Winnipeg Free Press - PRINT EDITION

Can't put onus on cabbies: expert

Drivers not equipped to aid ER patients

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Dr. Harvey Fineberg: 'It doesn't seem to be a complete solution to the problem.'

JOE BRYKSA / WINNIPEG FREE PRESS Enlarge Image

Dr. Harvey Fineberg: 'It doesn't seem to be a complete solution to the problem.' Photo Store

A U.S. patient-safety expert cast doubt Monday on the value of placing an onus on taxicab drivers to ensure discharged emergency room patients get into their homes safely.

Dr. Harvey Fineberg, president of the Washington-based U.S. Institute of Medicine, said waiting for clients to enter their homes before driving away "might be a nice courtesy" and some cabbies may be happy to do it.

"But I think the idea that you avoid medical catastrophes by charging taxi drivers with a responsibility to accompany the patient doesn't strike me, offhand, as a complete solution to the problem," he said.

"What happens if the patient suffers a medical episode in the presence of the taxi driver?" A taxi driver is not equipped to do anything to manage that. So it doesn't seem to be a complete solution to the problem."

Fineberg was interviewed during a visit to the University of Manitoba on Monday. Today, he is scheduled to address medical faculty and students on quality, safety and value in health care.

An expert on patient safety, quality of care and public health policy, Fineberg said the issues surrounding the deaths of the two Winnipeg men who died after being dropped off by cab are complex.

It's not uncommon in the United States, for instance, to read stories about individuals who go for a checkup, are given a clean bill of health and suffer a heart attack that evening or the next day.

"We do know that these events, the sudden-death events, can occur without notice, without ability to detect and to anticipate the precarious state of the patient at that time," he said. "It's not a unique kind of event by any means."

If a person comes in with a badly cut arm, is treated and sent home, you can't fault a hospital's patient-discharge protocol if the patient suffers a heart attack when they get home, Fineberg said. "You really need to know the specifics of the case before you make any kind of judgment."

A central question is whether patients are capable of being discharged on their own or whether they should have someone accompany them home, he said. That's a medical call.

"I don't think it's practical, for example, to say everyone... leaving an emergency room must be accompanied by another individual. That's probably too inclusive a policy. But there might be a threshold of condition or age in which it would begin to make sense to have that kind of expectation, if not (an) absolute requirement."

Fineberg said in reviewing the two recent deaths, hospital officials should do more than examine what occurred once the patient entered hospital. Their investigation should be carried out from the "patient's point of view" and start with what caused the person to go to the hospital in the first place.

larry.kusch@freepress.mb.ca

Republished from the Winnipeg Free Press print edition January 14, 2014 A4

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Updated on Tuesday, January 14, 2014 at 8:03 AM CST: Replaces photo

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