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Notes -
At a clinical level, I am going to call bullshit on the claim that this guy died because of shockingly poor medical care. I am not a doctor, but I have had two relatives die of aneurysms and been involved with the pro forma inquests into sudden deaths outside hospital that resulted. Based on the information provided in the MSM coverage:
First point - this guy is very low risk for aneurysm based on the presentation. The main risk factors in rough order of importance are age, smoking, blood pressure and obesity. History of cocaine abuse is also listed in some places, but not alcohol or meth. None of these were present. And in any case, aneurysm isn't one of the top 10 causes of acute chest pain at all (most aortic aneurysms are in the abdomen, not the chest).
Second point - if they had done the X-ray and bloodwork that the guy thought he was waiting for, it wouldn't have found the aneurysm - aneurysms don't show up on X-ray. You should find an aneurysm on ultrasound (but nobody does ultrasound in chest pain cases), and you will find it on CT or MRI. Whether the standard of care for chest pain with a normal ECG is chest X-ray or CT scan * appears to be controversial in the US. Anecdotally, the vast majority of aortic aneurysms are found as a result of doing a scan for some other reason. (In this case, it would have been while doing a CT scan of the heart to check for cardiac causes of chest pain other than a heart attack).
Third point - if they had found the aneurysm and chosen to repair it, it would have been scheduled as urgent surgery (the UK guideline is within 2 weeks), not immediate emergency surgery. They wouldn't have known that was going to rupture within 24 hours. So he dies with probability >50% even if they do find it.
Fourth point - the US standard of care for suspected-cardiac chest pain includes observation for 24 hours. If that's what you are doing, and (as the Canadian docs did) you know that the guy isn't having a life-threatening heart attack right now, the slowness is excusable if adequately explained.
Provisional conclusion - this guy was not killed by Canadian cheapness - the key clinical decision (i.e. not doing a CT scan) is balancing radiation risk against a marginal improvement in diagnostic accuracy, not a cost-based one. And in any case, this is a case that would if probably have been missed by a perfect medical system because when the horse is a heart attack, you don't fuck around testing for zebras. There may have been** a culpable failure of communication - if he didn't know why he was sent back to the waiting room after the ECG, or what the short-term plan was that was worth waiting another 6 hours for, and he absolutely should have done. If they told him and he just got tired of waiting without a clear ETA, then that is normal for a non-life-threatening case in a busy ER, regardless of funding levels. But even if they had provided an adequate explanation, it probably wouldn't have changed the result.
* Chest CTs are one of the highest doses of radiation that a normie is exposed to, so they are treated as an "only if strictly necessary" procedure. ** It isn't clear if he was told he was waiting for bloodwork and X-ray, just not when it would happen, or if he worked that out himself.
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