Woman's death in hospital emergency department ruled a homicide

"ED Homicide" may sound like a television thriller, but the term instead describes an Illinois coroner's jury's findings following the death of a heart attack patient who waited for two hours before emergency medical staff saw her.

The immediate cause of 49-year-old Beatrice Vance's death was a myocardial infarction. But a jury at a Sept. 14 coroner's inquest found that her death also was "a result of a gross deviation from the standard of care, which a reasonable person would exercise in the situation." With that, the jury determined "the manner of her death to be homicide," a ruling that physicians and state officials say is extremely rare and possibly the first in the state.

The case, at press time, was in the hands of the Lake County State's Attorneys Office to decide whether to pursue criminal charges and, if so, against whom.

While the case is under review, doctors worry that the threat of criminalizing emergency department care will endanger a specialty already burdened with high medical liability risk and limited resources.

"We are being asked to do more and more with less and less, and as that continues, we are going to be at risk to have more situations like this where we can't match the care to the demand," said Frederick C. Blum, MD, president of the American College of Emergency Physicians.

"It's one thing to get sued for malpractice and another to go to jail for doing your job," Dr. Blum said, adding that he has only seen criminal convictions in cases where doctors were impaired by drugs or alcohol. If criminal charges ensue in the Vance case, it could set a dangerous precedent that would have a "chilling effect" on doctors entering the specialty, he said.

A jury evaluates evidence

Lake County Coroner Richard L. Keller, MD, said that questions surrounding Vance's natural death and delayed care are what prompted the inquiry.

She "presented with classic symptoms of a heart attack and shouldn't have been made to wait," said Dr. Keller, a retired emergency physician.

Vance arrived at Vista Medical Center East emergency department in Waukegan, Ill., at about 10:15 p.m. on July 28 complaining of nausea, chest pains and shortness of breath, according to testimony presented to the jury. Nurses triaged her at 10:28 p.m. as semi-emergent with chest pains weighted at a level of 10 out of 10.

Nurses called Vance in for treatment at 12:25 a.m., despite several earlier attempts by her daughter to notify them of her mother's worsening condition, according to the testimony. At that time, nurses found Vance in the waiting room unconscious and without a pulse. Doctors got a weak response from Vance at about 1 a.m. after performing CPR. She was pronounced dead at about 2 a.m. due to a heart attack caused by blockage in the left main artery, according to the testimony.

The six-member jury had five choices as to the cause of death: homicide, suicide, accident, undetermined, or the office of the coroner's recommendation of "natural causes with a contributing factor of delayed and inadequate treatment," Dr. Keller said.

He does not believe the jury's homicide finding will result in criminal charges because the case "doesn't necessarily raise to the level of criminal homicide, despite that it may indeed have been a reckless act."

Meanwhile, Dr. Keller's office sent a report to the Illinois Dept. of Public Health for possible violations of the federal Emergency Medical Treatment and Active Labor Act.

"What this case points out is that indeed our system is failing people right now, so some changes need to be made," Dr. Keller said.

Cheryl Maynen, a spokeswoman for Vista Health System, said the hospital cooperated with the coroner's investigation, but she declined to comment on the homicide ruling.

Will criminal charges follow?

Matt Chancey, chief of the criminal division of the Lake County State's Attorneys Office, said his office is still investigating the case. He noted that Illinois criminal law does not have a statute for negligent homicide, although state law does include involuntary manslaughter, or reckless homicide.

"It would be a very extraordinary circumstance if the facts of this case were sufficient to support a criminal charge," Chancey said, adding that in nearly 30 years as a Lake County prosecutor he has not come across a ruling like the one in the Vance case.

Still, the ACEP's Dr. Blum said he has already heard anecdotal evidence of patients citing the incident to get emergency care more quickly.

"So it has the potential for great risk," he said.