Natasha Richardson's Death Raises Questions About Healthcare Reform

Trisha, you are correct that the Canadian healthcare system is not to blame. Being Canadian, I know that we have some of the finest facilities in the world, and those in critical condition (regardless of financial status for citizens) receive the timely help that they need (when it is sought).

Head injuries are a unique type of trauma. I know someone who violently refused treatment after a head injury, but it was because of the damage to his brain that he was acting that way. It’s hard to know in the case of Ms. Richardson who, if anyone, is to blame.

Ultimately, we as patients can screw up our own care – or it can get that way from an inattentive doctor. So – if Natasha Richardson had just let the medics attend to her, she might be recovering, or in treatment right now, instead of on the way to eternity. And, if Anna Nicole Smith had not trusted the wrong people with her health, she might still be enjoying her baby and her life. It seems that life and death are matters that may depend on good judgement and wisdom. Which is why we need to be proactive about our own health.

A US hospital does not need to be a Level One trauma center to have a CT scanner available, nor does an acute head trauma patient be able to “afford” prompt & excellent care before receiving it.

An epidural hematoma is an acute surgical emergency that requires immediate intervention. Many patients recover fully with no sequellae. Over the course of several hours, an initially concious Ms. Richardson apparently was shuttled to TWO separate Canadian hospitals before being transferred to NYC. What was done by the Canadian system to handle her problem? When did she receive a CT? Was she evaluated by a neurosurgeon? Was she taken to the OR in Montreal for evacuation of the hematoma? If not, why not?

The media has been typically silent about addressing them, but these are serious questions that many medical professionals are discussing today. To simply ignore them by placing the blame on Ms. Richardson herself is doubly tragic.

Interesting — there are two points that are important here. Firstly, we need sufficient resources to treat the healthcare needs of the population, and secondly, we need to be proactive and assertive in getting out needs met. Although I don’t think it was relevant in this case here, some provincial Canadian healthcare systems also exclude people from medical coverage for three months if they have been out of the country for over 6 months. This is an appalling situation for Canadians returning from their travels and needing immediate medical attention.

Finally an educated response from an American physician! Thank you; I couldn’t agree more! How telling that this patient was not triaged at the first sign of neurological deterioration to the neurosurgical specialty hospital in Montreal…and yes, there is one. Or could it be that there were “no beds” available in Canada’s broken health care system? A time line would indeed tell all.Though not an optimal surgical situation,emergency burr holes to relieve intracranial pressure can be done in small hospitals too…if you’re not too busy trying to locate an appropriate hospital to which to transfer the patient. Speculation? Yes. Probable? Highly…this is the kind of thing that happens in govenment operated health care systems…delay in care to jump through hoops of red tape. My heart goes out to the family for this needless and tragic loss. And also for the terrible sadness they will experience when they learn that the situation was mishandled.

American Physician and RN MSN,

I absolutely understand what you are saying about the care that COULD have been received, and as American Physician said, the media (or more probably the first hospital she went to) has been silent…

But please help me understand….

I have read that she would have needed care (CT scan, then opening her skull) within an hour of the accident. She never got to the hospital until at least 2 hours later, and now some reports say it was closer to 3 or 4 hours later….

So how could you hold a system responsible? It makes no difference which side of the border she was on — she did not get to any hospital in time to help herself.

My point about responsibility is this: if you don’t seek the help, then you don’t get the help. And blaming the system, no matter which system it is, does not change that fact.

Trisha

Why is there no account of the treatment richardson received at the two Quebec hospitals. What was her condition at the local hospital that they sent her on a 60 mile trip to Montreal? Did she have a CT?
Blaming the victim for failing to ask for help is obscene, Canadians. Once the ambulance attendants saw her condition, a compassionate, caring system would have RUSHED her to a proper hospital.

And is it true that Catholic hospitals in Quebec refuse to take people off life support?

