• Sweden edition
Patient dies after nine-hour ER wait

Patient dies after nine-hour ER wait

Published: 27 Dec 2011 09:43 GMT+01:00
Updated: 27 Dec 2011 09:43 GMT+01:00

The patient, who suffered from lung disease, arrived to Sahlgrenska University Hospital's emergency room complaining of breathing difficulties.

Doctors at the emergency room concluded that the patient needed to be brought to the respiratory medicine department for further care.

Despite repeated attempts from staff, however, no spot was secured until nine hours later, according to a reported filed with Sweden's National Board of Health and Welfare (Socialstyrelsen) about the incident, which took place in April 2011.

Fifteen minutes after being brought to the respiratory medicine wing, the patient died.

According to Sahlgrenska University Hospital's chief of medicine, the long wait was likely not the cause of death.

"The outcome would probably have been the same anyway. This patient was that severely ill. But that's exactly why the patient shouldn't have had to wait," Tullberg told local newspaper Göteborgs-Posten (GP).

Sahlgrenska University Hospital's own guidelines hold that a patient should have to wait no more than 90 minutes in the emergency room before seeing a doctor, and that the total time spent in the emergency room, before being sent home or taken in to another department, should not exceed five hours.

The incident has now been reported to the health board in accordance with Sweden's Lex Maria, the informal name for regulations governing the reporting of injuries or incidents in the Swedish health care system.

Clara Guibourg (clarabara@hotmail.com)

Your comments about this article

11:00 December 27, 2011 by naimad
No rarity here! Sahlgrenska equals long time waiting. I hope they get what they deserve.
11:08 December 27, 2011 by Great Scott
This has nothing to do with the hospital concerned, it is the result of Reinfeldts and Borgs loony cut back program to delivery further tax breaks for the well off.
11:48 December 27, 2011 by krrodman
"The outcome would probably have been the same anyway. This patient was that severely ill."

This case highlights the difference between health care in the USA and healthcare in Sweden - for better or for worse depending on your perspective.

In the USA, this critically ill patient with severe respiratory problems would have received maximal care. He/she would have been intubated and placed on a ventilator in the Emergency Department, even if no bed were available in the intensive care unit. For better or worse, hundreds of thousand of dollars would have been spent trying to save a life that PROBABLY could not be saved. We spend more money on "end-of-life" critical care than any other country on the planet, by far. In fact one of the primary criticisms of the current system is that money that could be going to the uninsured is "wasted" on the dying who have free government insurance(medicare).

In Sweden, the triage is different. No doubt this patient had end-stage lung disease and the actions of the hospital speak to the fact that they were in no hurry to spend money on a patient who was likely to die.

While it is easy to frame this debate in moral terms (did Sahlgrenska act with callous disregard for this person's life?), in fact no country has enough money to give unlimited care to every citizen. In the USA, the uninsured get substandard care. Sweden makes other choices to control costs. Wait times for routine procedures are horrifically long (0 -7-90-90 is an embarrassment!!) and limited care is given to the elderly.
11:58 December 27, 2011 by skogsbo
krrodman, what are you on about, what about the millions who can't afford basic medical care in the US? You say it yourself, you spend millions of the insured's money on wasted treatment, because hospitals can bank the cash?, whilst you don't treat the uninsured. Sounds like a great system, provide you are in the right group!

Only those involved know how they were treated, they could will have been indubated and put on Os in a room in A+E, just because they didn't go to a specific ward doesn't mean they didn't have care. The ward was probably maxed out, so if A+E was quieter then arguably they had better end of life care there.

At least in Sweden EVERYONE gets treatment after a nominal payment, if only the same could be said globally.
12:19 December 27, 2011 by Already in use
krrodman "In the USA, this critically ill patient with severe respiratory problems would have received maximal care. He/she would have been intubated and placed on a ventilator in the Emergency Department, even if no bed were available in the intensive care unit."

More likely he'd have died right in the emergency unit, and nobody would have noticed he'd been lying on the floor for an hour or so

13:20 December 27, 2011 by Abe L
Let me guess, this was an 'incident' and nobody will be held responsible or fired? What is the point in generalized healthcare if you a) don't get it and b) need to keep a private health insurance on the side to get proper care?

