Who is to blame when patients die in overcrowded and understaffed emergency rooms?

The story of the death of a psychiatric patient in a large Brooklyn, New York hospital got my attention, both as a nurse and as a human being. These stories are, thankfully, rare but still happen too frequently. In this case, lack of a bed for the patient was cited as the reason the patient was in the ER for almost 24 hours. The patient was reportedly suffering from a psychiatric condition, but deaths of patients have occurred in emergency rooms among patients with medical conditions as well.

Who is responsible when patients die in emergency rooms, sometimes while they are awaiting care? Can overworked ER doctors and nurses be held liable when patients die in these circumstances?

I can recall waiting 17 hours in a large hospital waiting room with a family member, who spent much of the time in the hallway on a stretcher waiting for a bed to become available. We were told our chances of getting a bed would be better in the morning, after doctors had made their rounds and discharged some patients. I remember feeling angry that the wait was so long, but also feeling some compassion for the staff that I watched throughout that long night, running constantly and looking harried and exhausted. My two sides, anxious family member and professional nurse, warred with each other. I don’t recall ever feeling ignored or that no one cared about our situation, but I did feel a great amount of frustration that our health care system, in one of the richest countries in the world, could be like this.

Angry family members are much more likely to find themselves in a litigation frame of mind. Could not more be done to “soothe the savage beasts” in the waiting rooms of the busy and overcrowded emergency rooms? It is my humble opinion that one way of alleviating the bad moods of waiting patients would be to have a circulating staff member (perhaps a nurse or paramedic) whose sole responsibility would be to offer understanding and comfort to those waiting for long hours to be seen by a doctor. The current triage system practiced in most hospitals does not allow for such handholding.

Such a simple thing… but it could make a big difference to those forced to wait, and cause them to look a little more favorably upon those who are doing the best they can in trying circumstances.