As an anesthesia provider who first practiced in Pittsburgh, Pa and now practices in southwest rural ga, I find much of your argument dead wrong. Wether you are insured or not insured in the US, if you have an epidural bleed your outcomes are far better in the US than Canada. In the US, if you are poor come to any hospital with those symptoms you can not be turned away. In southwest Ga, we have no level one trauma center, but preform hundreds of emergency burr hole, and craniotomies for bleeds similar and not similar to Ms. Richardson. Had Ms. Richardson been skiing at Killington Vt, even after she turned away health at first, she would have been life flighted to a center able to perform the surgery. She would be alive today had it not been the canadian socialist health care system killing her. I know to many physicians who have practiced all over the world in socialist systems that kill people everyday by their bureaucracies that prohibit what in the US is routine. “The lack of medical helicopters in the province of Quebec may have played a role in Richardson’s death,” Montreal’s top head trauma doctor said Friday. Canada doesn’t spend money on things like helicopters. In other socialist health meccas like New Zealand they offer no open heart surgery at all. In Great Britain, Germany and other, if you are deemed to old and have an emergency need you will die from the socialist health systems refusal to care for you. Soon if Obama has his way every citizen in the US will experience this also regardless of your desire to pay. Only Obama and his cronies in the government will get healthcare we all will die like Ms. Richardson and many others whom have died becuase socialist systems poor health care.

You are mistaken.In the US,there are level 1 trauma centers in rural areas.An example is the Dartmouth-Hitchcock Medical Center in rural Hanover, New Hampshire.

IS — thanks for the correction on the Level I trauma center. That’s why I said “as far as I know” — because I wasn’t sure.

I agree with other posters — we don’t know what went on in any of the Canadian hospitals. Very true.

But my statement still stands: it makes no difference what kind of medical system exists — for profit or government or even a combination — if the patient doesn’t access the system, then no system can be held responsible.

Trisha

Response to Ms. Torrey’s request for understanding, A head injury like the one in question has a pattern of progression of symptoms, beginning with a headache and progressing to confusion, disorientation, weakness of extremities, loss of consciousness, dilitation of one pupil, dilitation of both pupils, herniation of the brain stem, and brain death. These events occur over time, that’s why a time line would be useful. We also have no idea what other responsible adult may have been with her while these things were occuring. But, the patient doesn’t always “talk and die” as the slang says,at a particular rate of speed; these events occur depending on the rate of intracranial pressure caused by the rate of the bleeding. Trained emergency personnel know what all these symptoms mean after head trauma. At some point I’m sure she had a head CT. As the anesthetist (above) and I pointed out, burr holes were in order..a neurosurgeon would have talked the local doc through this if necessary in our country. Regarding the failure of the system, if she had been transported fast to Montreal’s trauma center at the time of her headache(e.g. by helicopter, not available to those in Quebec due to cost, a spending priority decided upon by the Canadian Health Care system,)things likely would have turned out differently. That said, there is also the remote possibility that she had a malformation in the blood vessels in her brain that could have contributed…a much, much less common scenario, but it could happen. As CRNA said, any head trauma patient taken to an ER in our country would be treated, not turned away. So “affording” has nothing to do with true emergency care in the U.S.A. Sure, we have problems in some areas of health care here, but emergency treatment is not one of them. If you want to lower costs in our system, start with tort reform. (Of course that’ll happen…with the masses of lawyers in Congress and Obama’s values…that’s sarcasm by the way..) Our health care is still the most advanced in the world…why would we want to let the government get involved and destroy the things that make it so? Incidentally, why do you think Canadian physicians come here to practice?

Basing our (currently) 3 trillion dollar health care system on one person’s experience is a mistake.

Considering that we are spending an increasing large fraction of our GNP on medical care (under all the recent presidents), I think we’re going to have to figure out another plan. Otherwise, there won’t be enough resources left for capitalists OR socialists.

WRT to Natasha Richardson, for all we know, she herniated by the time she reached to 1st hospital or she received a Burr hole and herniated anyway.

May she rest in peace.

I am Canadian, and would like to add that the Canadian healthcare system is not all that it’s cracked up to be. Did you know that Montreal for example does not help a medical helicopter? Had such a helicopter been available, it could have taken Natasha more expediently to Montreal. US hospitals tend to have much more high tech, and savvy medical equipment, and unfortunately, it is true that a bed shortage can delay care even in emergency situations. This routinely, happens in Canada and des result in deaths.

