Hostages: Episode 8 Analysis 3/3

Over the past several posts I've been analyzing the CBS drama Hostages. These posts have concentrated on one particular episode and here are Part I and Part II.

Ellen discovers that the primary hostage takers wife is a patient at another hospital and she gives her one of the other captor's the slip and proceeds to go over there and snoop.

The primary hostage taker's wife is dying of cancer and desires for all treatment to stop. Her husband has begged her to press on and try one more round of chemo for the sake of their elementary school aged daughter.

Ellen finds the ill wife and she happens to be sleeping and begins to read through her chart that is located on a clipboard at the end of her bed.

Problem #1: This is a plain and simple HIPAA violation. Patient information is highly guarded and there is no way that much information is going to be out in the open for public consumption. Anyone could grab it-- from our snooping doctor to housekeeping and if you aren't directly caring for the patient then HIPAA says you have no reason to view the patient's healthcare information.

The patient awakens and sees Ellen there. She assumes Ellen is a doctor her husband has hired to consult for an experimental medical treatment related to her cancer. Ellen wants her to go back to sleep so she grabs the patient's PCA button and depresses it about three times and within five seconds (I counted) the patient falls quickly back to sleep.

Problem #2: Let's just classify this section as PCA pumps in general.

A PCA pump (Patient Controlled Analgesia) functions to let the patient decide when they need pain medication. They allow the patient to stay on top of their pain before it gets out of control where it can be more difficult to temper down. They can deliver a basal rate (a small amount of medication all the time), a PCA dose (which is a bolus dose of the medication the patient decides when to self administer) or a combo of these two.

PCA pumps have safety mechanisms. The patient can only give themselves one dose every several minutes. Generally, it's between 8-10 minutes. When our good doctor gives three subsequent doses-- this is not medically feasible. No PCA pump would allow a patient to deliver that much for fear of overdose. Pumps are never set that way.

The other issue is how quickly the patient falls to sleep. IV morphine does work quickly but not THAT quickly.

Eventually, Ellen is discovered by the primary hostage taker. With her back turned to the PCA pump she is able to unlock the door and grab the syringe and threatens to inject the whole thing into his wife-- thusly killing her.

Problem #3: PCA pumps are ALWAYS locked and doctor's never have a key (unless you're an anesthesiologist.) This is another safety feature of the pump for this very reason-- we don't want anyone accessing it and thereby overdosing the patient. The person in possession of the key would have been her bedside nurse. Newer pumps could have a key code for access.