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November 11, 1992

What Are We Teaching About Indigent Patients?

Author Affiliations

From the Department of Medicine, Division of Geriatric Medicine, Center for Biomedical Ethics, Medical School, University of Minnesota, Minneapolis.

JAMA. 1992;268(18):2561-2562. doi:10.1001/jama.1992.03490180093032

AN ADULT woman without health insurance presented to the emergency department of a private, not-for-profit, university hospital. A male acquaintance had assaulted her and had fractured her forearm. After the assault, she impulsively took an overdose of an anticonvulsant, phenytoin. A friend brought her to the emergency department. Because a history of intravenous drug abuse had scarred the patient's peripheral veins, peripheral intravenous access was not possible. An attempt to place a catheter in her subclavian vein led to a pneumothorax and a chest tube. Intravenous access was then obtained through a jugular vein. As the overdose was an emergency, the arm was splinted and she was admitted to the medicine service on which I was the attending physician.

Two days later, she was medically stabilized. The overdose was resolved, the chest tube was pulled. A psychiatrist concluded that the overdose was in response to the stress of the assault