What is the name of your state? Virginia
My family and I are struggling emotionally over what we believe is at least medical incompetence and possible worse. A few months ago, my 81-year old mother complained of stomach pains and nausea for about three days. She finally decided it was time to seek medical help and asked me to take her to the Emergency Room on a Friday evening. Personally, I was relieved that she was seeking professional help.
Upon admitting, her history of illness and her recent issues were discussed. She was generally in reasonably good health. She drove everyday and cared for my elementary-aged son after school while I worked. She was a cancer survivor and had a colostomy that she cared for without complications for over 20 years. Her diet was limited to a bland diet due to gall stones and she would occasionally have an attack. She was 5'3" tall and weighed 78lbs upon entry to the hospital. Over the past few days, she was unable to eat much due to the nausea and she had dropped a few pounds. It was noted on her medical entry that I had concern over her recent (10-day prior) exposure to pneumonia from me. Approximately nine months prior to this visit to the hospital, she had received care for pneumonia, had chest x-rays and she made a complete recovery. After a brief examination in the ER, she was admitted to a critical care room at the hospital.
Initially, her care seemed to be fine and I was not concerned. She was started on IV antibiotics and glucose early that morning (roughly 3:00AM). The next morning I visited her in the hospital and we talked. She was very tired and restless from a long night of test and evaluations. She complained to me that she just needed some sleep and was having difficulty resting with the external noises. During the visit, I noticed that she was generally lucid with moments where she would forget things. She seemed very tired, a bit agitated and was restless. She was also very cold and asked for several additional blankets. At this point, she was being treated for mild pneumonia and it was not concerned to be life threatening. Her blood work showed a white blood count of 10,000. There was some concern over her stomach pain and nausea and x-rays were ordered to determine if she had some type of blockage in the intestines. I spoke with her nurse after the visit with her and we discussed a care plan for her upon her release from the hospital.
Later that afternoon, my brother visited and had similar observations about our mother. She seemed tired, agitated and restless. When we asked her about visitors, she responded that she just really wanted to get some rest.
Early that evening, I called the hospital to see she was doing. A nurse responded that she was resting comfortably and I decided not to visit that evening. The next morning, I receive a call from the doctor asking if we had any desires concerning a "living will." I was curious why she asked and she explained that my mother was in a "non-responsive" state and that her condition was now life threatening. I was shocked and told the doctor that I could not approve a DNR (Do Not Resist ate) order until I spoke with my brother and sister. I learned later that my response was taken as a limited DNR. I immediately call my brother and sister. We rush to the hospital and immediately notice her depilated state. Her hands were cold, they had her on an oxygen mask and I noticed her blood pressure had dropped considerably. It was now around 75 over 55. When I held her hand and talked to her, I received no response from her. She had a tube inserted into her nose and I noticed the contents of collection from the tube were bile-like in color (greenish and several ounces in volume). Immediately, I asked what had happened since I was there the previous day and I got no immediate response from the doctor or the nurse on staff. I asked the doctor what she believed was wrong with my mother and she indicated concern over a potential blockage in her small intestine. The doctor was concerned that my mother's white blood cell count had jumped to 14,000 and that she was possibly septic from a perforation of the small intestine.
Later that afternoon, I learned about the DNR that had been placed on her chart and I immediately told the nursing staff to remove this from her chart. The doctor was called in to discuss this with me and my siblings. It was decided at this point that we wanted everything done with the exception of full life support. Over the next 24 hours, her vital signs improved for a short period, but she never regained consciousness and passed away at roughly 6:00PM the next evening. During that entire period, a family member was always by her side.
After her passing, my sister and I began questioning her care and requested an autopsy to be performed by the hospital. In addition, we requested a full copy of her medical reports. I went through the reports looking for an answer and I believe I found what happened to her. Overall the report was thorough, however, I did notice a period of time where there were few notes about her care. Unfortunately, this is the period of time that I'm most concerned with. It does show that Saturday evening a .5 to 1mg dosage of Ativan was order by one doctor to be administered in her IV. After that a second doctor ordered, at what appears to be midnight, a 2mg injection of Ativan to be administered every 2 hours as needed for agitation. It appears that three doses of Ativan each at 2mg were given over the next six hours. It was this morning that the doctor called me and indicated my mother was non-responsive.
I apologize over this long-winded diatribe at 5:00AM in the morning, but this brings me to my concern. (It is now been two months and I'm still having problems sleeping many nights). I'm not in the medical profession, but I can read and interpret information from the drug manufacturer. It indicates that the drug must be carefully administered to elderly patients and those with reduced lung capacity. In addition, contra indicators for this drug show the possibility of agitation and the possibility of further restricting airways. Also, the dosage for someone of her age, weight and physical condition seem to be completely inappropriate. All indications from what I read, indicate that someone of that condition should not receive more than 0.5 to 1mg for the first day and it is generally not recommended that more than 2mg be given in a 24 hour period.
I firmly believe that her comatose state was brought on by the overdose of Ativan and that ultimately her death was directly related to the overdose. The autopsy (performed by the hospital) concluded that the pneumonia was the cause of death and personally I don't believe that is the "root" cause of the problem. What I find especially alarming from the autopsy was the lack of any trace of benzodiazepines (Ativan) in her system. With a dose of over 6mg within that period of time, wouldn't a trace of it be found in her system 72 hours later during the autopsy? This just doesn't make sense to me and sounds like a cover-up to me.
Am I wrong to believe that this is complete medical incompetence and a possible cover-up by the hospital? I would sincerely appreciate any assistance (legal, medical or otherwise) with this issue.
Thank you very much in advance,
Sleepless in Virginia