An elderly woman who had suffered several strokes and had advanced diabetes was admitted to the Emergency Department (SOR) in Bolesławiec with suspected circulatory obstruction in her legs. After returning home, her granddaughter noticed a huge hematoma on the woman’s breast. “According to the assessment of the orthopedist who later examined my grandmother, the hematoma could have been caused by an impact,” our reader wrote in a letter to the editorial office.
“On April 25, 2012, at around 10:00 p.m., I called an ambulance for my grandmother. My grandmother requires constant care, has no logical contact with others, cannot walk independently, and, according to the doctors’ assessment, requires medication to be administered in hospital conditions.
After the ambulance arrived, the emergency team decided to take my grandmother to the Emergency Department. That same evening, I was informed by telephone that my grandmother would remain under observation until morning.
The following day, at around 8:00 a.m., I was informed by telephone that my grandmother did not require hospitalization and would be taken home. After she returned home, the caregiver noticed that my grandmother had a huge hematoma on her breast. After reviewing the hospital records, I did not find any entry concerning the appearance of the hematoma.
The following day, the doctor who had examined my grandmother in the Emergency Department contacted me by telephone. She could not answer the question of how the hematoma had appeared. She stated that perhaps my grandmother had hit herself or that too much Fraxiparine had been administered. The doctor also could not explain why my grandmother had been sent home or whether she really did not require hospitalization.
My grandmother was eventually admitted to the psychosomatic ward of the Provincial Hospital for the Mentally and Nervously Ill in Bolesławiec. During admission, the consulting orthopedic doctor stated that the hematoma on the breast could have resulted from an impact. I also learned that the resulting hematoma prevented the effective treatment of my grandmother’s other medical conditions.”
Upset and concerned by the events at the Emergency Department, the reader filed a complaint with the director of the District Hospital. Nikolaj Lambrinow replied that the hematoma on the patient’s breast could have developed while she was being transported home, as a result of being secured with safety belts, and was caused only by pressure, not by an impact. Below is an excerpt from the director’s response.
[…] The patient was admitted to the emergency department with suspected acute ischemia of the lower limbs. The Emergency Department physician requested a consultation with the on-call doctor from the general surgery department. Following the consultation, anticoagulant medication was administered. The patient was monitored continuously, and her vital signs were checked.In the morning, after another surgical consultation and upon observing improved blood flow in the lower limbs, a decision was made to discharge the patient and continue her treatment at the Surgical Outpatient Clinic.
[…] The hematoma on the breast visible in the photograph probably developed while the patient was being transported home. In accordance with procedure, the patient was secured with belts during transport. The hematoma visible in the photograph is linear, running along what was probably the safety belt with which the patient was fastened. It was caused only by pressure and not, as you write in your letter, by an assault.The patient received large doses of heparin, an anticoagulant. With this type of treatment, the tendency to develop bruises or even hemorrhages is unfortunately greater. […]”
At the end of the letter, Director Lambrinow wrote that he understood the granddaughter’s frustration caused by her grandmother’s generally poor health, but considered the complaint unfounded. Asked for comment, he said that the matter had been closed and that he would provide no further explanations.
(information: Grażyna Hanaf)