't work and those responsible for it need to be questioned on their (in)action(s).

[Pridilives]

20 minutes ago, hgma said:

If that was the case, why is this country infested with corruption?

Top down!-Bottom up

It is indeed infested. It took a long long time to get that way though. in order to maintain the corruption  Some are fighting very hard to prevent democracy becoming establish. Only one elect government last full term. That government give universal healthcare. Before universal if family no money this boy just die at home. Best thing for improvement is government come from people. 

[LannaGuy]

Just now, Prbkk said:

Agree with that but for the description of severe pain in the article. IE, not just pain, not moderate, not strong...but SEVERE, indicating urgency, priority, immediacy. Who would leave a child in that state in a waiting room? 

I'm sure they didnt want him to die but the fact remains, admittedly at first glance and without all the facts, that a child died in the waiting room when he should have been assessed as an urgent case.

Sometimes the system doesn't work and those responsible for it need to be questioned on their (in)action(s).

where is this word "SEVERE" or "severe pain"? I have re-read the article because maybe I missed something but those words are not used. Often people with stomach pains don't want to sit I doubt this could have been foreseen. The relatives, in shock and grief, but they are not doctors I assume and they can't say "could have been saved" they are just reacting to the obvious shock.  RiP 

The poster said that the boy had repeatedly been told to wait after arriving at the hospital with stomach pains.

Even though he couldn't even sit he was still told to wait his turn.

He passed out and was given CPR and then an X-Ray revealed a large blood vessel had burst.

Following the X-Ray he went into shock again and this time could not be revived.

The shocking scene was witnessed by relatives and others waiting at the hospital.

A video was even made.

The poster of the clip said that he had died because he had been told to wait and that the relatives believed he could have been saved if the hospital had given him the appropriate treatment right from the start.

[todlad]

3 hours ago, LannaGuy said:

Very difficult for hospital staff to know it was that serious. Just a very unfortunate incident but I wouldn't blame the hospital as long as they triage as normal. 

I go to the eye hospital every few months to check the pressure in my eye. I arrive and within minutes they take my blood pressure and weigh me. Basic practice.

 

In A&E they prioritise their patients, of course. However, I believe children are always somewhat prioritised. In this case, this boy's blood pressure would have been lower than normal: red flag. Move him up the list. Do they treat on a first come, first served basis here?

 

 

[Prbkk]

3 minutes ago, LannaGuy said:

where is this word "SEVERE" or "severe pain"? I have re-read the article because maybe I missed something but those words are not used. Often people with stomach pains don't want to sit I doubt this could have been foreseen. The relatives, in shock and grief, but they are not doctors I assume and they can't say "could have been saved" they are just reacting to the obvious shock.  RiP 

The poster said that the boy had repeatedly been told to wait after arriving at the hospital with stomach pains.

Even though he couldn't even sit he was still told to wait his turn.

He passed out and was given CPR and then an X-Ray revealed a large blood vessel had burst.

Following the X-Ray he went into shock again and this time could not be revived.

The shocking scene was witnessed by relatives and others waiting at the hospital.

A video was even made.

The poster of the clip said that he had died because he had been told to wait and that the relatives believed he could have been saved if the hospital had given him the appropriate treatment right from the start.

You are correct; I was extrapolating from the description of his inability to sit and read "severe" when it's not printed. 

[mommysboy]

3 hours ago, LannaGuy said:

Very difficult for hospital staff to know it was that serious. Just a very unfortunate incident but I wouldn't blame the hospital as long as they triage as normal. 

I'm not so sure about that!  If he was unable to sit down, that really should have rung bells.

[thaibeachlovers]

3 hours ago, colinneil said:

Tragic the loss of any life is tragic, the boy was taken to hospital and told to wait.

Happens every day in every country in the world.

So why are some posters here condemning staff training/ government policy?

Stop it you silly buggers, staff at the hospital were probably busy with other patients.

Had they known the boy was in need of urgent attention, they would have attended to him sooner.

Well said. We don't know from the OP if the staff were all dealing with more critical situations at the time. If however, they were sitting around flirting, then there is a problem.

While I'm not a fan of Thai hospitals, we don't know enough about this incident to judge.

[mark131v]

8 minutes ago, Here2008 said:

That is a problem usually associated with being middle aged/elderly/

 

I have just searched the PubMed and Cochran databases for reports/stats of pediatric case of AA  which resulted in a total of five cases all of which were found in children with serious problems associated with life shortening genetic abnormalities.

Very, very, rare !

