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Asthmatic Boy Dies during Transport to Third Hospital in 11 Hours

Posted on 27 September 2011

Natasha Korecki. Staff Reporter/nkorecki@suntimes.com

Seven-year-old Aaron Pointer spoke his last words from the back of an ambulance.

“I . . . am . . . tired . . . of . . . breathing,” the asthmatic boy gasped, taking breaths between each word, according to a nurse’s report.

From the front seat of the ambulance, worried mother Sharese Pointer waited and waited, hoping at any minute they’d arrive at the hospital.

It would be the third hospital in 11 hours that her son was taken to after he suffered an asthma attack at home early in the morning of Sept. 13, 2010.

Aaron was moved out of the first two hospitals after his family was told he needed facilities better equipped to deal with his condition.

The minutes ticked on as the ambulance fought through rush-hour, 4 p.m. traffic and construction.

Sharese Pointer kept looking back at her son and then at the road construction ahead of her, wondering when they’d get to the hospital.

It was only later that she learned something that stunned her: The hospital where they were headed was 45 minutes away.

By the time they reached St. Joseph Medical Center in Joliet, after the roughly 30-mile drive, her son’s brain was “starved for oxygen,” according to a lawsuit the family has filed. Aaron later died.

The Pointer family, of Matteson, charges that their son died unnecessarily, a result, they say, of a series of errors and gross negligence by medical professionals along the way. They have filed a lawsuit in Cook County Circuit Court that seeks damages and charges his asthma was not properly treated.

The circumstances around Aaron’s death raise questions about why an asthmatic pediatric patient was transferred among three hospitals in less than 12 hours, whether he was really stable when he was transported and why he was taken to a facility 45 minutes away when there were closer options that could have handled pediatric care.

Sharese Pointer said she was never told her son would be transported that distance.

“Who would send a sick child almost an hour away? That’s crazy,” Sharese Pointer said.

“All I knew was we needed to get him there as soon as possible and get him help. I don’t understand why they didn’t say something. As a parent, you know, we don’t know. We go with what the doctor says. The doctor knows best. I’m just trusting that he’s putting my child in good hands.”

About 30 minutes into the ambulance ride, Aaron’s condition worsened and the emergency technicians in the ambulance decided to insert a tube to assist in breathing. First, though, they used paralyzing drugs.

“Intubating a 7-year-old is difficult in the best of circumstances, much less in an ambulance,” during a long ride, said the family’s lawyer, Joseph Miroballi. “It’s a disaster waiting to happen. It’s a formula for death.”

Those named in the lawsuit declined to comment. They include the three hospitals where Aaron visited: St. James Hospital in Olympia Fields, St. James Hospital in Chicago Heights, Provena St. Joseph Medical Center in Joliet, as well as two physicians: Ravi George and John Davis. In addition, Kurtz Ambulance Service was named. Kurtz did not respond to a request for comment.

A spokeswoman for the Illinois Department of Professional Regulation said the office could not comment on specific cases.

The Illinois Department of Public Health said the agency doesn’t govern the transfer of patients.

“It’s up to the physician and the family to decide if they want to transfer a patient to another hospital,” said spokeswoman Melaney Arnold. “If a family says, ‘no,’ we want to do it here, then, yes, they can remain at their hospital. It’s up to the physician and the family.”

The Pointers, who have Medicaid, say they were not given a choice and were never told he would be taken so far.

“It’s not supposed to be that way,” Arnold said.

“No one explained anything,” Sharese Pointer said, breaking into tears. “We had no clue what was happening.”

Sharese Pointer said she and her husband, Adarien, still struggle to find answers to what went wrong that day.

Aaron suffered from bronchial asthma, but his family said they felt it was under control. He always carried an inhaler and used a nebulizer. He had been hospitalized in the past but bounced back quickly once he was treated, they said.

“We know the routine. We were prepared to sit in a hospital . . . once they get him to where he needs to be, we’re fine,” she said. “This situation went wrong, completely wrong.”