Waste of taxpayer money.
13:54 December 27, 2011 by engagebrain

In the US everything possible that could be billed for would be done,

There would then be a fight with the insurer about who would pay and for what.

Amid the cash flow the patients needs are pretty marginal in the USA - massive costs, poor healthcare and quality of life - except for the 1%
14:07 December 27, 2011 by rybo1
I came to Sweden 14 years ago, from the US. Since being here and becoming a Citizen, over the years both myself and family have had to use the "ER" many times. We've never waited anything remotely close to nine hours at Karolinska University Hospital.

By far and large, healthcare here easily outstrips healthcare in the States. What happened in Gothenberg is sad and very unusual.

Bottom line, is that I don't lose sleep at night worrying about healthcare for myself or my family, as do untold millions of "we're #1" Americans.
14:10 December 27, 2011 by RobinHood
Thank you Kroddman for pointing that out. It's good to hear from someone who actually knows what he/she is talking about when it comes to the economics of healthcare.

Ignore the trolls who don't.
15:59 December 27, 2011 by babychuma
I'd hope that anywhere in spite of economics medical professionals would race to help a critically ill person, I bet in the US or Sweden this would be true. We can't take rare occurrences and read a whole theory into them, I have to say that I've never not been satisfied with the healthcare I get.
17:06 December 27, 2011 by AmericanSwede16
engage brain.. LOL. you don't have to be in the 1% to have good healtcare in the US. All you have to have is a good job that offers healthcare (most do). Sweden does not have free healthcare folks. The government takes the healthcare money right from your paycheck. If Sweden didn't take the healthcare tax from the paycheck, it would be even more expensive than the US.
17:48 December 27, 2011 by cogito
#4 Skogsbo,

Your ignorance is showing. By law, everyone, insured or not, including 12 million illegals, has the right to care in the USA.

Remaining uninsured is often by choice. Some prefer to spend their money on boats, cars, beach houses or drugs.

The "substandard" care that the uninsured receive in America is at about the same substandard level of care that the insured receive in Sweden.

@#2 Great Scott. The level of care in Sweden was actually worse under the Soc.Dems. Nine-hour waits, or even 12-15 hour waits were common.
17:51 December 27, 2011 by skogsbo
if the US care system is clearly so fantastic, why does it need reforming then?

I would much prefer to pay for healthcare through taxes, the more you earn, the more you contribute. Seems fair?
19:28 December 27, 2011 by krrodman
I am not an apologist for health care in the USA. We do many things well, and do many things poorly.

I am shocked at how blind Swedes are to the weaknesses in the Swedish system. In my note above, I was trying to point out one of those weaknesses; that is, the unwillingness/reluctance to spend money on the elderly.

Here are some basic facts:

1. The average age of a patient on dialysis is 6 years older in the USA than in Europe; and the average duration is 6 years longer. In other words, in the USA we willing to start dialysis on older people and maintain dialysis for longer than in Europe. What happens to these people in Europe? Simple....They die for lack of dialysis.

2. In countries with socialized medicine, more patients die WAITING for their heart bypass surgery than in the USA.

3. 0-7-90-90. Will someone please tell me why it is acceptable to make a patient with a surgical disease to wait more than 180 days for elective surgery? How is this acceptable to anyone in Sweden?

21:23 December 27, 2011 by AmericanSwede16
Would you rather Sweden just give you back a few thousand kronors per month so you can go out and buy a health plan that enables you to go to any hospital, any doctor, any dentist, any clinic of your choice? Instead of getting chosen for a few in your area?
22:53 December 27, 2011 by jan.petras
The maximum time before seeing a doctor in the ER should not exceed 90 minutes? Why is it called an "EMERGENCY ROOM" then?

Emergency means NOW. How about if I was brought in by the ambulance with internal bleeding? I'm from Romania and even there I was flown 200km away with a helicopter and given emergency treatment (Vitamin K, blood transfusion, to stop the bleeding).

