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Never Again.

On May 10, 2021, Billy Miller died in the emergency department of Yale New Haven Hospital.  His death was senseless and entirely avoidable.  His story involves the intersection of many public health issues.  Billy unknowingly ingested Fentanyl prior to his death leading to acute Fentanyl toxicity.  Fentanyl is increasingly common in both recreational drugs and counterfeit pills leading to a nationwide epidemic of inadvertent ingestion and toxicity deaths. Billy should have been one of the fortunate ones.  He received a life saving dose of Naloxone from paramedics.  By the time he reached Yale New Haven Hospital  via ambulance, he was walking, talking, and texting his mother that he was doing well.  It appeared that he had fully recovered from Fentanyl toxicity.  Unfortunately, Fentanyl has another lethal quality.  Fentanyl is a long-acting drug that can last hours in the human body.  Naloxone is very effective at countering the effects of Fentanyl, but Naloxone is a short acting drug and is only effective for approximately 45 minutes.   Victims of Fentanyl toxicity can therefore suffer from a Fentanyl re-toxification once an initial dose of Naloxone loses efficacy.  Health care providers need to be acutely aware of this phenomenon.  A patient in the emergency room can appear to be completely fine while the Naloxone is effective, but quickly decline and suffer cardiac arrest once the Naloxone wears off.  This is precisely what happened to Billy in the Yale New Haven Emergency Department.  Yale was aware of the problems associated with Fentanyl re-toxification.  Unfortunately, Yale failed to follow its own protocols and left Billy completely unattended for seven hours.  By the time Yale medical staff checked on Billy, he had been in cardiac arrest for several hours and was brain dead.  Billy's family is currently pursuing a medical malpractice lawsuit against the hospital.  As the only level one trauma center serving southern Connecticut, Yale must do a better job in the future to prevent a similar death in the future.  Never Again.  

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