In July, 49-year old Beatrice Vance arrived at the Vista Medical Center Emergency Room in Lake County, Ill., complaining of nausea, shortness of breath and chest pains.
A nurse saw her briefly and told her to wait. But two hours later, when her name was finally called, the staff found Vance slumped in a chair, already dead.
"Ms. Vance had the classic symptoms of a heart attack," said Dr. Richard Keller, coroner for Lake County, Ill. "She should have been in the emergency department much quicker and received the care that we have in modern medicine."
It was a tragic lapse that raised some troubling questions about how the emergency room staff responded in this situation. The guidelines and regulations governing ER practices are generally quite strict. For example, federal law prohibits hospitals from discriminating against patients based on insurance status, race, color or sex. Hospitals must also make accommodations for patients who do not speak English.
In this specific situation, the American Heart Association recommends that patients suffering from an apparent heart attack be put on cardiac monitoring immediately and that they be given an electrocardiogram within 10 minutes of their arrival.
The coroner said in Vance's case, none of that happened.
In a startling decision, a coroner's jury investigating the case ruled Vance's death a homicide, which opened the door for criminal prosecution.
"The definition of homicide that I give to the jury is either a willful and wanton act, or recklessness on the part of someone, whether that's by their actions or by their inactions," Keller said. "Certainly, by that definition, this is a homicide."
The hospital has not commented on the ruling.
But nationwide, long emergency room waits have become commonplace. The average wait is now nearly four hours.
"The number of uninsured are rising in this country, and ERs are closing everywhere," said Dr. Leigh Vinocur of the American College of Emergency Physicians. "So more people are coming to the ER and using services. ... It's just a big domino effect."
But the wait isn't the same for everyone. Emergency room staff members are trained to give immediate care to those who need it.
"When they go to an emergency room, it isn't ... first come, first serve," Vinocur said. "It really is taking care of the most ill people first, and if you think you haven't been triaged correctly, tell them you want to be reassessed."
According to the president of the American College of Emergency Physicians, if patients don't feel they're getting the care they need, they should try to talk with the triage nurse.
If that doesn't work, patients should ask to speak to the emergency room physician; some hospitals have patient advocates within the unit to help the sick get the care they need. As a last resort, ask to speak with the on-call hospital administrator. Patients should not leave the emergency room if they feel their lives are in jeopardy.