The day before his health spiraled, Aaron – who loved his big brother Amari and enjoyed making up songs with his dad, watching Sponge Bob and riding his bike – was as energetic and entertaining as ever, his mother said. The family had just celebrated the father’s birthday at a barbecue.

“He was running around, playing, eating everything in sight,” she said.

According to the American Lung Association, the death of a child under 15 from asthma is relatively rare. In 2007, there were 6.7 million children with asthma and around half had at least one attack. There were 213 deaths that year – 48 deaths for those 5 to 9 years of age. The most recent number for hospitalizations was in 2005, and there were 145,000. That year, there were 145 deaths of children under 19 nationwide, and 44 who were 5 to 9 years of age.

“While no formal risk estimate can be determined from this, it can be reasoned that it would be very low given the magnitude of asthma prevalence and the relatively small number of deaths,” said Mary Havell, manager of public relations for the American Lung Association. “In addition, it is often believed that most asthma deaths among children were uncontrolled cases. If this is the case, the risk for those who were being treated or received treatment would be even lower.”

The morning after his dad’s birthday, Aaron woke up with an asthma attack. His mother recognized that it seemed more severe than usual. So instead of driving 15 minutes to the hospital the family had visited in the past, the Pointers went to the closer hospital – Franciscan St. James Hospital in Olympia Fields.

At around 7 a.m., the family was told he needed to be taken to a facility better equipped for his needs.

“They didn’t have the equipment that Aaron needed, so they said they had to move him,” Sharese Pointer said she was told.

Aaron was again put in an ambulance, something attorneys referred to as a “destabilizing event.” He was taken to Franciscan St. James Hospital in Chicago Heights.

“What is so unusual about this is, why St. James Olympia Fields to St. James Chicago Heights? They have the same facilities. There’s no difference,” Miroballi said. “Why didn’t they transfer him to Hope Christ Hospital, it’s not even 18-19 miles away.”

Aaron stayed at St. James Chicago Heights for about eight hours. The Pointers were again told that their son needed to be relocated, this time to a pediatric intensive care unit.

The fact that Aaron was wheezing and struggling to breathe should have been a sign not to put him in an ambulance, Miroballi said.

“They send him even though he’s not stable,” he said. “Why they didn’t put a doctor in that ambulance with him, or an anesthesioloist or someone who would manage his condition during that long transfer, we don’t know.”

“Who would send a sick child almost an hour away? That’s crazy.”

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All Rights Reserved

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27 Responses to “Asthmatic Boy Dies during Transport to Third Hospital in 11 Hours”

  1. Why wasn’t air transport considered for this patient?

  2. BoxerRob says:

    How many critical failures can one little guy survive? Three hospitals? I guess 2 ambulance rides? Must have been dozens of doc’s/RN’s/medics/RT’s who laid eyes on this guy. Nobody pushed the panic button? That many providers afraid to secure airway?

  3. JG says:

    WHy did the Paramedics on each ambulance accept a patient with an unstable airway knowing they had a long distance to travel? They could easily have intubated prior to departure. This is one case I hope the attorneys get the answers to the parents so this type of turfing off never happens again to a child. So much for EMTALA.

    • Bulldog says:

      JG, I’m no attorney but I’m pretty sure no ENTALA violation was broken. Pts are entitled to a medical screening in the Er. and it sounds like this pt. got exactly that.

      • XT says:

        EMTALA requires a medical screening and stabilizing treatment within the capabilities of that facility or transfer to another facility with the required capabilities. However, transfers of unstable patients are restricted unless the patient or guardian has been explained the risks of the transfer and makes the request in writing or the medical professional determines the risk of transfer is outweighed by the expected benefits.

        In the first transfer, it’s not entirely clear what benefit the 2nd hospital provided over the first since it is reported that both hospitals had the same facilities and neither could provide the necessary care. That creates an EMTALA violation right there. Had they transferred the pt to the facility with a pediatric ICU initially, I think this might be a different case.

