The LeRoy Catastrophe: A story of death, determination, and the importance of nutrition in medicine.

“To this day, I wonder whether his death certificate truly reflected the cause of death: ‘physician-induced’ malnutrition.”  – from The LeRoy catastrophe

Below is the abstract of this article as published by The Columbia Medical Review. It can be viewed in full here. The Review has recently launched a place for thought leaders to convene and develop action-oriented agendas to combat contemporary and anticipated social issues in medicine.

Abstract

In August 1976, a young man named LeRoy fell from a ledge, fracturing his femur. Major internal bleeding was suspected. During a laparotomy, the trauma team ensured that all internal organs were intact and the orthopedic team set his fracture. Thirty days later, LeRoy died. He had eaten little; each day he only received three liters of glucose, the equivalent of 510 calories, intravenously. The glucose was insufficient to meet his nutritional needs, and he lost over 20% of his body weight during his hospital stay. The cause of death was due to “physician-induced” malnutrition. Meanwhile, a paper around the same time documented that the prevalence of malnutrition in Boston hospitals was 44% and that malnutrition itself was a predictor of higher complication and death rates.

As a result, like-minded physicians formed a society that created training programs and encouraged formation of hospital nutrition teams. Industry produced nutrition formulas and catheters. Complications in sick hospitalized patients plummeted while survival rates rose, and California passed legislation to mandate nutritional support. Though the health care industry recognized the importance of nutrition in patient care, Congress failed to pass fiscal support for nutrition teams. As a result, hospitals disbanded their newly created nutrition teams, nutrition education and skills declined, and hospital complications and death rates have risen again.

There are none so blind as those who will not see.

John Heywood (1546)

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