Where does the real truth "lie"?

• Author: Klebanow, Diana
• Position: Medicine & Health - Libby Zion

"NEVER LIE to a physician" is a well-worn adage. Few stories illustrate this as well as the one dealing with the death of 18-year-old Libby Zion 30 years ago. It deserves another look at a time when deaths from drug abuse--whether from recreational drugs like cocaine or from prescription medications --are spiraling out of control, and many patients remain unaware of the risks involved in lying to physicians about using drugs.

The young woman's father was the late Sidney Zion, a prominent attorney and journalist, and he succeeded in getting the media to tell his version of his daughter's death. It went on to become a sensational story--the care that Zion received from hospital doctors "resulted" in her death. However, this version omits an important fact: Zion had taken cocaine prior to entering the hospital.

Her death led to the enactment of the so-called "Libby Zion Rules," which limit the number of consecutive hours worked by interns and residents in hospitals throughout the country. The enactment was viewed as a victory for the father because he declared that his daughter's death was due to a medication error made by overworked interns and residents in the hospital. While these rules still are in effect today, they have been relaxed considerably in a number of states, including New York, where the story had taken place.

On the evening of March 4, 1984, Zion--accompanied by her parents--entered the Emergency Room at New York Hospital with an earache and a fever. When placed on a gurney, she was unable to sit still, and kept bouncing around. A nurse took her temperature, which was 103.5[degrees]. In order to control her temperature, she was given fluids through an intravenous line. A series of tests were ordered to discover the source of her fever, and she spent two hours in the Emergency Department.

The uncontrolled movements of her arms and legs continued, although they were followed by alternating periods of calm. At approximately 1:45 a.m., the Emergency Room physicians decided to admit her to the hospital for further tests.

Her highly agitated state suggested a drug overdose to the Emergency Room physician. When her parents were out of earshot, he asked the girl if she used marijuana. She said she often did, but not on that day. He also asked her about other illegal chugs, including cocaine, but she denied using them. This pattern continued when she was admitted to the hospital. Not only was she asked about any possible drug use, but her parents were taken aside and asked the same question. In all instances, the question posed was met with a denial.

Following her admission to the hospital, an intern was with her for two hours, beginning at 2 a.m. She also was seen by a resident. During the...