    • steve says:

      who’s to say it was an ALS transfer it could have been a couple of basics and placing an oral airway and giving albuterol via nrb

      only the family’s attorney stated he was intubated and it sounded like he was a former medic

  4. Shante Rivers says:

    Im with you Ms. Newman why wasn’t air transport considered for this child.

  5. Buleah says:

    I am wondering what equipment 2 ERs did not have??? All ERs, large or small, should be able to care for a child with respiratory problems.

    • Jason says:

      An ER is not an ICU. Very few ERs are equipped to manage a child or even an adult with airway problems this severe for very long. A critical care team of ICU trained RNs, Doctors and RRTs were needed. Chances are an RRT never even saw this child in either ER and would not have been called unless intubation was considered.

      • BoxerRob says:

        Jason, Do you live in Bolivia? Intubation and ventilation is not a skill in ER’s in your area? Team my ass, this kid suffocated, a tortured death, because every single licensed practitioner within 6 feet of him was an incompetent coward. Any MD, RN, RRT or paramedic holds the skill set to rescue this condition. As I know these professions anyway, but I’m not in the Bolivia part of the US.

        • Jason says:

          BoxerRob you don’t know the first thing about “managing” a child with asthma. It involves a lot more than just “intubation”. The ventilation part may require special equipment and gases. Your way of thinking is exactly why a Paramedic transport is not the best choice for a situation like this. You believe “a skill” is the end all solution and don’t have the education and training to see the complexity of this situation.

          It is possible the hospitals did realize they would be very limited if the patient was intubated and the damage that could be done without the proper equipment. They may have been hoping he would be able to maintain his own airway until he reached the appropriate facility rather than trying to place 4 chest tubes in the child or blast air to nowhere with PIPs over 60 cmH20.

    • Bulldog says:

      Buleah, Yep they should right down to a level 3 hospital Er.

    • Benning says:

      This child needed an ICU. ERs are not the place for critically ill patients to be kept. There should be an intensivist, pulmonologist and crtical care staff with the appropriate training and equipment. The ER physician’s knowledge is limited as it the staff. This hospital may not have had Heliox, the appropriate ventilator or pediatric critical care staff. Even if they had intubated the patient, they might not have been able to stabilize the ventilation or oxygenation. This is why the most appropriate transport team with all the necessary equipment and extensive pediatric experience should have been called.

      • BoxerRob says:

        The proper place for emergency respiratory support is anywhere that condition occurs. Heliox? 2 specialists? Uber-staff? What ‘they’ ‘might not have been able to stabilize the ventilation or oxygenation’? ER’s in your area can’t do this? Getting intubated is no harder than getting a latte in my world.

        • Mike says:

          Intubation or sticking a tube down a child’s throat is just one part of the equation. If the pressures are too high from airway constriction and plugging, you will not ventilate or oxygenate. You will end up killing the patient if you do not have the proper equipment and knowledge to go with it. It is possible the ED personnel saw this but failed to recognize it sooner and get the appropriate staff with the necessary equipment. Some doctors for the children’s hospitals will advise remote EDs on alternative methods until their team can reach the patient for the intubation. If you do not have a plan in place for before, during and after intubation of an asthmatic child, you will fail and the child will die. Yeah, simple as a latte.

  6. Bulldog says:

    First off this child should have only been transported once. Transported to a hospital equipped to handle peds one with a PICU,intubated prior to transport. It wouldn’t have mattered if the transport was 2 hours away if the pt. was on a vent being properly ventilated.

    Second why was this child not intubated prior to transport?

    Third In this day and age no one should die as a result of an asthma attack period.

    Was this pt. given steriods, mag. sulfate drip at anytime?

