Emergency Department Failure – Rabies

It’s Too Loud in Here – Mark Alyn Talks About Hearing Aids


Emergency Department Failure   By Eric T. Rosenthal

I was bitten by an unleashed dog during a walk in early June in suburban Philadelphia. I had to make several calls to locate the correct township police department to make a report and I was told that I had to personally visit the station. I complied with these instructions and received a call from the animal control officer a few days later who said he didn’t see the dog when he arrived at the scene.

The next day I saw my internist who prescribed antibiotics and told me to go to the Lankenau Medical Center’s emergency department as soon as possible for rabies shots. I was in the ED for more than 3 hours and seen by several nurses or physicians assistants but not one asked to see the actual bite.

One of those I spoke with mentioned the CDC protocol for rabies, which I confirmed on the CDC website while I was waiting. However, when a nurse was about to administer the initial three injections she was going to inject me in the buttocks rather than in the thigh, which was the site of the wound. The CDC protocol said that two shots were to go into the shoulder and the buttons but the rabies immunoglobulin shot was to go directly into the wound site. I insisted she check and she returned and finally agreed to inject me in the wound. (The next day when I spoke with Dr. Joseph Bushra, the physician head of the ED, he said that the package indicated that it was to be injected into the area that was bitten but that the nurse did not follow those instructions.

Upon discharge, I was given written instructions to return in 7 days and then subsequently 7 days later and then 7 days after that. I told the nurse that the CDC protocol said that a patient already bitten had to return in 3 days, and then again one week after the first set of shots and then again one week later. She argued with me and told me to follow the written protocol that also indicated I had been seen by a physician, which was not the case.

I spent the additional time that evening to confirm when I should return for my second injection, placing several calls to Lankenau’s ED, patient advocate’s office, and its nurse supervisor until the latter said I’d be contacted the next day.

I subsequently spoke with a patient advocate who was an RN and then later that day with Dr. Bushra who said that it appeared that the ED had a “big gap” in its learning and he would arrange for sessions to retrain his staff about rabies vaccination. He also arranged for me to get the three followup shots at the health system’s urgent care center when I told him that I had been advised by two nurses to return the ED at about 5 am before it got busy. Three weeks following the day of my ED visit I received a call from another Lankenau patient advocate followed by the ED’s nurse manager who agreed that I had been mismanaged and thanked me for bringing some of these shortcomings to her attention.

Emergency Department Failure

Leave a Reply

Your email address will not be published. Required fields are marked *