20 March 2009

Just a lucky sumbitch, apparently

The New York Times reports, in an article by Ian Austen and Liz Robbins, about the beginning of the end for Natasha Richardson:
The actress Natasha Richardson, who died on Wednesday from a brain hemorrhage after a fall on a beginner’s ski slope in Quebec, was not admitted to a hospital until nearly four hours after her accident, according to ambulance dispatch records obtained by The New York Times on Friday. That is nearly three hours later than the timeline that officials at the Mont Tremblant ski resort, about ninety minutes north of Montreal, offered on Tuesday, the day after Ms. Richardson’s fatal fall.
The first paramedics to arrive were turned away after Ms. Richardson declined treatment, ambulance records show, though they reported seeing the actress briefly from a distance. In that instance, they said they saw her sitting on a stretcher— not laughing and walking off her fall, as a resort spokeswoman said on Tuesday. Those discrepancies seemed to introduce new questions about whether Ms. Richardson, who suffered an epidural hematoma— an accumulation of blood between the brain and the skull— after her fall, could have been saved had she been treated faster.
The New York medical examiner ruled Ms. Richardson’s death an accident on Thursday, resulting from blunt trauma to the head. The autopsy results suggested that the fall tore an artery in Ms. Richardson’s head and led to bleeding between her skull and the outer lining of her brain. Ms. Richardson was not wearing a helmet at the time of her ski lesson.
A brain surgeon not involved in her treatment, Dr. David Langer, the director of cerebrovascular neurosurgery at St. Luke’s-Roosevelt Hospital, Beth Israel Medical Center, and Long Island College Hospital, said that a clot can develop from the bleeding following such a trauma. Dr. Langer added that if a patient undergoes surgery— ideally within an hour of the injury— to relieve the pressure, remove the clot, and stop the bleeding, the patient can recover. “It can be quite dramatic,” Dr. Langer said. “It’s one of the most acute neurological emergencies. It’s one of the few times where it’s life or death, where you can truly save somebody’s life, or they die if you don’t get to them.”
In Ms. Richardson’s case, ambulance records showed that she did not receive her first attention from a doctor until 4:20 p.m. at the local hospital, in Ste. Agathe, Quebec, about 25 miles from Mont Tremblant. Yves Coderre, the director of operations at Ambulances Radisson, which serves the resort under an arrangement with Quebec’s public health care system, said in an interview on Friday morning that his service received its first call at 12:43 p.m. local time on Monday.
That is consistent with the resort’s report that the accident occurred midday. An ambulance arrived at the resort 17 minutes later; but the crew, told that Ms. Richardson did not want medical attention, left soon afterwards. Mr. Coderre said that Mont Tremblant frequently calls for ambulances after skiers experience minor falls. And just as frequently, he said, the ambulances are turned away.
Officials at Mont Tremblant said Ms. Richardson initially declined to see a doctor on Monday, but was taken by ambulance to the local hospital about an hour later after complaining of a headache to an instructor and ski patrol member who accompanied her to her hotel. However, the ambulance record shows that it was not dispatched to Ms. Richardson’s hotel room until 3 p.m., Mr. Coderre said. It arrived nine minutes later, and the crew began attending to her. At 3:42 p.m. it left the resort and arrived at the hospital in Ste. Agathe at 4:20 p.m.
Ambulance Radisson did not conduct the transfer to the hospital in Montreal, and it is not clear when Ms. Richardson arrived there on Monday. The Globe and Mail, a Toronto newspaper, reported on Friday that she may have arrived as late as 7 p.m. There is no helicopter or airplane-based ambulance service in the Laurentian hills where Mont Tremblant is situated. According to Mr. Coderre, those services are only available in certain regions, like the Arctic north, which lack road access.
Early Tuesday afternoon, about 24 hours after she fell, an ambulance took Ms. Richardson from the Montreal hospital to the airport, and she was flown to New York. She was then taken to Lenox Hill Hospital, where she died the next day. Questioned about the sequence of events, a spokeswoman for Mont Tremblant said on Thursday that the resort would no longer comment on the accident but would cooperate with any investigation.
In Quebec, there are several possible channels of investigation into the circumstances surrounding Ms. Richardson’s accident and the medical treatment she received. Marie-Eve Bédard, a spokeswoman for the minister of health and social services, said that Ms. Richardson’s family could ask the commissioners at either hospital that treated her to review the case. If the family is not satisfied, or if they believe that there were significant medical errors, it can then file a misconduct complaint with the province’s medical licensing body. As for legal action against the Mont Tremblant resort, the provincial coroner’s office can order a staff investigation or hold a public inquiry. Although the coroner’s office could not be reached for comment, a spokeswoman for the minister of public security, whose office oversees the coroner, said Thursday that she was not aware of any such action.
Rico says it was nearly twenty-four hours between the time of the onset of his brain bleed and the time he was finally admitted to Jefferson Hospital in Philadelphia. The fact that he didn't die in the interim has been duly noted by his ladyfriend, when she compared his situation to that of Ms. Richardson: "Do you see how fucking lucky you are?"

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