Doctor, hospital sued in alcohol death | York Daily Record | 5.4.05
The complaint alleges Amy S. Gebhardt died after being discharged by the doctor.
A Hanover woman died from alcohol poisoning last year hours after being released from the hospital where police had taken her for a blood alcohol test, according to a complaint filed Tuesday in York County Common Pleas Court.
The woman’s mother, Susan Bilbo, is suing Dr. Michael R. Denney, his employer and Hanover Hospital, alleging negligence and wrongful death. …
A blood test showed her blood-alcohol level to be 0.332 percent, more than four times the legal limit for driving.
Bilbo’s complaint states that “despite obvious signs of intoxication,” Denney discharged Gebhardt back into police custody at 2:24 a.m. with his “okay for incarceration.”
Gebhardt was released without bail to her boyfriend after her 3 a.m. arraignment on DUI charges, the complaint states.
The 39-year-old woman was found dead at 7:30 a.m. and, according to the lawsuit, the York County Coroner identified the cause of death as ethanol toxicity. …
via Kevin, M.D.
Acute (and chronic) alcohol intoxication are a daily occurrence in any ED. A BAL (or BAC) of 0.332 mg/dl (or 332 using a different reporting scale) is a significant way to the LD50 of 0.5 (some use 0.4) for an acute ethanol intoxication. How you manage these folks is highly dependent on the individual clinical assessment and serial observations over time. Fortunately, ethanol follows zero-order kinetics, where there is a fixed metabolism of 25-50 mg/dl/hr of ethanol. I don’t necessarily get serial BALs, but I will follow for several hours clinical status against the metabolism of the initial ethanol level. I want to see them walking, talking, able to drink water, and have demonstrated their ability to protect their airway. Additionally, they must go with someone that will watch them. Many ED have the “sunrise spots” in their halls where they watch folks until sober enough to go home, usually by morning. Good place for them. They are our malpractice waiting to happen. I never discharge with “okay for incarceration,” what an incredibly dangerous statement — rather, patient is clinically stable (stop the EMTALA obligation) and document, “there is no acute medical condition that requires any further evaluation or management in the ED.” That’s what we really do! “Okay for incarceration” sounds too much like a blank check.
{ 2 comments… read them below or add one }
I'm with you. I know docs that write “Go To Jail” and that is actually what our local authorities request. However, I write, “Medical screen complete, no indication for continued acute medical care.”
I don't even measure initial alcohol if I can help it. I prefer, as you do, to evaluate the patient clinically. If they seem OK, I will discharge them. if not, I may have to check the BAL to get an estimate of when they may be able to go.
The problem is that there are people out there who would seem normal with a BAL that I couldn't stay awake long enough to achieve.
I’m with you. I know docs that write “Go To Jail” and that is actually what our local authorities request. However, I write, “Medical screen complete, no indication for continued acute medical care.”
I don’t even measure initial alcohol if I can help it. I prefer, as you do, to evaluate the patient clinically. If they seem OK, I will discharge them. if not, I may have to check the BAL to get an estimate of when they may be able to go.
The problem is that there are people out there who would seem normal with a BAL that I couldn’t stay awake long enough to achieve.