I believe had the same accident happened in the US, that Ms. Richardson would have been more likely to survive, because her medical care would have been delivered expeditiously, in general all around better than what is available to Canadian residents. Doctor: Lack of medical helicopter cost Richardson
http://news.yahoo.com/s/ap/20090321/ap_on_re_us/natasha_richardson

Actually, the province next door to Quebec, Ontario, had too frequently had to send neurosurgery patients to the US. These were trauma patients brought into the ER at busy Toronto hospitals. Due to the bed shortages, ER nurses and doctors had to scramble to find care. In the meantime, these delays meant that the patients were not getting a crucial operation and moving them would perhaps presents lead to further deterioration, brain damage, and possibly death that might otherwise be prevented if more immediate care was available at the Toronto hospital. There are many problems that exist in all provinces and territories throughout Canada.

Its important for Americans to keep in mind, when travelling to Canada, that healthcare may not be up to that received at home. If you get injured, rather than take a chance, go to the hospital, because it can take hours to get care in a Canadian emergency room. Often there are l-o-n-g delays. This even occurs when its necessary to send a person from a smaller hospital to a larger trauma centre. In some cases this happens when the tertiary hospital lacks critical care beds. In Canada this happens a lot, please be forewarned.

You might find the following interesting:

“More than 150 critically ill Canadians – many with life-threatening cerebral hemorrhages – have been rushed to the United States since the spring of 2006 because they could not obtain intensive-care beds here.”

http://www.theglobeandmail.com/servlet/story/RTGAM.20080119.neuro191/BNStory/specialScienceandHealth/home

This is pure fiction. I have treated dozens of brain bleeds and never had an epidural hematoma die. The CT can be very basic. A cheapo 16 slice is perfectly adequate. Once identified we insert a catheter in the ER and send the patient to neurosurgery or the OR. Depending on the severity of the bleed dictates whether the skull will be surgically decompressed and the bleeding stopped. Canada simply doesn’t treat emergencies very well. I know a patient with a brain aneurysm that has waited 11 months for surgery. Each day they run the risk of dying for something we do daily at our hospitals in America.

We often get Canadians in the ER and they want nursing to get pre-approval for procedures such at CT scans. I couldn’t care less about some Canadian cost saving measure when I have a patient in jeopardy. Not long ago I had a Canadian that simply fell while walking out of an eatery. He didn’t want the CT scan and I ordered it anyway. He had a bleed and was admitted and a followup CT and MRI were done later. Some idiot from Canada got on the phone with my nurse and was second guessing my judgment prior to getting the CT results. I got on the phone and said we clearly treat emergencies differently than Canadian doctors. I called back with glee to report my findings to the canadian care eliminator.

I have no doubt in my mind that I would have been able to save Natasha Richardson’s life. Canadians get very defensive about their medical system and they don’t like criticism. But in the case of Ms. Richardson’s family, they were preaching to the choir. Vanessa Redgrave and the family are card carrying Communists. Somehow it seems just even if totally unnecessary that the tragic death of this young woman came at the hand of a socialist medical system that devotes little attention to trauma.

Our American system may be deficient in prevention but when it comes to big trauma, or cardiac emergencies, we are the best in the world and we deliver the goods. I deliver Stemi one cardiac cases to the cathlab in twenty minutes flat. There is not a single hospital in all of Canada that can match that time by even triple!

Even with our shortage of neurosurgeons due to idiot lawsuits, if the weather is permitting I can have a helicopter ready to take my patient to neurosurgery at a distant facility in a matter of minutes.

In the US this would be a malpractice case pure and simple. The idea of accepting a head injury’s refusal of paramedic care as sufficient is absurd. The paramedics had an obligation to do a simple neuro assessment and mini mental exam. Undoubtedly if they had looked at the retina, they would have seen changes like loss of venous pulsation, or engorgement, raised optic disc.