True it is very rare but some of the common symptoms are mentioned here and also the description fits from what the hospital has stated

 

What I would say is if I was called or any other NHS paramedic for that matter to those symptoms he would be a very high priority and would be triaged properly from the outset again simple questioning and a simple assessment should have flagged him as a priority case

 

What is reported here is a failure to notice a high priority patient with tragic consequences which may or may not have been treatable and I have had several incidents with Thai hospitals that highlight some really poor practices and a lack of basic skills that we take for granted in the west 

[DavisH]

57 minutes ago, LannaGuy said:

Yes if that's what actually happened but I suspect no one thought it was that serious but they all jumped to it once he collapsed. Easy to sit here and say "they should have known" and they may have had a couple car accidents in with patients in dire need and they made a judgement call (we don't know).

One wonders what information was given to the hospital when their son was brought in. I've not heard of spontaneous internal bleeding, but I guess it could happen. What was the cause? Was the child assaulted or in an accident? The nurses obviously didn't expect it to be this severe, and perhaps they see many children with the same symptoms everyday. Hopefully the incident will be properly investigated and their system corrected to minimise such occurrences. 

[masuk]

4 hours ago, LannaGuy said:

Very difficult for hospital staff to know it was that serious. Just a very unfortunate incident but I wouldn't blame the hospital as long as they triage as normal. 

yes, but was he triaged?

[phetpeter]

Sorry to say, But at a government hospital you will not be asked to pay first, you will receive treatment in ER quickly. You will be check over and of course move into the line of treatment on the seriousness of the problem. When I had my heart attack, I was in hospital and being treated within 30minutes. and when A stent was required I was given an appointment within a week, spend 2 days in hospital. 5 years later I still have 3 month check ups. 40 mins max in the morning and 40 minutes seeing doctor and getting medicines in late afternoon. and if it wasn't for the social security scheme I am on the bill would only average 8,000baht every 3 months. The ER treatment was free. The stent cost 120,000baht, but would have been free except the school hadn't paid my health insurance. and I laugh at the foreigner's who insist going to the private hospital paying buckets of cash and in some towns then being driven to the government hospital has they don't have the doctors or equipment to do the job. 10,000 baht per night at private hospital,with menu choice 3,500 baht for a 5 night stay in government hospital VIP room, discount if you share the VIP room. decent meals if you don't like hospital food brought in with family. Had a bowel lump spend 5 nights on drip, plus 2 CAT scans X-rays and 3 hourly visit from doctor and 2 visits from surgeon. All clear but have 6 monthly CAT scan and check ups 18months now....FREE

Edited July 22, 2017 by phetpeter
speelin mistake

[atyclb]

3 hours ago, petermik said:

Sadly the lack of real basic training in most government hospitals here is obvious,lots of nurses/staff with little or no real knowledge to deal with cases such as this....tragedy that never should have happened but sadly will again and again

R.I.P. young man

what do think happened to the boy then?  something the nurses did not have adequate training to suspect?

[xerostar]

 

Recently a 34 yer old Thai lady in Bangkok told  me of her terrible experience.

She was pregnant and in the 40th week and looking forward to see her new baby.

She went the the maternity hospital for her scheduled checkup.

 

It was noted that the baby's heartbeat was slow. (This is considered a sign that the baby could be in trouble.)

The junior doctors suggested that she stay in hospital as early signs of labor had begun.

She was directed to the senior doctor upstairs for a final say and he told her to go home.as it was "too early."

 

Not long after returning home her waters broke.  She said the baby was no longer moving at that time.

She rushed back to the hospital where they carried out an emergency cesarean.

The baby was still-born. The mother was devastated as everything had progressed so well up to that point.

 

To me this seems to have been a totally mismanaged  labor.

From what I have seen, Thai public hospitals offer only a very basic health care.

In this case the doctor concerned failed miserably in his duty of care.

 

The woman is now terribly depressed. The hospital did not offer her counselling or  any support .

They are more concerned with getting the extra money for the cesarean operation.

Now she told me she a lot of pain and feeling cold.   It's now 2 weeks since the operation.

I told her to seek medical advice immediately as she may have a severe infection developing.

[petermik]

10 hours ago, colinneil said:

 

Stop it you silly buggers, staff at the hospital were probably busy with other patients.

Had they known the boy was in need of urgent attention, they would have attended to him sooner.

Thats where proper training comes in.........had they known...........he should have been checked out properly when he was admitted/assessed

[Sydebolle]

Most hospitals, even private ones like Rutnin Eye Hospital, is VERY, VERY, VERY generous with the time of their patients. For a standard treatment - on pre-arranged appointment -  which I need every month I've spent between 45 minutes and 5 ½ hours; in one case I even left. 