Everything happened in under 45 minutes, I was bleeding out really bad, would have been dead in 60 minutes for sure. I didn't pay a dime. I don't see why the Swedish healthcare is sooooooo good. I really doubt I would receive the same care here according to all these horror stories I hear.
01:23 December 28, 2011 by kinan
Bureaucracy in everything !! the hospitals in Sweden are so bad and slow !

but let's ask ' was the sick guy a native swede ?? " I bet NOT .

every time i need health care i take the boat and go to Riga Latvia and get the health treatment i need . sick of waiting ( minimum 6 hours ) in crazy hospitals and to be sent home after with some pain killers !!!

now I'm in Riga because i just had surgery ! I have been on the waiting list in Stockholm since Nov 09 ! I could not wait any longer it was painful !

shame on the healthcare system !!
01:50 December 28, 2011 by Dajake
According to Lancet Oncology, the 5 year survivor rate for prostate cancer in the U.K. is 41%. Whereas the 5 year survivor rate for prostate cancer in the U.S. Is 91%. Socialized health care run by the Government may make the fat, lazy, stupid & drunk feel as if the government loves them, but not so much if they get cancer of the ass.
12:25 December 28, 2011 by cogito
#13 skogsbo, Why did the American system need reforming?

Here are a few reasons:

-Because no system is perfect and Americans demand perfection. Whey they don't get it, they sue, leading to...

-Frivolous malpractice litigation, which accounts for much of the costs. This could have been rectified by reforming tort law. But as Obama gets big bucks from trial lawyers, he refused to touch tort law.

-Excellent, abundant and free care for those over 65 (Medicare). The Swedish system severely rations care for the elderly, figuring that if they die early they are less a burden on the state.
16:45 December 28, 2011 by J Jack
Even if the patient would die anyway, how about dignity? Even if I knew I had 9 hrs to live, I would not want to spend it waiting in ER to be admitted, I would put my credit card in the bar of a hotel and order champagne while enjoying an illegal cigarette. Getting arrested would have got me admitted more quickly. RIP victim of subjective medical bureaucracy.
22:53 December 28, 2011 by VicTaulic
They should have brought her back and just sat her on a chair or something. At least that would have been better than the waiting room. There is probably more to the story.
01:39 December 29, 2011 by pulltheweather
Cogito, perhaps your view of tort reform is somewhat one-sided.

Examine how the McDonald's hot coffee burn case was used by lobbyists to set caps on damages rightfully owed by corporations.

What is frivolous malpractice? There is no such thing. An occurrence is either malpractice, or it is not.

I do not doubt that Obama is inappropriately receiving campaign donations from trial lawyers. I do not doubt that frivolous suing does occur. What is the success rate of truly frivolous suits? Do you know? How often do corporations even have to go to court? More and more often, consumers are contractually obligated to seek in house litigation in pursuit of any grievances. Corporations will continue to win by bigger margins, with or without this cherished tort reform legislation.

Americans demand perfection? Really? I'm American. I don't get this impression. Maybe you're thinking of the Swiss. Americans demand convenience and undercut prices on artificially produced goods. Well, I guess that is perfection in the eyes of an American.
05:24 December 29, 2011 by bcarroll
I live in the U.S. and wish to move to Sweden. We pay 1,800$ a month for childcare so that we can go to work, and 900$ a month for student loans (we have been paying for ten years, and have 17 to go). Health insurance for my family of five would top 1000$ a month and we cannot afford it. If I ended up in the emergency room in the U.S. I would spend my wait time terrified of the likely 40,000$ bill and realize that my half-way paid for house would have to be sold to pay it, and we would end up with nothing. I would rather wait for 9 hours and get care without worrying about the bill. As far as the case in this article, I can say that I work in the U.S. healthcare system and that I have seen abuse and unfairness, except for those who have medicare (universal coverage for those over 65). They get excellent care. But, from birth until then, it's very poor.
13:24 December 29, 2011 by flintis
@krodman# would have been treated immediately?? yeah immediately after his medical insurance was confirmed.

The health care in Sweden is relatively excellent compared to 80% of the world, ok is it slightly more expensive than the UK which still has the worlds best FREE health care.
14:00 December 29, 2011 by cogito
@flintis. The UK? the best health care? You've got to be joking. The horror stories are endless. The NHS is so awful that people coming from the U.K. think the Swedish system is functional.

@bcarroll #23:

Your sob story conveniently leaves out a few essential facts: how much is your combined salary? What percentage do you pay in taxes? If you are going to compare, compare the whole picture.

Surely if you could afford to buy a house, you could have afforded the $1,000 for health insurance. In Sweden, the taxes are so high and the salaries so low that many can never afford a house. They have to live in rentals.