    Something about this story does not make any sense…

  7. gm,rn says:

    First of all my greatest condolences to the Pearson family. As an ICU nurse, this unfortunate event should not happen at all. I don’t work for the above mentioned hospitals. I think the sick boy was tranferred to St James Chicago Heights because that is where the pediatric unit, and not at St James Olympia Fields. As a mom and a nurse, my opinion is that if the sick boy was properly and thoroughly assessed at the two ERs of St James Hosp, SOMEONE, be the Resp Therapist, ER MD or ER RN should have mentioned that this sick kid needs to be flown to Hope Memorial Hosp.

  8. Jean Herndon says:

    We, in EMS, tend to look at this case from a clinical viewpoint. However, as someone who has asthma, has raised a child with asthma, and has a background in Social Services, I see this from at least two additional viewpoints. The parents ascertained that this incident was more severe than usual; no surprise considering the potential smoke irritants at a BarBQue the day before. Therefore, they took their son to the nearest hospital. PARENTS NEED TO BE EDUCATED BY THEIR MEDICAL CARE PROVIDORS TO CALL 911 WHEN AN ASTHMA PATIENT IS IN RESPIRATORY DISTRESS. THAT IS, UNLESS THEY KNOW HOW TO ADMINISTER OXYGEN AND HAVE A PORTABLE UNIT AVAILABLE. It only took one experience of arriving at the ER doorin the back seat of my husband’s take-home State Trooper car withlights and sirens running to make me appreciate the PA’s admonition to NEVER transport an asthma patient unless you have O2. Meanwhile, no mention was made of a home nebulizer treatment, which could have been running while the parents made ready to drive to the hospital or, better yet, awaited the arrival of EMS. OH! MAYBE THAT’S SOMETHING MEDICAID DOES NOT COVER! We’ll probably never know if the parents even knew to try the old standard home remedy–steaming hot water in a basin and inhaled by the patient, who uses a towel over his/her head to retain as much steam as possible. MEDICAID PATIENTS OFTEN DO NOT RECEIVE ENOUGH TIME AND ATTENTION FOR PATIENT EDUCATION. FURTHERMORE, IT ONLY TAKES HAVING MEDICAID REFUSE TO PAY FOR EMS TRANSPORT AND GETTING STUCK WITH THE BILL ONE TIME FOR PATIENTS TO DO THE BEST THEY CAN ON THEIR OWN. Ive had Blue Cross/Blue Sheild initially decline a county EMS claim until documentation was received that an on-site paramedic dialed 911 because my rescue inhaler did not help, she had no O2 and could not stabilize me, EMS could not get a BP when they arrived,and O2 and a nebulizer treatment were needed during transport. (It was terribly embarrassing to land in an ER where I was well-known.) I WAS ABLE TO GET A COPY OF MY PCR; MOST PEOPLE DON’T KNOW WHO TO ASK FOR DOCUMENTATION’

    OK, so by now you have known where I was going with this–IT IS TOO OFTEN ABOUT THE ALMIGHTY $$! As clearly reiterate already, and Trauma III center should have the basic tools and “man”power to stabilize an asthmatic patient. It’s easier to say you need specialized Treatment than to admit that the hospital doesn’t want to treat medicaid patients because medocaid does not pay enough, fast enough, and without a lot of paperwork hassle.

    • Jason says:

      Sometimes taking the child to the hospital is quicker than waiting for EMS and multiple IV attempts in the home. A neb of albuterol and some oxygen are not going to fix this problem. Dicking around on scene to see if it does and if the child improves alittle, Paramedics will just get the parents to sign a refusal of transport so they can drive their child to the hospital themselves especially if the parents probably cannot afford an ambulance.

      This child spent 11 hours in hospitals. That is a long time for anyone experiencing an asthma exacerbation.

      EMTALA also states the appropriate team for the transport.

      All the way around there were violations and poor judgement.