To do nothing is stupid. For a second call to have come in from “friends later” is the red flag of red flags. Now they know she has a brain bleed or should have a huge suspicion! She would need to be intubated with rapid sequence and hyperventilated to reduce CO2 and reduce ICP. So the patient would be laid flat for transport. IV started and run at 70 (dry) bolus with manitol and call a status alert of a likely incoming brain bleed and permission to go directly to a hospital with neurosurgery.

Again this was a total cluster f..k. The article here reads like an excuse. Whoever Kevin MD is, I would caution anybody in making foregone conclusions. The reason we have success now in cold water drowning victims is because some doctor continued to work to revive the patient long after all the Kevin MD’s would have thrown in the towel and called it a day. Medicine is an art and saving lives is a privilege. I don’t care what mountain I have to move. I will fight for a patient’s life, not blame them for their circumstances.

Trisha! What PLANET do YOU LIVE ON? The number of Brain surgeons in Los Angeles County are the same as in all of Canada! Why would any Canadian doctor want to be in a ’specialized’ medicine such as trauma? That would require much study, time, & talent invested only to have the Government’s National Health Care System pay you PEANUTS. There is no INCENTIVE to be a successful physician in Canada nor does it attract the
most skilled & talented in the profession — know why….they all moved HERE in the U.S.
That is why the United States border between Canada is FULL of American HOSPITALs that the Canadians USE when they require QUALITY HEALTH CARE and want to LIVE.
Trisha you need to do your homework and I hope and PRAY that YOU DON’T get sick and hope that the physician didn’t read your story.

Wow Nancy. Turns out I’m living on the same planet you are. And it turns out that no matter where you live on this planet, if a patient sends away an ambulance and doesn’t go to a hospital for 4 hours, a patient doesn’t get help, no matter where on the planet that person lives.

NOW — if NR had gone to the Canadian hospital and had received substandard care, THEN you would have an argument. But last I knew, there were no neurosurgeons treating people in hotel rooms.

My advice remains: if we get sick or hurt, we need to seek the care we need. It isn’t going to come to us.

Natasha Richardson’s refusal of care is a red flag waving for a nursing assessment. If someone with more medical training than an EMT or Paramed was in the ski patrol, she would have been told of the seriousness of her injury and the imminent possibilities. Armed with accurate and descriptive evidence, Ms. Richardson would have felt compelled to go to an ER for further evaluation and not treated the situation so lightly. Nurses are experts in assessment and unfortunately in this uninformed world of lean is the word, less skilled medical personnel are employed without any medical professionals physically present on the team. When is the world going to recognize the immense value of the nurse and the myriad of skills they bring to the table? One can never have too much medical information or too thorough of an nursing assessment.

America’s health care system is at its best when patients are at their worst, it’s true. However to say our system is “better” than Canada’s ignores the bigger questions of how long and how healthy people live in both countries. The health systems in other industrialized countries focus on prevention and health maintenance while America focuses on treatments which is why they have healthier populations. There is more money to be made treating sick people than in keeping people healthy, the basic difference between America’s system and national health programs.

The key is empowerment and personal responsibility in any health care system. If we remain ignornant or refuse to speak up for ourselves then bad things happen. What could be more important than your own health?

Wrong!
Sorry, but you are being nieve.
All healthcare systems treat common, mild conditions well.
The real test of a healthcare system is how it deals with a malady that requires treatment within 30 minutes.
Resources need to be on constant standby for these problems to be dealt with successfully and that costs money.
Natasha had a medical problem that could have been CURED by a second year neurosurgical resident in about 15 minutes.
She died because she was not diagnosed in time because there was no CT scanner available at the time of the accident at the first hospital.
Even if there was a CT, she was “walking dead” unless there was a neurosurgeon to turn a flap and relieve pressure on the brain.
Can death from an epidural hematoma happen in the U.S.?
Not likely!
And regardless of whether you have insurance.
Socialized healthcare is a step down.
There is a better way.

Louis,

You have missed this point entirely. The point is that Natasha never got to a hospital until almost 4 hours after her fall. She couldn’t be treated because she didn’t seek treatment.

The real point to all this is that it makes no difference what testing could/should/would have been done or what treatment could/should/would have been performed — therefore it made no difference what country she was in when she got hurt.