You sound like a perfect candidate for immigrating to Sweden and milking the Swedish system.
14:05 December 29, 2011 by bcarroll
Hey cogito...

I have. Sweden is a much better buy.
20:57 December 29, 2011 by cogito

For those who come to milk the system, yes.

For those who have to pay for the slackers, not so much.
21:48 December 29, 2011 by efm
As an MD. in the USA, I find this incident, ridiculous.

Who ever made that silly rule that you are going to wait for 90 minutes before seeing a doctor?

I would say that in any US emergency room, the reason it's called Emergency is because, people who go there are expected to be critically ill, and thus needed immediate attention.

In my hospital, a patient with possible lung or heart problems are attended to as soon as possible, and if somebody

comes in with a broken toe nail, then, he may have to wait for some time to be seen. Emergency room nurses can usually assess who needs to go in front ofthe line. Also some lifesaving meds. or proc. can be done right in the ER.

Ah, the vagaries of socialized medicine!
00:57 December 30, 2011 by bcarroll
@Cogito I have my first U.S. tax return when I was 14 years old. I own a U.S. based company which I will be running while in Sweden. I will NOT be "milking" the system. I will be paying tax into it and reaping the benefit of a government who places it's priorities in it's people, and not in a monstrously large military who's "job" it is to police the world. I am happy to pay 50% ax with the social benefits afforded to people in Sweden.

@efm above, now that's if you have health insurance! If you don't the hospital dumps you to avoid unpaid bills. Your Adam Smith regularly gives people the middle finger. U.S. ranks 55th in the world in fairness in distribution of healthcare resources. Our earlier death rates and higher infant mortality rates seem to vindicate the private model? Please. You are a brainwashed American.
02:17 December 30, 2011 by oledeluca
While Swedes would never agree with the US on punishments for 2nd degree murder aka depraved indifference, it still seems to me that this should be punished by at least 20 years in prison. But then again, that's why we Norwegians left the Swedish Kingdom and why my Norwegian ancestors left Norway for America. At least here, we care and if we don't we pay - dearly! Really, how much does it cost to intubate and give O2. Come on, I did that as a First-Aider. It's simple, even simpler than helping deliver a child which I'/m trained to do and all as a volunteer or poorly paid lifeguard. Disgusting medicine! And an outrage! A lot has changed since I was in Stockholm in 1986!
16:23 December 30, 2011 by jbkulp
A lot of what is being said here about the US system is either misleading or wrong. To wit:

a. Medicare is NOT free. Only part A (hospitalization) is not charged a yearly premium. Part B (doctors) you pay a yearly premium (usually taken out of you Social Security pension) as is Part D (drug coverage with a doughnut hole in the middle)

b. With all the chest beating about how great some of these posters think the US system is, it ranks #37th in the world according to World Health Organization statistics.

c. You are NOT guaranteed healthcare under US law. What you are entitled to is to go to an emergency room to be treated and must be treated IF you cannot pay. And then, you are only entitled to be stabilized not cured. This has resulted in a great deal of what is called patient dumping in the US.

d. this is why the MD described how it works. Triage is performed and the most seriously ill are taken first just as he described. If you are going there for less serious illnesses, you can be there forever.

e. using the emergency room as a primary care provider is senseless. It attracts the uninsured to go there resulting in much higher costs to treat them then if they go to a regular doctor, but there they have to pay.

f. the US system is infinitely more costly (by a factor of two or more) than any other developed country system, and the US is the ONLY one of them that doesn't provide universal coverage. What is the morality of providing universal coverage for seniors but not for everyone else anyway?

g. we pay over twice, on average, for the same drugs in the US as elsewhere in the world--a main form of treatment, of course--than anywhere else in the world because of cost shifting to the US by parasitic drug companies. How many other things can you name that cost half as much in Europe than in the US? And, of course, these very same drug companies have gotten laws passed that forbid us from importing these same drugs in order to insure that we pay twice as much.

I could go on and on, but this will give you some idea of how ignorant so many Americans are about the facts of the system.
16:23 December 30, 2011 by cogito
@bcarroll #29

Your puerile political opinions are irrelevant. As is what you did when you were 14. Neither has any bearing on the issue.

Irresponsibly, you neglected to pay for health insurance for your double-income family, because you had other priorities. Toys for boys, I'm guessing.

