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Ambulance call death trial opens in Stockholm

TT/The Local/pvs · 14 Nov 2011, 16:08

Published: 14 Nov 2011 10:12 GMT+01:00
Updated: 14 Nov 2011 16:08 GMT+01:00

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The case dates back to the early hours of January 30th this year when the Stockholm man called SOS Alarm, a company operating emergency response services in several counties in Sweden, repeatedly and asked for an ambulance.

He had been experiencing difficulty breathing and had lost consciousness several times while he spoke with the nurse on the phone.

Several family members chose to leave the courtroom when officials played the recording of Lindell's call to SOS Alarm, while several of those who remained burst into tears.

“Help! Please, send an ambulance,” Lindell could be heard saying.

The 52-year-old man responded on the tape, “I don't hear that you are having any trouble breathing.”

According to prosecutors, the 52-year-old nurse should have prioritized the call and sent an ambulance directly.

By not doing so, prosecutors argue, the man deviated from a medicinal index checklist and through “conscious risk-taking of a serious nature” caused Lindell's death.

The 52-year-old nurse, who no longer works for SOS Alarm, faces charges of aggravated manslaughter

In court, he denied committing any crime.

“I'm completely innocent,” the nurse told the court.

He subsequently gave his version of events from January 30th.

“I couldn't get the puzzle pieces to fit together. The sounds he was making didn't correspond with the physical symptoms. I became uncertain,” he said.

The 23-year-old man was suffering from a ruptured spleen, a condition that requires emergency care, the prosecutor concluded.

A ruptured spleen causes breathing problems and affects circulation to the extent that it can cause a loss of consciousness, as well as pain and extreme anxiety.

Lindell rang SOS Alarm twice in the course of 13 minutes and related the symptoms which he was experiencing.

His mother told the TT news agency of her feelings regarding the trial.

“It's tough, but my son can't be here himself so I have to do this for him,” she said.

“The worst is that he begged for an ambulance. I can't understand that they didn't send an ambulance, but instead torment him with more questions.”

At the same time, however, she doesn't put all the blame on the 52-year-old.

Story continues below…

“I actually feel bad for him. He's not the only one responsible,” she said.

Lindell's mother contends that the nurse shouldn't have been working in the position he was in at the time of the calll and that SOS Alarm failed by letting him do so.

The case generated a great deal of interest in Sweden and prompted scrutiny of the service provided by SOS Alarm.

The National Board of Health and Welfare (Socialstyrelsen) published a report on Friday sternly criticising the firm for severe flaws in their judgements of ambulance call-outs.

The agency has investigated around 50 cases across the country in the course of its investigations and has demanded that SOS Alarm reply by January 15th with a plan of action to address the deficiencies.

TT/The Local/pvs (news@thelocal.se)

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Your comments about this article

08:55 November 14, 2011 by RobinHood
Outrageous breaches of duty of care to the public are not unique to private companies, there have been plenty of public employees who have behaved in equally atrocious ways; this is a people issue, not a political issue. Either way, this is the correct way to deal with the culprits. It removes them from the system, and warns people like them to behave properly - or else.

Having said that, there should be some leeway for people who simply make a mistake; even a huge mistake with terrible consequences. There is a big difference between negligence and criminal negligence. Very few experienced medical practitioners have never made a rotten decision, or forgotten to do something important. A society that criminally prosecutes its doctors and nurses for less than criminal negligence, will soon find itself running short of doctors and nurses.

Whether this matter is negligence or criminal negligence remains to be seen. Management guidelines will be an important issue here. Was the nurse following policy, or was he/she exercising his/her own judgement. If it was policy, the wrong person is on trial. We shall see!
12:26 November 14, 2011 by krrodman
I agree with RobinHood on this one. I am extremely uncomfortable with the idea that poor judgement allows for criminal negligence. Poor judgement is malpractice. Criminal negligence involves intent to harm. And, while the the nurse is on trial, the larger and more important question regards the SOS Alarm company itself. Would anyone be surprised to learn that SOS pressured or incentivized employees to send fewer ambulances?

I would also like to add that there is a general trend toward demonizing medical workers. The State of Florida requires that all physicians get finger-printed in order to obtain a medical license. The State claims that this is the best way to expose identity fraud. In fact, identity fraud in the medical world is extraordinarily rare, and the fact that there are finger prints on file do not prevent the fraud; rather it makes the fraud easier to confirm once it has been exposed. The more subtle and dangerous effect of forcing doctors to get finger printed is that it sends the message that doctors are a dangerous enemy of patients, and the the State needs to protect patients from doctors.

While I am not an advocate of the malpractice system in the USA, it seems to me that this case should be a civil tort against SOS for failure to provide a contracted service. The nurse, acting on behalf of SOS, does not belong in criminal court.
13:36 November 14, 2011 by krrodman

Before you condemn this nurse to a slow and painful death, don't you want to know why she didn't send an ambulance?

While making her a scapegoat is very satisfying in the short run, if the larger problem is with SOS, then very little will be accomplished by convicting the nurse. In fact, it may serve to deflect blame away from SOS.

My bet is that the system is broken. Incarcerating the nurse will not fix the system.
14:52 November 14, 2011 by krrodman
@Phantom of the Vasa

The problem with health care worldwide is that there is not enough money to provide universal care without rationing, or without compromising care.

The situation with emergency care in Sweden is a perfect example of the problem at hand. Obviously, the simplest way to address the ambulance issue in Sweden is to send an ambulance for every single call. No triage. No nurse to filter calls. Just send the ambulance. Imagine the expense to the system of having to purchase hundreds, if not thousands, of new ambulances to meet the need - not to say the added expense of new drivers and EMT staff, as well as the cost to hospitals of having to evaluate in the emergency department untold numbers of new patients. Is there an advantage to this system? Certainly. Our 22 year old with the ruptured spleen may still be alive. How much are you willing to spend to ensure that there are no errors?

This type of analysis can be applied to every facet of medical care. Recently, I took care of a 44 year old man complaining of abdominal pain in the right upper quadrant of his abdomen. He was a moderately obese, diabetic with well controlled hypertension. Everything about his clinical presentation indicated that he had gallbladder disease. To be complete I ordered an EKG for our high risk patient. To my surprise, his abdominal pain was not his gallbladder, but his heart. He was having a heart attack. Should everyone with abdominal pain have an EKG? Before you say yes, imagine the expense of getting an EKG every time a patient complains of an upset stomach. Before you say no, imagine that every once in a while a patient with abdominal pain will die from a heart attack for lack of an EKG.
15:05 November 14, 2011 by Kevin Harris
It is extremely unusual in Sweden, or anywhere else, to prosecute a nurse for making a bad medical decision. This prosecution smells like a classic old-school Swedish political show trial. Someone is using this nurse either to protect, or to damage SOS. Either way, prosecuting nurses for mistakes is not the right way to do things. The nurse may be negligent, but he is not a criminal.

SOS is a private limited company, exclusively owned by the health authorities that employ its services. As shareholders, the health authorites select and employ the SOS managers, and it is they who are ultimately responsible for their managers' policies. I wonder in whose interest it is to blame everything on the nurse and move on?
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