Surgeon informed me original ER dropped the ball after a serious motor vehicle accident

Location: Iowa

On the evening of Tuesday 7/1/25, a surgeon told me that a critical access hospital in rural Iowa failed to adequately assess my fiance’s condition after a motor vehicle accident that occurred 6/6/25. The facility in question decided not to triage my fiance to a higher level of care despite the severity of the situation. Instead, he was discharged several hours after the accident.

Details:
6/6/25 – Fiance involved in single-vehicle automobile accident in rural Iowa. Someone (unknown witness) called emergency services, and he was taken by ambulance to a nearby critical access hospital (Level IV trauma designation).

The entire ER visit was a nightmare for him. At no point did he have a call button. When I arrived in the ED ~4 hours post-accident (he’d been in ER 3+ hrs by then), here’s what I walked in to:
– RN tells me the CT scan and X-rays have been reviewed by a provider & decision is that no further imaging needed at that time.
– Fiance is lying flat on his back in the hospital bed, literally sobbing in pain
– Nurse instructs him repeatedly that he needs to provide a urine sample.
– Fiance tells me that he has asked for water multiple times & has been asking not to be lying completely flat for some time (I understand the importance of moving someone with a neck injury as little as possible. Likewise, providing oral fluids could be disastrous in the case where emergency surgery is needed. However by this point, such a neck injury had been definitively ruled out, and the decision had been made not to consult anyone else in the medical field for the duration of the given visit, thus ruling out any surgeries for the time being)
– At no time was/is he given IV fluids.
– Given the lack of fluid intake being provided (presumably resulting in lack of output – not like it’s a complicated concept), I ask if they will refrain from discharging him until he can at some point miraculously provide requested urine sample
– Instead of a clear answer, staff takes my question as a refusal to provide a urine sample. Neither my fiance nor I even eluded to him being unwilling to pee in their stupid little jug.
– About an hour after I arrive, he is finally given a first dose of pain medication (of any medication)
– ER doc says they’ll send a prescription for pain meds in to pharmacy of his choice. The time is approx. 5 pm on a Friday evening. He lives in a small town where the only pharmacy has limited hours, so at 5 pm on a Friday he’s looking at an entire weekend with a freshly broken sternum & no meds to help alleviate any of the pain
– I ask if their facility offers “bedside delivery” of prescriptions so fiance doesn’t have a huge gap of uncontrolled pain & ER doc says yes
– RN provides the standard “new medication” consult for oxycodone tablets.The strength of the tabs being sent home with my fiance is different than the strength of tablets the ER doc sends Rx for to his outside pharmacy. Discharge paperwork has instructions for the Rx sent to fiance’s local pharmacy; this discrepancy in tablet strengths is never mentioned (unsure if intentional, or no staff even noticed)
– No work note is offered, and I have to ask several times about getting one
– No mention is made of fiance’s 4 fractured thoracic vertebrae

The entire ER visit was essentially a “what not to do” crash course.

6/9/25:
Fiance establishes care with new family med provider/PCP. Provider decides a referral to 1. Cardiothoracic surgeon (appt on 6/17) 2. Neurologist (appt on 6/19) are warranted. The respective clinics call my fiance within a day or two to inform him of the appt times.

6/17/25:
At appointment with the cardiothoracic surgeon, surgeon states that he wants to surgically implant a plate ASAP in order to correctly align the sternum so it heals with proper alignment. (During this visit he remarks “Why the hell didn’t they send you here sooner?” )

Insurance sidenote: Although he has (up until the date of car accident) consistently worked full-time his entire adult life, my fiance’s income qualifies him for Medicaid (state insurance) as a household of 1. After the accident I learn that he failed to return some paperwork (a one-page form) on time a couple months prior, so his Medicaid insurance was recently canceled. He was eventually approved for presumptive Medicaid (thankfully the facility in question does accept this) however his surgery was put off approx. an additional week due to needing to get this mess sorted.

7/1/25: Cardiothoracic surgeon comes out to the surgery waiting room immediately after the procedure to talk to me. He said the sternal fracture was completely healed already when he began a sterniotomy + fixation of the sternum a couple hours prior. Due to the sternal fracture being so healed, the incision they had to make in order to rebreak the sternum spans from the base of my fiance’s neck and down the entire length of the sternum.

So surgeon re-broke the sternum in order to lengthen it more than the way it had naturally healed. He also made it very clear that due to the delay from the time of the accident -> surgery, the length he was able to add anteriorly was simply not possible to match that of my fiance’s original structure/stature. Placement of a plate soon after injury would have preserved this.
He also stated explicitly that the original facility – the tiny, level IV trauma hospital – did not handle the situation correctly. He said that based on the information they (the original ED) gathered/had, my fiance should have unquestionably been (at the very least) triaged to a facility equipped to deal with the extent of trauma clearly presented before them. With proper assessment and decision-making, an injury of this nature warrants emergency surgery and would have been a relatively easy fix (literally – a smallish incision to insert a single plate/bracket).

Instead of an overnight stay in the hospital, he will now be here 3-5 days and came out of surgery with multiple drains and a wound vac on the rather major incision.

Is the critical access hellhole that failed to escalate my fiance to a higher level trauma center liable for the extensive & unnecessary damage their negligence has now resulted in?