And now you're going to move to Sweden to "reap the benefits" (your own words) that Swedes have been paying for for decades.

That's milking the system.
16:44 December 30, 2011 by jbkulp

Your comments are completely ignorant. If bcarroll moved to Sweden AND PAYS TAXES for his/her family's medical care, they are paying for it aren't they? Just how is paying for something milking it in your fantasy world anyway?
16:52 December 30, 2011 by tadchem
Did the unforgivable delay in receiving medical attention contribute to the patient's death? Could the patient have been saved with faster treatment?

We will never know.

The patient is DEAD.
20:19 December 30, 2011 by kerry1
Sorry to hear that a Man died while waiting for treatment, God I would not be shocked if it happened in Ireland with all the cut backs but Sweden? However,

bad it is in Sweden, you should come to Ireland, but Sweden really has no excuse to have cut backs on Health, it is a wealthy and thriving Country and you dont have

the IMF.
14:39 December 31, 2011 by littlemu
To efm and others:

The "90-minute" rule says that no one should have to wait longer than 90 minutes to see a doctor. 90 minutes is a maximum time!

My experience from the emergency room is that if you are calm and sit down to wait, you get to meet a couple of nurses within a few minutes. They make a first examination to put priority on your case. If it's urgent, you will see a doctor immediately. I have been to the ER with pneumonia and came to the hospital on my own by bus and then I didn't need to see the doctor immediately, within a few hours would have been enough.

If you are obviously injured you don't have to wait at all. A friend of mine injured his forhead and was bleeding a lot and the second he came in through the door the staff took him in. It turned out to be not serious but they checked him immediately.

In general I think that the ER system is a good concept. The staff puts priority on the patients to take care of the urgent cases first. If there are few patients you will see a doctor sooner even if your case is not very urgent. To have enough staff to treat everyone immediately under all circumstances would mean that half of the staff would not be working at all on slack days.

From my understanding this story was a case of faulty judgement from the staff.
07:26 June 18, 2012 by feathernoodle
bcarroll - If you can afford $1800 for child care (meaning both of you must be working), you can afford $1000 for health insurance. Otherwise, why not stay home and raise your own children and use the daycare money to pay for your insurance premiums. And I'd love to see you wait 9 hours in an ER for "free" health care when you're in pain, feeling very sick or worse. And don't think it's "Free" in Sweden, you'll be paying a WHOLE lot more in taxes to cover your "free" care than you'd ever pay in the U.S. with a lower quality of care. Fine if you are healthy & rarely need a dr. Your Swedish utopian dreams are just going to bring you back here complaining about Sweden in a couple of years, you've not done enough research - how on earth do you think you'll be permitted to 1. move to Sweden and 2. start a business there?. As for the student loan issue, what does that have to do with anything? You could have worked your way through college like others. You'd have student loans in Sweden too. Though the tuition may be free, you'd have to pay for everything else (housing, food, books, fees, etc) and would end up with MORE debt. Every Swede I know (all in middle ages) are paying back student loans. Still. Also, the comment about the U.S. "policing" the rest of the world - well, who do you think the rest of the world calls when they're in trouble? That's right, the U.S. And we go & people love us until they get what they want, then they are bashing the U.S. again. For the person who doesn't understand why drugs cost more in the U.S. than anywhere else, do some research, it's simple: American consumers subsidize health care for the entire world. ALL of the research & development is done in the U.S. Then, other countries enjoy the benefits of those drugs without the expense of creating them. Why doesn't anyone mention the free or under $10 generic rx drugs you can get at many places? Or the rx assistance programs for low income people? And for your WHO stats, anyone who digs deeper knows this is misleading. The WHO judged a country's quality of health on life expectancy. But that's a lousy measure of a health-care system. Many things that cause premature death have nothing do with medical care - car accidents, poor diet, smoking, murders. Another reason the U.S. didn't score high in the WHO rankings is that we are less socialistic than other nations. The WHO judged countries not on the absolute quality of health care, but on how "fairly" health care of any quality is "distributed." The problem here is obvious. By that criterion, a country with high-quality care overall but "unequal distribution" would rank below a country with lower quality care but equal distribution. Higher infant mortality rate? Because there are many people who, upon learning their child will most likely die at birth because of a defect or disease feel morally obligated to carry the child to full-term instead of aborting
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