Although the editors are not participating in his care, we have noted reports that Tiger Woods was intubated (i.e., placed on a breathing machine) and admitted to the intensive care unit (ICU) in the hospital where he was treated after his accident in the early morning hours of Friday, November 27.
MSNBC columnist Courtney Hazlett is reporting that an unnamed physician who did not participate in Woods’s care said that Woods was taken to the ICU where he was extubated and then shortly afterwards released to home. This source is stating that he felt not going to a step down unit before discharge was a highly unusual move.
In addition, the MSNBC column is reporting that Woods had taken alcohol earlier in the day and is reportedly on Ambien and vicodin and there was a request for a subpoena to obtain blood test results for Woods from Health Central Hospital.
There appear to be some unusual aspects to these reports and some thoughts on these alleged facts are as follows:
First and foremost, the physician who is leaking this information is not acting in the most professional manner possible, even if he is not technically violating Woods’s right to privacy.
Woods’s treating physicians would be bound by the privacy rules in the Health Insurance Portability and Accountability Act (HIPAA) that prevent healthcare professionals from publicaly disclosing details of a patient’s care without their permission, except in certain circumstances.
But physicians (even those not technically bound by HIPAA guidelines) generally should not be revealing specific details of care of ANY patient without permission, even if they are not personally involved in that care.
The intent of the HIPAA legislation is that patients have a general right to privacy concerning their personal healthcare and a physician repeating to the press details heard in the doctor’s lounge violates this trust.
Secondly, the report on MSNBC states that the neighbor who called in the accident told dispatchers that Woods was asleep on the ground and snoring. The physician source then states that this is a sign of an unstable airway and was the reason he was intubated after he got to the hospital.
The physician source is correct that Woods may have had an unstable airway that is possibly lifethreatening.
If, in fact, Woods was unarousable for any reason (head trauma, sleeping, intoxication) and making sounds that sounded like snoring, he should have been intubated at the scene, assuming the first responders unit was an advanced life support crew that included paramedics that were trained to do so.
It is not considered standard of care to wait for intubation to take place at the hospital. Patients can and do die if a needed intubation is delayed.
Stridor caused by laryngeal spasim in an unconscious patient is often mistaken for “snoring” and is an indication for emergent intubation.
Almost certainly, if Woods was unconscious or semiconscicous and had unstable airway signs and had not been previously intubated in the field, he would be immediately after being seen at the hospital by a trauma surgeon or an emergency room physician. All emergency room physicians are trained to intubate.
Thirdly, what happens next to a patient who is injured and brought into an emergency room intubated in the field or shortly after arrival depends on whether the hospital has a formal trauma care program.
If the hospital is a designated trauma hospital, the trauma surgeons would be notified either before Woods arrived or shortly thereafter and would assume care immediately after notification and presentation to the emergency room.
After the surgeons take over, Woods would have been evaluated for injuries and,if stable, sent through the CT scanner to check for injuries before he was admitted to the ICU.
Fourthly, the source for MSNBC said that once admitted to the ICU you “don’t go straight home” and are usually sent to a step-down unit and the fact that Woods was discharged from the unit indicated some unusual and extreme privacy measures were being taken.
Unfortunately, this is just not true.
There are many trauma patients who come into the trauma bay intubated or who are intubated shortly after arrival who receive their radiographic studies and who are then extubated in the trauma bay, particularly if all radiographic scans are negative.
In fact, some patients come into the trauma bay intubated, get their scans, get extubated, and are discharged to home from the trauma bay without ever being admitted to the hospital.
Likewise, it is not uncommon for patients who are intubated but not immediately extubated to be transferred to the ICU on the ventilator and then subsequently to get extubated in the next several hours and to be discharged from the ICU to home, particularly if the patient is reliable and does not live alone.
The fact that Woods was not sent to a step-down unit before discharge is in no way an unusual occurrence, especially for a young person with no serious injuries and no preceding medical illness.
Fifthly, Woods allegedly may have been driving with Vicodin and Ambien in his system and there was concern that he may have been driving while impaired.
Patients generally are told by physicians not to operate any vehicle while actively taking narcotics (Vicodin), generally within the previous 24 hours.
Although narcotics levels in the body rapdily decrease with time and a small amount of narcotic in the body probably does not significantly impair driving performance, the lab tests routinely used in the trauma bay (urine testing) to detect recent narcotics ingestion are qualitative (not quantitiative) in nature.
Thus, there is no way to tell how much or how little narcotic has been ingested and how much impairment it has caused.
But, it is serious legal development for a driver to be in an accident while there are narcotics “on board.” And, as such, almost universally, any driver in a single motor vehicle accident is tested for the presence of alcohol and drugs.
But, despite the fact that the tests are widely performed in trauma patients, the police do not have the right to access this information unless a subpoena is granted by the legal system.
Although the alleged request for a subpoena in Woods’s case was apparently denied, this is highly unusual for the driver in a middle of the night, single vehicle motor vehicle crash.