Hospital Director: "Indescribable Negligence" in Sharon Treatment

15 minutes after the first report of Sharon's brain hemmorrhage, IRIS had this headline posted: Sharon's Political Career Over, Likely Caused by Poor Medical Judgement. In that post I paraphrased my neurologist source: "A cerebral hemmorrage in these circumstances is often the result of overly aggressive anticoagulation." Updates over the next several hours specified aspects of negligent treatment. Later I clarified that "stroke #2 was caused by the treatment of stroke #1 in terms of the aggressive anti-coagulation strategy." Again, the mainstream press is amplifying the IRIS-scooped stories, such as this one from today:

Several senior doctors raised a host of questions Thursday about the standard of treatment Ariel Sharon has received over the last two weeks, with the director of a large hospital telling Haaretz that according to the media reports on Sharon's medical treatment, he fears "there was indescribable negligence."

The questions cover the period from Sharon's first stroke two weeks ago to his arrival Wednesday night at Jerusalem's Hadassah University Hospital, Ein Karem, where he is being treated for a severe stroke and cerebral hemorrhage. They pertain to the supervision over Sharon's physical state, following the blood-thinning medicine he received after his first hospitalization.

Such supervision is essential, as these medicines could cause a cerebral hemorrhage, like the one Sharon suffered. Questions were also raised about the dosage he received.

"Yitzhak Rabin was not wearing a bulletproof vest that could have protected him from the murderers' bullets, and now, 10 years later, Sharon was not given the required medical treatment that could have saved him," the hospital director said. "Israel has not learned the lesson from Rabin's murder, and thus lost two prime ministers because of inadequate protection - one from weapons, the other from illness. I cannot understand how the prime minister could have been sent to stay in an isolated farm, more than an hour away from the hospital he was supposed to be treated in, two weeks after a stroke and one night before a heart procedure he was afraid of."

"A night before the catheterization he should have been hospitalized in Hadassah or at least made to stay in Jerusalem," the director said. "I also have questions about the dosage of blood-thinning medication he received. My feeling is that Sharon did not get the best medical treatment he deserved."

A senior doctor told Haaretz that "Sharon's medical condition was iatrogenic - that is, induced by treatment of physicians, as it was likely that the blood-thinning medicine Sharon was receiving had caused the severe brain bleeding."

According to the initial plan, a doctor was to be with him after the catheterization, when he returned to convalesce at the ranch.

This article mentioned the high blood pressure risk of worrying about his impending surgery, but ignored the much greater worrying associated with a ongoing media hype over his corruption case breakthough announcement. Here, for example, is the cartoon that ran that day:

Here is a quote from my neurologist source, who mentions two aspects of the case that have apparently not been touched on yet: the ironically poor medical outcomes for VIPs and leg vein clots associated with the long car trips:

Previous reports described the nightly returns to the ranch as being at Sharon's insistence. A non-VIP would have been more likely to be told to stay nearby.

One thing we haven't heard about is leg veins. Leg veins are common sources of clots. Long car rides promote clot formation in leg veins. Aggressive anticoagulation can loosen clots in leg veins, freeing them up to travel to the lungs and cause a pulmonary embolus and, if there is an atrial septal defect, also travel to the brain. In an anticoagulated person with loosened clots, a clot can lodge in a blood vessel and lead to a secondary hemorrhage.

On the day after Sharon's first stroke, I disputed the medical team that announced he had a clean bill of health. I brought the following quote:

a minimum of several weeks of rehabilitation are necessary for the vast majority of minor-stroke sufferers, an immediate return to work is not recommended, and the prime minister may be at risk for recurring strokes...."almost unheard of to send even the most minor of stroke patients back to work within days. At least a week, usually two or three are needed"...."It is important for Sharon to lay off serious stressful situations for at least a short period of time. He needs to avoid making big decisions right now. He also needs to be monitored closely for the next few weeks."

While my neurologist source thought this source was too black-and-white, he emphasized the risk of brain hemmorrhage when the aggressive anticoalgulation strategy was taken.

Let me clarify because the technical details are critical to the negligence aspect of the story. Sharon's medical team took a calculated risk to go with aggressive anticoagulation. The major risk of this strategy was the kind of devastating bleeding that eventually occurred. The precautions that should have been taken, therefore, were:

1. Monitoring, preferably by a neurologist on-hand
2. Protection from blood pressure spikes
3. Immediate access to the nearest hospital

If they had chosen a less aggressive anticoagulation strategy, there would have been other, different risks. One clear conclusion, therefore, is that the precautions associated with the chosen medical strategy were woefully inadequate.

See also: IRIS Scoops the MSM on Sharon Medical Crisis

Click here to see all of the IRIS Sharon coverage.