Lo Que Los Medicos No Nos Dicen

Volume 43, Number 4 · February 29, 1996

What Doctors Don't Tell Us

By David J. Rothman

The Girl Who Died Twice: The Libby Zion Case and the Hidden Hazards of Hospitals

by Natalie Robins

Delacorte Press, 350 pp., $22.95
Except for Karen Ann Quinlan's, no other patient's death has transformed American medical practice so much as that of Libby Zion. Karen Ann Quinlan made history inthe mid-1970s when the medical staff at St. Clare's Hospital in New Jersey would not remove her from a respirator, as her parents wished them to do, even though she was in a "persistent vegetative state." The Quinlans took the hospital to court and eventually won their lawsuit on appeal; in doing so they helped to define the ethical standards by which the question of when to take someone offlife-support systems is now decided. Libby Zion made history in 1984, when she died eight hours after entering New York Hospital's emergency room with seemingly minor complaints of fever and earache. Her parents, too, took the hospital to court. Even though they did not win their case, they brought into the open the need to reform one of the least well understood aspects of American medicine, itsresidency training programs.

1.

After years of inquiry into Libby Zion's death no one can be sure why she died, and who, if anyone, was to blame. A grand jury considered bringing criminal charges against her doctors; the state's Professional Medical Conduct board held extensive hearings, and a civil court gathered testimony in a trial that lasted several months. To this day no one is certain whyan apparently healthy eighteen-year-old suddenly developed a fever that soared to a fatal 108 degrees.
One popularly held theory appeared as Question 49 of the November 1995 pharmacology examination given to second-year students at the Columbia College of Physicians and Surgeons.
Which of the following drugs was administered in the Zion case at New York Hospital and had an interaction with anantidepressant MAO inhibitor that was fatal?
A. Morphine
B. Meperidine
C. Fentanyl
D. Codeine
E. Heroin
The correct answer, according to the examiners, was B, meperidine, more commonly known as Demerol. That answer, however, was wrong. It is true that Libby Zion was taking an anti-depressant, and that the New York Hospital staff should have known better than to give her a sedative likeDemerol. But the dose they gave her was very low (in fact, too low to be effective), and there is no case on record of anyone's dying from the two drugs as administered.
Libby's parents also got it wrong. Their major claim (among many others) was that the staff physicians were so exhausted from lack of sleep that they could not treat their daughter properly. Not only did they prescribe Demerolincorrectly, but when the nurse on duty reported that Libby was thrashing about, the intern, instead of going to see her, ordered her tied to her bed. In fact, whatever errors were committed were not the result of fatigue. One of the interns was coming off a weekend break and the other had just begun his shift in the emergency room.
New York Hospital also got it wrong. Its lawyers and spokesmen blamed thepatient. Had Libby Zion candidly informed the hospital staff about all the drugs she was taking—more precisely, had she told them that she was using cocaine—the outcome, they said, would have been different. But while there was evidence that Libby had taken cocaine shortly before being admitted to the hospital, it was not conclusive. One postmortem analysis revealed a trace of the drug in hernostrils; a second did not. Indeed, the bungling that surrounded the testing of blood and tissue in the Zion case calls to mind the O.J. Simpson case. In both, medical examiners showed a knack for raising more questions than they could resolve.
Even more important, New York Hospital's effort to shift the blame makes one ask why its doctors had not diagnosed the drug problem themselves. Libby had...