After 14 days and 2 visits to the emergency room of a university hospital in Lyon, a student died of a brain abscess, secondary to a complicated ear infection. A dramatic story that raises the question of what has become of the organization of healthcare in France.
The story turns on a loop and is now known: Leana Bonilla Cruz, a 19-year-old Nicaraguan student, in good health, who had been studying literature for six months in Lyon, consulted twice in the emergency room of the Édouard-Herriot Hospital, in Lyon. , for an ear infection and dies of a brain abscess, according to our colleagues from Progress.
The first time, on February 9, the emergency room doctors pointed out to him that it was not an emergency and prescribed him a treatment with painkillers and antibiotics. Three days later, faced with the persistence of pain and the onset of vomiting, she returned, spent 8 hours there and the doctors sent her home with another antibiotic treatment.
On February 21, after 12 days of suffering, she was transported in a coma to the Edouard-Herriot hospital in Lyon. She died there of intracranial hypertension secondary to a brain abscess, without the doctors being able to do anything. A rare complication of otitis, which we hardly see in France since the advent of antibiotic treatments.
Rhône | Leana, 19, died of ear infections despite two emergency room visits https://t.co/qF8hezVubH pic.twitter.com/SEPauBRXrq
– Progress (@Le_Progres) March 10, 2018
How can you die from an ear infection?
Otitis is an infection of the ear, which is located deep in the bone and behind the eardrum. Extremely frequent and commonplace in children, ear infections have a slightly different causal mechanism in adults, which requires a careful ENT assessment according to all good medical textbooks.
Thanks to antibiotic therapy, in the vast majority of cases, adult otitis is a mild disease that heals without sequelae. However, an acute purulent otitis, poorly treated and “lingering”, can progress to a spread of the infection, first in the bone and it is a “mastoiditis” (infection of a bone at the base of the bone. skull), or to the brain and this results in “meningitis” (infection of the envelopes of the brain) or a brain abscess, which is an abscess inside the brain.
Brain abscess causes many additional complications (thrombophlebitis in the brain) and swelling of the brain (abscess and cerebral edema), which produces “intracranial hypertension”, in an inextensible bony cranial case … Brain death then occurs quickly.
Emergencies in charge
The mother of the victim, who claims that her daughter suffered from severe headaches, recurrent vomiting and a discharge from the ear, all signs of complication, claims that her daughter was not listened to and denounces “a medical error ”. She filed a complaint against the hospital for “manslaughter”.
According to the head of the emergency department, there would have been “no dysfunction” in the procedure set up in the emergency room. Even though Leana waited to see a doctor, she had seen a reception and guidance nurse within half an hour of her arrival. The emergencies were very overcrowded.
This applied the procedure in force (“sort 4”) and the “examinations were strictly normal”. He ensures that her temperature was normal and that she did not vomit during her visits to the emergency room (?) Contrary to what her friends say.
She should have seen a specialist
As we have stated, otitis in adults is less simple than otitis in children and it is necessary to explore otitis in adults differently than in children. This is especially essential if the fever is above 40 ° C, if there is a purulent discharge from the ear and if there is severe headache. In the present case, the last 2 criteria were present and his fever could have been partially masked by a medication against fever (NSAIDs, paracetamol).
An examination with an ENT specialist should have been performed or scheduled promptly, or at least during the 12 days before the final hospitalization. This should have been done during the 2nd visit, given this prolonged and pejorative development, with signs of complications. According to the head of the emergency department, this consultation could not be organized. The ongoing investigation will allow us to better understand what really happened.
A disorganization of the French healthcare system
Normally, we do not consult the emergency room for an ear infection, the emergency room is at the door of the hospital to manage medical problems that cannot be done in city medicine: either because they are serious and urgent, or because they quickly require additional examinations that the hospital can provide quickly.
The doctors who work there are specially trained in the management of real emergencies, whether cardiac, respiratory, digestive, traumatic or others. They work fast because of the large number of sick people and the urgency of the illnesses they treat. They are not really there to manage the “care journey”.
The first problem is that there are fewer and fewer general practitioners and those who are available are overworked. They are more badly paid, badly treated by the administration in general and take less and less custody. All the excess care to be taken in charge is transferred to the hospital and emergencies, which are therefore also overwhelmed.
This young Nicaraguan student probably did not have an attending physician since she had just arrived, we do not yet know if she had tried to see other doctors, but it was not illogical for her to go to the emergency room, while we were during the February vacation and some of the doctors were not available, neither in town, nor at the hospital.
A refoundation is necessary
This sad story shows to what extent our medical system is in “loss of direction”. By vocation, the profession of doctors has become more commonplace with people who have families and who want to live like the others, in a society where the value of work has been devalued and where the profession of doctors is little considered.
Doctors are not the only ones to suffer from it and it is all the health professions which are “burned out” with too much work, complete disorganization and not enough consideration. It wasn’t just the doctors who had a problem with Leana’s case, it was probably the nurses, few in number and overwhelmed as well, who didn’t have time to help the doctor find a place. for Leana with an ENT specialist …
If you’ve ever had a real medical emergency and been through a hospital emergency room, you may have seen how your problem was handled: lots of people, lots of waiting, overworked doctors, not a lot of people. nurses … but after waiting a long time on the “famous” stretcher, in the end, it ended well. Some are calling for the hospital to be saved, but the entire healthcare system must be reviewed. Otherwise, whether it is an ear infection or a stroke, the problem will recur more and more often.
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