      • Todd says:

        “Sometimes taking the child to the hospital is quicker than waiting for EMS and multiple IV attempts in the home. A neb of albuterol and some oxygen are not going to fix this problem. Dicking around on scene to see if it does and if the child improves alittle,”

        Did the article state that EMS was on scene? Did the article state that EMS was on scene too long with a critical pt? I didn’t see the part where there was data supporting Paramedics “just have the parents sign a refusal so ‘they’ can just drive their child to the hospital themselves.” And exactly what do these statements have to do with the article? The article referances a family that took a child to an E.D. either POV or by EMS, I cant tell. It appears the initial entrance into the healthcare system was via this quote from the article, “So instead of driving 15 minutes to the hospital the family had visited in the past, the Pointers went to the closer hospitaL”. The article never says EMS was on scene too long making multiple IV attempts. The only place I see we can maybe assume that there was EMS on scene is at this quote from the article. “At around 7 a.m., the family was told he needed to be taken to a facility better equipped for his needs.

        “They didn’t have the equipment that Aaron needed, so they said they had to move him,” Sharese Pointer said she was told.

        Aaron was again put in an ambulance, something attorneys referred to as a “destabilizing event.” He was taken to Franciscan St. James Hospital in Chicago Heights

        So, “the again” makes me feel that maybe EMS took the child from home to the initial E.D.

        I am not trying to me a smart @ss, but what is your point on your statements? The article is talking about transfers of pt. care from hospital to hospital and an intubation during transport and how it sucks that this kid died because someone (or many someone’s) didn’t realize the kid was decompensating and needed to go dirtectly to a PICU.

        I just didnt get it.

        • Jason says:

          Todd did you bother to read all the responses discussing this article?

          Did you happen to notice where my reply was placed and to which post?

          Try to keep up with the discussion in the future.

  9. John J Watts says:

    The author states that the child was at “…St. James Chicago Heights for about eight hours…” and needed to be “…transferred to a pediatric intensive care unit…” Dealing with traffic at 4pm in the city is a real problem. Flight service would have alleviated the issue, and the patient would have arrived at the pediatric facility in 20% of the time. I will say that the paramedic team most certainly made decisions that were in the best interest of the patient given the situation at the time. If a medic decided to perform ETI with paralytics, why was there not a changed transport decision to divert the patient to the nearest ED for intervention by a physician(s)? I am certainly not playing armchair quarterback here, but when the patient is starting to go downhill, one must decide to change the plan quickly, and with precision. A flight could have changed the situation – and I say COULD. The patient may never have been able to be reversed, as it seems that his issue was in play for an extremely long time, most likely the day before during the BBQ while “…running around and eating everything in sight…” While at the other hospitals, I am sure that this patient was given inhaled anti-inflammatory agents, oral corticosteroids, long-acting bronchodilators and/or leukotriene modifiers. With the obvious failure at the hospital(s) of these medications to reduce the inflammation and advancement of the disease process, why was this kid placed into the back of an ambulance for an extremely long ride, and during rush hour? If the patient was to be sent by ambulance, and the hospital physician(s) knew of the patients’ potential for respiratory failure, why did someone not utilize a pediatric specialty transport team, or at the very least, place a physician and a Pediatric Nurse Practitioner on the ambulance to assist in the transport? Someone was not thinking on this one, and I believe that the paramedic team is not to blame, but they will carry this for a long time to come, and I feel for them. Hospital Administrators evaluating this case during the monthly M & M should be asking some very pointed questions, and if they do not, then they are failing in their duties, just as the physicians have in making a poor transport decision.

  10. Denny says:

    You are just kickin my ass with the blame…..Let’s see if my comments make you sit back and go “Holy shit what happened here” Ready? ok- “Do no harm” are you kidding ? “Pt advocacy” where ? “Who is respoonsible” we all are, dumbasses, and does it really frickin matter. This kid is gone and every person that works in the profession should be hangin his head, this was a screw up period. When we say we are “Doing everthing we can, are we ? Oh ya, I can point my finger at another crew, or hospital, whatever man, a kid is dead, get over yourself and make a pledge to do better so it doesn’t happen again. FOR GODS SAKE BE HUMAN!!!!!


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