A Lake County coroner's jury ruled Thursday that the death of a patient who waited nearly two hours in the waiting area of a hospital emergency department was homocide.

The jury's verdict stated that although the cause of death was a heart attack, she also died "as a result of gross deviations from the standard of care that a reasonable person would have exercised in this situation"

The woman's daughter, who was with her mother in the waiting room of Vista Medical Center East in Waukegan, had previously alleged that her mother had waited too long to get care.

At the hearing, a Deputy Coroner testified that he subpoenaed the records after noticing discrepancies in the hospital's version of events after the woman arrived at the emergency room at 10:15 p.m. July 28.

The daughter told investigators that her mother had complained of chest pains and the two drove to the hospital, about a mile north of their home.

Investigators testified that the woman was seen by a triage nurse at 10:28 p.m According to hospital records, she complained of nausea, shortness of breath and chest pain of a level she rated as a "10" pain scale. The triage nurse reportedly triaged the patient as "semi-emergent".

The daughter reported she twice asked nurses when her mother would see a doctor. The first time she asked, a nurse reportedly told her that her mother was next on the list to be called. The second time, a nurse told her that two ambulances had just arrived with more urgent cases.

At 12:25 a.m., an emergency room nurse went to the waiting room and called for the woman but got no response, the jury was told. The woman was leaning on her side on a waiting room seat, unconscious and without a pulse.

Doctors rushed her into the emergency room and administered CPR, the jury was told. About 12:55 a.m., doctors detected a weak pulse, but 10 minutes later it stopped, and they restarted CPR.

Beatrice Vance was pronounced dead at 2 a.m. An autopsy showed she died of a heart attack caused by blockage of an artery in her heart.

The jury was advised of standards from the American Heart Association that showed the woman's symptoms fit the description of a heart attack "pretty much to a T."

The jury also considered medical guidelines that recommend patients apparently suffering from a heart attack should be put on cardiac monitoring immediately and have an electrocardiogram done within 10 minutes of arrival at the hospital, he said.

Neither measure was taken while Vance was waiting according to the Coroner.

Professional organizations also recommend that blood thinners and other medications be administered within three hours of arrival, but in this casecase, no medication was given until after her heart stopped, the Coroner stated.

1. In all probability, this patient would be properly classified as type of patient that is to be taken back to the treatment areas immediately in hospital protocols -- a triage error therefore probably occurred, and that in and of itself is typically cited.
2. But, assuming that the triage protocol actually permitted this managment of the patient, CMS is likely to cite the protocol as a violation of EMTALA.
3. The third element is that even if CMS could be convinced that the patient was properly sent to the waiting area, the reassessment requirements of EMTALA would clearly find that a delay of 2 hours without reassessing a chest pain patient would not be likely to escape citation.

Now, out of fairness, Lake County hospitals are quite busy, but there is no indication that they were on diversion or sufficient overload to justify this event if the details reported are correct.

The report also seems to suggest -- but doesn't come out and give details -- that the hospital attempted to "clean up" the facts initially. Putting a spin on facts or outright altering records is becoming more and more common, but this case and many others show that it is seldom successful and actually makes matters worse.

It is quite obvious that the Coroner's jury went way out of their way to send a message on ED delays and indifference to patient care to this hospital and all hospitals. It appears that the public is saying that ED delays are going to come back to bite hospitals.