She didn’t ask for help until it was too late. Period.

I find it remarkable that so many people, including some experts (and self-avowed “experts”), can seem to find no fault in the Canadian system of health care regarding Natasha Richardson’s death.

I’m stunned to see you, Ms. Torry, a “patient empowerment activist,” so quick to wholly blame the patient. Especially because it is hardly “ludicrous” to believe that Natasha Richardson couldn’t have gotten better care than she received.

Yes, Richardson initially refused medical assistance — because she felt FINE. Most people would’ve done the same. That, however, accounts for only part of the delay in Richardson’s receiving appropriate care.

Per the New York Times, when Richardson did arrive at a smaller local hospital (apparently with no CT scanning equipment?) she was still presenting as a 12 on the Glasgow coma scale of alertness (15 being fully alert). She was still in a condition where she would have normally been expected to live, NOT to die. This largely debunks your statement in the comments section that Richardson “didn’t ask for help until it was too late. Period.”

Problem was, Natasha Richardson needed help that the hospital in the immediate vicinity of the ski resort could not give her, and at least in part could not give her because Canada’s nationalized health care system is more stingy with distributing major medical technology (such as CT scanners) than is the U.S. system.

Thus, she needed to be treated at a larger, better-equipped trauma center.

Yes, she would’ve been transferred more quickly had she been treated immediately after the fall — when she didn’t see any need — but just as crucial as any other delay was the fact that she had to then be driven by ambulance to the larger hospital in the city. And there are very few places in the United States (including in the middle of the wilderness!) that medical helicopters can’t reach in a dire emergency, which Richardson’s case had become.

Argue if you will on behalf of the Canadian system that it makes sense to ration expensive technology to keep the cost of government-funded universal health care affordable for taxpayers. But that means when someone needs health care that the local facility can’t provide, it is IMPERATIVE to have an emergency transportation system that will get the patient to the hospital that CAN help her. The New York Times’ timeline suggests she sought treatment about three hours after the fall, when her condition was still sufficient for survival, and it was four more hours before she was in the appropriate hands, having first been taken to a hospital that (for better or worse under the Canadian system) could do little more than stabilize her.

At the very least it is appalling that the entire province of Quebec, presumably for cost reasons (because it’s hard to fathom any other explanation), has no helicopter medivac capability that would’ve gotten Richardson to the proper hospital much faster than a highway-bound ambulance.

It’s remarkable that a “patient empowerment advocate” like yourself wouldn’t recognize at least THAT lack of air transport service — mind you, a lifesaving service upon which virtually every American patient can rely in time of need — as a potential weakness in the Canadian system, and a possible factor in Natasha Richardson’s death from a fall that normally wouldn’t have killed her, even if she waited for treatment.

I think its ridiculous to even mention health care systems. Canadian is a developed intelligent nation with a health care system that takes care of everyone. These assumptions that everything in the US is better than other nations is ignorant, there are a lot of developed countries that do things better than the US. In fact our health care system is disgusting the way its set up. We all know the reasons and I am not going to get into them here.

Natasha should have been treated to relieve pressure on her brain immediately following her fall and it was her decision to shun the paramedics when people obviously recommended she see a doctor. She essentially probably cause her own death and my thoughts go out to her family She thought she was fine.

Its a mistake that anyone could have made, people all over the world hit their heads and shrug it off, and maybe now with this accident bringing head injuries to the forefront we will see people making sure to see a doctor as soon as possible if they hit their heads, maybe her death will save someone’s life.

As a Neurosureon with 20 years experience I read much of the above with interest. Whilst much of the comment medically is correct I would ask why burr holes were not done, in many countries these are even done in local medical centres as they are basic medical care. Whilst I cannot judge the Canadian system from experience I can the USA, for me any system based on care to wealth ratio system stinks and the lets sue everbody mentality has done more damage to the system than Obama ever can, I work in Hong Kong a small place with a high density population. Whilst not perfect for an SAR of a communist system we have amazing budgets and patient care. USA Doctors, people who live in glass houses shouldnt throw stones.