On Saturday, September 16, 2023, Sam Terblanche, a junior at Columbia University, attended a soccer match at Yankee Stadium. During the subway ride to the venue, he confided in friends that he felt unwell. His condition worsened, and by Sunday, he found himself in the emergency room, complaining of severe headache and chills. Despite his worsening symptoms, Sam was discharged with a reassuring diagnosis of “acute viral syndrome” on both visits to the hospital.
After his discharge on Monday night, Sam texted his parents to provide an update, stating, “Just a bad virus, will have to Advil, vomit, and hydrate it out.” His father, Villiers Terblanche, responded with relief, “Good news re no major known problem (I guess).” However, by Thursday, September 21, the family received devastating news from a Columbia dean. Villiers recalled the moment vividly, stating, “When he said ‘I’ve got sad news,’ I knew something bad happened.” The call caused chaos within the family as they grappled with the shocking news of Sam's death just two days after his second emergency room visit.
Two years after Sam's untimely death, his father, whom friends call "VT," remains perplexed by the circumstances surrounding his son's medical care. After meeting with Tracy Breen, the chief medical officer at Mount Sinai Morningside, VT recorded the conversation as part of the pretrial discovery process. Breen stated that despite an internal review, the hospital was “comfortable” with its decision to discharge Sam from the E.R. This revelation was a profound shock for VT, who felt that the acknowledgment of possible medical errors was at odds with the hospital's insistence on its blamelessness.
Determined to seek justice, VT filed a lawsuit against Mount Sinai Morningside and five of its doctors for medical malpractice and wrongful death in August 2024. In a statement, Mount Sinai expressed sympathy for the Terblanche family but declined to comment specifically on Sam's case, emphasizing the emotional toll patient loss takes on both families and healthcare teams.
Traditionally viewed as last-resort care for acute medical issues, such as midnight fevers and weekend sports injuries, emergency rooms have become primary care centers for millions. Patients now present with a wide range of symptoms, from stomach pain to overdoses and mental health crises. Reuben Strayer, an emergency physician at Maimonides Health in Brooklyn, emphasized that the first responsibility of any emergency physician is to identify patients in need of immediate resuscitation. However, distinguishing between those who are critically ill and those who are not can be a daunting task.
As more patients use emergency departments (E.D.) as their primary source of care, the challenge of identifying those in imminent danger increases. “The more ‘well’ patients who use the E.D. as their primary care, the harder it becomes to find these needles in a haystack,” Strayer explained. This dilemma is compounded by mounting pressure on E.R. staff to discharge patients quickly, leading to a concerning phenomenon referred to by some cynics as “moving the meat.”
Despite the challenges, diagnostic accuracy in E.R.s is generally high, though a recent systematic review found that 5.7% of E.R. patients may experience at least one diagnostic error. Of these, 0.3% may suffer serious harm, including death. A key factor in diagnostic errors is what researchers termed “the cognitive challenge” of identifying serious conditions in patients presenting with non-specific, mild, or transient symptoms. Sam's case exemplifies this challenge.
During his second visit to Mount Sinai Morningside, Sam reported ongoing headaches and other alarming symptoms. Despite a fever of 100.6°F and a heart rate of 126 beats per minute, which are concerning vital signs, the attending physician deferred to the attending physician’s judgment. Agyare, a senior physician, noted that he did not order further tests or treatments based on his examination, which he deemed “entirely unremarkable.” This decision-making process highlights the difficulties E.R. physicians face in high-pressure environments.
Sam's medical records from his second visit are extensive, spanning 51 pages of abbreviations, billing codes, and contradictory notes. Vital signs were recorded but not acted upon effectively, raising serious concerns about the hospital's adherence to safety protocols. The electronic health record system, while designed to assist in medical decision-making, sometimes creates “note bloat,” overwhelming physicians with alerts and warnings. This can lead to “alert fatigue,” where critical warnings are overlooked.
Despite the overwhelming evidence that something was seriously wrong with Sam, including multiple abnormal lab results, the emergency staff concluded he was likely suffering from a viral infection and discharged him with instructions to return if symptoms worsened.
Following Sam's death, the Terblanche family relocated to New York, and VT enrolled in a master’s program in health policy at New York University to better understand hospital safety and risk management. He discovered alarming statistics: more than 200,000 people die annually from preventable medical errors, a figure that translates to a catastrophic loss of life, comparable to a Boeing 747 crash every week.
The aftermath of Sam's passing has left a lasting impact on his family and friends. His brother Ben, who was profoundly affected by Sam’s death, faced his own health scare almost two years later. Fortunately, Ben received timely care and recovered, but the experience reignited fears within the family about the healthcare system's ability to safeguard their loved ones.
The case of Sam Terblanche underscores the critical need for accountability and improvement within the healthcare system. As the Terblanche family continues to seek answers through legal channels, they hope to shed light on the systemic issues that contributed to Sam's tragic death. Their story serves as a poignant reminder of the importance of patient advocacy and the need for vigilance in medical care, particularly in high-pressure environments like emergency rooms.
