Health care in the YouTube era

August 11th was the 2nd anniversary of the epic implosion of George Allen’s presidential campaign, the first defeat at the hands of YouTube. Two recent videos of unattended patients dying in ER waiting rooms leave me wondering whether health care has also entered the YouTube era.

Remember the George Allen fiasco? A 20-year-old Indian-American named S.R. Sidarth, working for Allen’s opponent Jim Webb, was filming an Allen campaign stop in Breaks, Virginia. Twice, Allen pointed to him and called him “Macaca,” a racial slur meaning “monkey.” Once the video hit YouTube, it went completely viral (this clip, one of many, has been viewed 350,000 times) and Allen’s promising political career was toast.

What does this have to do with health care? In the past 18 months, two powerful, highly troubling videos have surfaced of patients being left to die in ER waiting rooms. The first, in May 2007, involved a woman named Edith Rodriguez. Rodriguez began vomiting blood while waiting outside the King-Drew ER, and soon collapsed. Rodriguez’s husband called Los Angeles’s 911 system, but got nowhere. Then someone else in the waiting room called:

Caller: “There’s a lady on the ground, here in the emergency room at Martin Luther King and they are overlooking her, claiming that she’s been discharged. And she’s desperately sick and everybody’s ignoring her.”

911 Dispatcher: “What do you want me to do for you, ma’am?”

Caller: “Send an ambulance out here to take her somewhere where she can get medical help.”

911 Dispatcher: “OK, you’re at the hospital, ma’am, you have to contact them.”

Caller: “They’re the problem. They won’t help her.”

It’s not that the ED staff did nothing –- the video clearly shows a janitor coming out to mop up the patient’s bloody vomitus partway through her dying process.

The disgust over the YouTube video was the last straw for hapless King-Drew, leading to the hospital’s closure late last year.

Last month, another videotape surfaced showing a woman collapsed on the floor of the Kings County psychiatric ER waiting room in Brooklyn, NY. After sitting for a day waiting to be seen, the woman fell to the floor, where she lay face-down for about an hour before anyone appeared to notice her now-dead body. A few weeks ago, the family notified the hospital of their intent to file a $25 million wrongful death lawsuit.

In both the King-Drew and Kings County cases, the videos made a splash when they hit the news. But what really kept the stories alive was their viral spread on YouTube – for example, as of last night, the Kings County video had been viewed 470,025 times and had generated 1,845 comments!

Add to this brew the ubiquity of cell phone cameras, the increasing interest in physician and hospital rankings and comments (Yelp, Zagat), and the public’s growing skepticism of the safety – even the motives – of hospitals and doctors (for example, see Tara Parker-Pope’s recent article in the NY Times), and you have a formula for more “Macaca” moments, seen everywhere, by everyone.

So if professional ethics are not enough reason to be respectful of and polite to patients, perhaps the desire to avoid YouTube immortality is.

Bob Wachter is a professor of medicine at UC San Francisco and quality and patient safety expert. He writes the blog "Wachter’s World," where this post first appeared.

5 replies »

  1. Great point, Bob, but I wonder if we’re quite there yet.
    To me, it seems health care’s “YouTube era” won’t really arrive until we’re able to connect the dots from videos like these to reforming the systemic problems in our health care system. With Allen, it was simple to go from watching the video to helping defeat him electorally. There was action (watching the video) and reaction (voting for Webb).
    If we can connect the dots like this in the health care world, these videos will be truly devastating.
    More here: http://blog.healthcareforamericanow.org/2008/08/20/health-care-and-the-macaca-moment/

  2. I say yes to the increasing digital awareness phenomenon, and thus the welcomed potential accountability threat the “youtube generation” presents to the so-called “stewards” of these enterprises. They often repeatedly fail to implement even simple pro-patient remedies on their watch, IMO.
    Departmental silos, the group thinking they spawn, and predictable downstream political posturing that follows, only takes away any legitimate focus on the well being of patients; thereby encouraging a pre-occupation with the politics of the institution over the welfare of its patients (the real customers of its services).
    Too much cover is provided by accrediting, licensing and other regulatory entities, and most of their often faux standards or “quality” based indices, usually fall prey to the “garbage in garbage out” dismissal from the subject population.
    I just saw this video and it made me sick to my stomach. Perhaps a stretch, but I asked elsewhere: what is the culpability of the board, medical staff, administration, quality assurance “professionals”, other patients, the public, JCAHO, NYSDH, etc? No-one seemed to pull out a strategic plan and while examining the mission/vision/values statement say “hey wait a minute, this is not right! Somebody please something for this suffering soul.”
    Why doesn’t every vendor or supplier from software, to equipment, to quality, efficiency, strategic planning or quality consulting have some ownership here (even long after their fees have been collected?).
    What has the hospital bought from these vendor/suppliers over the years to serve the public trust invested in this facility? Is this a stretch, or might their be some legitimacy to the question?

  3. In a former life I personally witnessed something like this, but without such dire results. I was incensed to the point that I marched to the office of the chief of cardiology and told the whole staff who were there that time of the morning in no uncertain terms this was unacceptable. It was handled immediately. I do not know whether it prompted any system wide quality improvement effort.
    I have noticed that hospitals especially are very, very “departmentalized” &mdash to the point the janitor won’t help a patient: if he did he might be fired for working outside his “department”. (I did not care about being fired). The patient transporter transports his patient from point A to point B and does not worry about whether there are any staff at point B to care for the patient because he’s not permitted more than 12.5 minutes for the trip. This sort of wage slavery has squeezed any sense of purpose from people’s lives. Hospitals at the time at least hadn’t yet got to the point that the janitor or the patient transporter has permission to stop the whole assembly line, so to speak, when he sees something very wrong.
    I have seen this story told in several forms, but the point is always the same. The janitor, the cook, and the cost estimator ought each to see himself as a healthcare worker and not be afraid to do what makes sense for the patients.