Wednesday, November 29, 2006
A Mixed Bag - News from Here and There
The Libby Zion Case * Saudis threaten Big Tobacco * Pakistani Court rules in favor of Mother of Misbah Rana * Slaughter of Civilians in Iraq
Barron H. Lerner in the Washington Post: "Many people have vowed to avenge the untimely death of a relative. Lawyer and journalist Sidney Zion actually did so -- to the benefit of patients and doctors-in-training nationwide."
After his 18-year-old daughter Libby died within 24 hours of an emergency hospital admission in 1984, Zion learned that her chief doctors had been medical residents covering dozens of patients and receiving relatively little supervision. His anger set in motion a series of reforms, most notably a series of work hour limitations instituted by the Accreditation Council on Graduate Medical Education (ACGME), that have revolutionized modern medical education.
Just about everyone involved in the Libby Zion case -- her father, her doctors and the people who testified at the trial that eventually resulted -- has a different account of what happened. But there are some undisputed facts.
Libby was a college freshman with an ongoing history of depression who came to New York Hospital in Manhattan on the evening of Oct. 4, 1984, with a fever, agitation and strange jerking motions of her body. She also seemed disoriented at times.
Unable to diagnose her condition definitively, the emergency room physicians admitted her for hydration and observation. As the physician of record, Raymond Sherman, a senior clinician who had treated several members of the Zion family, approved the decision by phone.
On the hospital ward where she was sent, Libby was evaluated by two residents: Luise Weinstein, an intern eight months out of medical school, and Gregg Stone, who had one additional year of training. They, too, were not quite certain of Libby's diagnosis. Stone termed it a "viral syndrome with hysterical symptoms," suggesting that Libby was overreacting to a relatively mild illness. The doctors prescribed a shot of meperidine, a painkiller and sedative, to control her shaking. Sherman approved the plan by phone.
The events of the next several hours will always remain controversial. At about 3 in the morning, Weinstein went off to care for some of the 40 other patients she was covering. Stone went to sleep in an adjacent building, where he would be available, if necessary, by beeper.
After the doctors left, Libby became more agitated. The nurses contacted Weinstein at least twice. Weinstein ordered physical restraints to hold the patient down and prevent her from hurting herself. She also prescribed an injection of haloperidol, another medication aimed at calming her down. Busy with other patients, Weinstein did not reevaluate Libby.
Libby finally fell asleep, according to the nurses, but when a nurse's aide took her temperature at 6:30 a.m., it was 107, dangerously high. Weinstein was called and emergency measures were tried to lower the temperature. But Libby Zion suffered a cardiac arrest and died. Weinstein called her parents, telling them doctors had done everything they could.
To the doctors at the hospital, the case was an inexplicable "bad outcome" in which a healthy young woman had died of a mysterious infection.But the more Sidney Zion learned of the circumstances of Libby's death, the more he rejected this assertion. He became convinced his daughter's death was due to inadequate staffing at the teaching hospital. And he grew determined to ensure that others not fall victim to the same gaps in the teaching hospital system that he blamed for his daughter's death.
Saudi Arabia has warned that it will sue global tobacco firms unless they pay the full cost of treating patients suffering from smoking-related illness.
The health ministry said it had already rejected a lower offer from the tobacco firms, though did not say what level of compensation it was seeking.
A 12-year-old schoolgirl must return to her mother in Scotland, a judge in Pakistan has ruled.
Misbah Rana, also known as Molly Campbell, is at the centre of a custody battle between her estranged parents.
The military said the soldiers searching the building also found the bodies of two women.
Iraqi police said all the dead were civilians from two families.
Not all bad here though, unlike what some of the mainstream press have been reporting. Very low crime, traffic, pollution, urban sprawl. Beaches are good, too.