In other countries there is a quick assessment on arrival of the patient and, depending on that either attended to immediately or later. Appointments are in general kept too. 

[phetpeter]

The sad thing is that when a large blood vessel ruptures in the body, there may be no oblivious signs, blood pressure would not necessarily show that something was wrong in a young male, has his heart would continue to preform its role. Stomach pains are common due to poor food hygiene. and a serious flu situation is present in Thailand at the moment which includes stomach cramps. He was probably putting the brave Thai face, and the nurses at first had no reason to think differently. You can see from the photograph , that they are in attendance. but, with the large blood vessel ruptured his outlook was probably bleak and it was just the clock ticking. Not everybody can be fixed, so even if he had surgery he may not have survived, we have no knowledge of when the trouble began nor how long it was before he got to hospital. and the body cavity can hold a lot of fluid before it becomes noticeable. RIP

[colinneil]

14 hours ago, petermik said:

Thats where proper training comes in.........had they known...........he should have been checked out properly when he was admitted/assessed

Please get your facts correct the boy was never admitted 

Why are you going on about training?

WHERE YOU THERE? did you witness the incident?n answer yes to both questions, your comments are valid.

If the answer is no, which it probably is. Please stop condemning the staff.

[atyclb]

5 minutes ago, phetpeter said:

The sad thing is that when a large blood vessel ruptures in the body, there may be no oblivious signs, blood pressure would not necessarily show that something was wrong in a young male, has his heart would continue to preform its role. Stomach pains are common due to poor food hygiene. and a serious flu situation is present in Thailand at the moment which includes stomach cramps. He was probably putting the brave Thai face, and the nurses at first had no reason to think differently. You can see from the photograph , that they are in attendance. but, with the large blood vessel ruptured his outlook was probably bleak and it was just the clock ticking. Not everybody can be fixed, so even if he had surgery he may not have survived, we have no knowledge of when the trouble began nor how long it was before he got to hospital. and the body cavity can hold a lot of fluid before it becomes noticeable. RIP

 

pulse increases before blood pressure drops as the heart tries to compensate by pumping more blood but there is not adequate blood to pump even at a increased heart rate.

[atyclb]

a boy or teenager has an extremely low chance of having a triple A rupture or threatened rupture. appendicitis would be much more likely thus evaluation for same with sonography could have shown the triple A. not all hospitals have surgeons capable of taking care of a triple a and the mortality rate is not insignificant.  perhaps the kid was triaged and had no fever thus an appy was not suspected and he was made to wait. 

[Prbkk]

13 hours ago, colinneil said:

Please get your facts correct the boy was never admitted 

Why are you going on about training?

WHERE YOU THERE? did you witness the incident?n answer yes to both questions, your comments are valid.

If the answer is no, which it probably is. Please stop condemning the staff.

But that's the whole point: he should have been seen immediately he presented with those symptoms. It is not up to a poorly paid , marginally qualified triage nurse to make a judgement other than that his symptoms indicated a potentially ( tragically, actually) life-threatening condition. It's for the first-line doctors to diagnose, treat etc. The (possible)failure here was in triage...he should have been seen by a medic, promptly; he wasn't, he died on the waiting room floor. 

Frankly, I can't see your point as it's more than reasonable to ask questions about the quality of his treatment and ,if there were failures, did they contribute to his death.

[atyclb]

5 minutes ago, Prbkk said:

But that's the whole point: he should have been seen immediately he presented with those symptoms. It is not up to a poorly paid , marginally qualified triage nurse to make a judgement other than that his symptoms indicated a potentially ( tragically, actually) life-threatening condition. It's for the first-line doctors to diagnose, treat etc. The (possible)failure here was in triage...he should have been seen by a medic, promptly; he wasn't, he died on the waiting room floor. 

Frankly, I can't see your point as it's more than reasonable to ask questions about the quality of his treatment and ,if there were failures, did they contribute to his death.

 

a kid with severe abd pain imo would make for a difficult and limited abd exam by a medic, nurse or md. the guarding would likely be great, a sad and difficult case and a likely already overburdened facility.

[petermik]

13 hours ago, colinneil said:

Please get your facts correct the boy was never admitted 

Why are you going on about training?

WHERE YOU THERE? did you witness the incident?n answer yes to both questions, your comments are valid.

If the answer is no, which it probably is. Please stop condemning the staff.

