Open Letter to Yvonne B. Singletary

September 14, 2009 at 0500 my on-call beeper went off with a STEMI notification. Within seven minutes I was in my car and on the way to the hospital. At 0519, I was stopped by a patrol car for failure to come to a complete stop at a stop sign. I told the young officer that I was on my way to an emergency case. I was in full scrubs, wearing my ID badge, and carrying the beeper with the texted message. The officer apologized for the inconvenience. He then went on to explain to me that he had to write a ticket because I did run the stop sign. It took him twelve minutes to complete writing out the ticket, then explain my court date. I reached the hospital at 0545. I was the lead RN in the cath lab crew.

The American Heart Association and the American College of Cardiology have set the door-to-balloon time that is most fortuitous for ST-segment elevation myocardial infarction patients as 90 minutes or less. Here at St. Luke’s Episcopal Hospital, in Houston, Texas, we have gotten our after-hours door-to-balloon time down to an average of about 50 minutes. Studies have shown that the sooner the occluded vessel is opened, the more heart muscle is saved from infarction.

Although that young officer was polite and professional in doing his job, he made a serious error in obstructing me from doing my job. I accepted my ticket, then proceeded to the hospital. Luckily another nurse just happened to be in the lab early that morning and was able to help with the case.

When I got home that night, I thought about the options open to me in dealing with the ticket. I had three. I could pay the $230.00 ticket outright, I could plead guilty and ask for defensive driving class, or I could plead not guilty and fight. If I plead guilty, the ticket would go on my driving record (raising my insurance premium). If I pled guilty and asked for defensive driving my record would be clean, but I would still have to pay $110.00 for the privilege to take the class, which then cost an additional $45.00. If I pled not guilty and lost, I could still take the defensive driving course. I was mad and full of righteous indignation. So, I pled not guilty.

November 2, 2009, I went to court. I did not hire an attorney. I didn’t believe that any attorney could tell it like I could. Now Shakespeare has written that anyone who represents himself in court has a fool for a client. Giving Mr. Shakespeare his respect, he wasn’t an attorney or a nurse.

Before court, I searched the literature supporting door-to-balloon times. I got a letter from our STEMI Coordinator, Larry Brown, RN, verifying the page and the importance of my presence in the case. I had a copy of the staff assignments for that day with my name as the lead call nurse. I had also pranced around in front of my mirror for a month practicing my defense.

My husband went with me for moral support. I really appreciated him at my side. I was ready for battle. When my turn came, the case was thrown out because the officer did not appear. I had mixed feelings about that. I was relieved that it was all over. But, I also felt that I had been denied my day in court. I wanted to tell the judge, the jury, the policeman, and that courtroom just how important it was for me to get to the hospital expeditiously. I wanted to say that I did not recklessly blow a stop sign or drive dangerously.

I was not able to tell my story in court, so here I am now to tell the tale.

I am currently working on getting an appearance before the City Council. They need to know that each one of them, as well as I, could fall victim to myocardial infarction. I want them to realize that there is not a single cath lab in Texas, along with most of the U.S. (that I know of, and I have searched) that has twenty-four hour in-house trained cath lab coverage. I am aware of programs that have trained emergency department (ED) staff and rapid response (RR) nurses to take steps to getting patients steps closer to the lab before the trained team arrives. As a matter of fact, here at St. Luke’s, our ED and RR nurses are trained to take steps to getting the patient to the lab and set up for the cath team. However, the training and expertise to proceed with the case rests with the cath team.

So, for each minute that a cath team member is delayed receiving a traffic ticket, one minute is lost to getting the most expert care to a heart attack victim.

I am conducting this fight not just for myself, but for the many other team members that have received and are still receiving tickets. As I asked around, I also encountered several doctors who also said they received tickets en route to STEMIs and other cardiac emergencies.

When I approach City Council, I will present my case, and possible solutions. This issue can be addressed in several ways. First, when appropriate ID and evidence of a call is presented to the officer, I would like a city ordinance passed to allow the driver to go without further action.

Next, if the driver is caught on the red-light camera, he/she should be able to present evidence of a call and be forgiven (if an adequate stop was made). I have also received a ticket from the camera. I was answering a call at 0200 on another day. I stopped, checked for oncoming cars, then went through the light. That ticket was $75.00. The third option is for the officer to accompany the driver to the hospital to verify the call.

With hospitals all over the nation pushing (and rightfully so) the door-to-balloon initiatives, there must be some cooperation between local police and healthcare professionals. I live in a large metropolitan city. The average employee lives thirty minutes away. There are six red lights and four stop signs on my way to the hospital. Although I do my best to get to the bedside as quickly as possible, my brush with the law has made me more cautious. I in no way condone reckless driving or speeding. However, I really feel that we should be allowed some leeway, especially in the pre-dawn hours when the streets are barren (except for the lurking officer).

I am writing this article before I go before City Hall because I want readers to send me emails to take with me from around the nation. I want the Houston City Council to know just how seriously we take our business of saving heart muscle and lives.

The one sure way to get the absolute best door-to-balloon time is to have twenty-four hour in-house cath lab staff coverage. In these trying economic times, I do not see that as a viable option any time soon. So for now, we must work to get the best times as safely possible.

Yvonne B. Singletary can be contacted at zybs01@yahoo.com. She notes that she did make it to City Hall and addressed the City Council, but will address the results in a future article. She welcomes your emails.

Dear Yvonne B. Singletary, RN, BS, RCIS, CCRN, CVRN (your must be awfully proud of yourself with all those fancy letters after your name…)

I wish the officer would have been there in court that day. You have no right to disobey traffic laws when you are not in an emergency vehicle. You have not taken Emergency driving courses. You do not drive a vehicle equipped with emergency lights and sirens. You do not have the RIGHT to put others at risk.

YOU were at fault. It is YOUR fault that your patient had to wait 12 minutes for him to write a ticket–all because you couldn’t wait mere seconds at a stop sign.

YOU do not have the right to put other drivers at risk when responding for a hospital page. In fact, you very likely could create a whole new(and more critically injured) patient in the process.

Do not speed. Do not blow stop signs/lights. Do not complaint about being caught breaking the law.

The fact of the matter is that ambulance transporting code 3 do not save much time at all. Whatever made you think you deserved some privilege to break the law is foolish, at minimum.

In my state Volunteer Firefighters, even with flashing blue lights, cannot speed. Why should you be able to run lights and break the law? WHY?

The 3 seconds you would have wasted at that sign are not worth putting the citizens of your community at risk. It is your fault that the patient waited 12 minutes to see you, not the fault of this officer.

Obey the God Damn Law.

Sincerely,

MedicThree–the guy who will have to scrape up the the poor sap you or your colleagues run over…

I encourage my readers to contact her(as she wishes) at zybs01@yahoo.com