He should have been,that is the whole point,he passed away in the waiting room,and I,m not condemning the staff but questioning the ability of whoever it was looked at the poor chap when he came in seeking treatment

[spidermike007]

5 hours ago, missoura said:

Many years ago there was a Thai lady  selling noodles at the school I worked at in Bangkok. Her teenage daughter lived upcountry to attend school. One day while heading to the market with her two friends on a motorcycle, a car swerved from the other lane and hit the girls. No one was killed, but the noodle daughter suffered a serious leg injury.

 

She was taken to the hospital and told that proof of payment must be shown before receiving any medical care. By the time arrangements were made, it was too late. This young girl lost her leg. In the weeks following the accident, most everyone at school pitched in and bought a prosthesis for her.

 

The person who hit her, was a teenage son of a policeman. His family sued the girl's family for damages to their car. Never did hear the outcome.

 

Can you even begin to imagine the mentality, and perspective of a family who sues the family of the girl who lost her leg, due to the negligence of their pissant son? Hard to even begin to fathom the social and societal disconnect they had to experience to file that suit. Hope the judge threw them out of the courtroom with a serious word of advice about the usage of the legal system, and their obligations as members of society and a policeman. Being a policeman is nothing special. It confers no special status, but we know there is alot of abuse of that position, here in the LOS.

Edited July 22, 2017 by spidermike007

[pauleddy]

As someone who was Head of ER for 12 years, my first comment is that Abdo Pain in young children is very common and usually nothing or of unknown origin. By that, I mean that it's wind, constipation or 100 other things. Peritonitis following a burst appendix  can take a while to distinguish but it is pretty obvious and should not be missed. A burst aorta (blood vessel) in any part of the trunk is quite rare in children unless there is some type of congenital defect--ruptured aortas happen to older people who have loads of cholesterol. Diverticulitis can be very painful and may need surgery in extreme cases.

 

Differential diagnosis of Abdo pain is an art and a great skill. Only experienced surgeons do it well, and scans plus bloodwork often helps. Sometimes the surgeon has no idea, and will open the abdo to do an exploratory laparotomy

  But, this is a tragedy nonetheless.

 

Every ER dept "misses" things from time to time, especially when we are busy. Often, the stuff missed consists of fractures which are small and need difficult and unusual XRays to locate, but "silent" heart attacks do exist and I have had people die in my arms for no obvious reason.

 

RIP and best wishes to the family.

 

Eddy 

[psyvolt]

1 hour ago, Here2008 said:

A highly unusual occurrence. 

 

In the absence of a history of trauma (however inflicted) this will likely prove to be the result of a congenital condition affecting the cerebral blood vessels.

How do you come to that conclusion?

[LannaGuy]

Just now, pauleddy said:

As someone who was Head of ER for 12 years, my first comment is that Abdo Pain in young children is very common and usually nothing or of unknown origin. By that, I mean that it's wind, constipation or 100 other things. Peritonitis following a burst appendix  can take a while to distinguish but it is pretty obvious and should not be missed. A burst aorta (blood vessel) in any part of the trunk is quite rare in children unless there is some type of congenital defect--ruptured aortas happen to older people who have loads of cholesterol. Diverticulitis can be very painful and may need surgery in extreme cases.

 

Differential diagnosis of Abdo pain is an art and a great skill. Only experienced surgeons do it well, and scans plus bloodwork often helps. Sometimes the surgeon has no idea, and will open the abdo to do an exploratory laparotomy

  But, this is a tragedy nonetheless.

 

Every ER dept "misses" things from time to time, especially when we are busy. Often, the stuff missed consists of fractures which are small and need difficult and unusual XRays to locate, but "silent" heart attacks do exist and I have had people die in my arms for no obvious reason.

 

RIP and best wishes to the family.

 

Eddy 

this

[Prbkk]

6 minutes ago, atyclb said:

 

a kid with severe abd pain imo would make for a difficult and limited abd exam by a medic, nurse or md. the guarding would likely be great, a sad and difficult case and a likely already overburdened facility.

I'm sure that's right and the outcome may well have been the same. But the issue is about the quality of care, from arrival to end. He didn't get the best possible care because he didn't get past step 1.

The Australian system has had a significant number of similar cases over the last 5 years or so, some so egregious that commissions of enquiry were held, with scathing findings.

[akampa]

4 hours ago, seajae said:

in Australia you are seen by the nurse as you come in, temp and bp taken as well as pulse, this is everyone. If you happen to have bad readings you are pushed through, this is always the best method but here someone with a runny nose gets preference over someone dying because they were there first, very backward.

 

 large hospitals that I have been to here in Chiang Mai with my  baby always checks temperature and blood pressure  before anything else.