do I have a malpractice/wrongful death case?

[seekinglegal]

What is the name of your state? California

My father (age 75) became ill with a blood infection that entered his heart (endocarditis) a year ago. He showed classic symptoms starting in March (weight loss, fatigue, shortness of breath, a bloated look, back pain, ankle swelling, sweating, chills), but despite taking him to the ER several times and to a cardiologist, he was not properly diagnosed until June -- almost three months of having the symptoms – at which point he had become very weak.

He had also had a small stroke in April, which it turns out was caused by emboli from the endocarditis, but when he went to the ER with classic stroke symptoms (fell and could not get up, left-sided weakness, severe pain in neck area), he was sent home with a neck brace and no diagnostic tests were done (an MRI would have revealed he had had a stroke, and proper rehab could have been started and they may have found the endocarditis at that point – two months before they finally did. We finally were able to get him to an out-patient MRI in May – first available slot -- at which point it showed that he had had a stroke 3-4 weeks earlier, i.e., the April timeframe).

Once he finally was diagnosed with endocarditis in mid-June (after spiking a fever and getting his blood cultured), he was put on the correct antibiotic treatment and was responding well. He was then transferred from the hospital to a long-term care hospital for the last three weeks of antibiotic therapy. Here, he aspirated and ended up in the ICU on a ventilator. Because he had gotten pretty weak from the stroke and had had no rehab therapy to this point (despite our requesting it), he was a known aspiration risk and the nurses were told to have him drink or eat only in a forward-leaning position. He was not feeding or drinking himself, only with nurses aid, so we wonder why he was let to aspirate in the first place (a bronchoscopy showed that it was liquids and food he aspirated on).

Once in the ICU, he began to get repeated infections of multiple bacteria. The pulmonologist told us my father could be weaned off his ventilator if he quit getting infections. I noticed little to no infection control in the ICU, and made a formal complaint about it. Medical personnel did not wash their hands when entering my father’s room; fans were blowing directly on my father, toward his throat; doctors did not use the dedicated stethoscope in his room, instead using their own that they had used on other patients and had not wiped off between patients (I watched them carefully and they did not); gloves and masks were not routinely used; trash being shaken up and down to get it to settle in the bag while also having whatever dust or bacteria was in it spread around the room; anybody being let into the ICU ward – entire families with kids were running around one day; and ICU room doors wide open.

The nurses were also supposed to keep my father turned every two hours. I would have to go out and remind them. One day, my father was lying in a pool of feces for almost an hour. He developed a large bedsore the size of a saucer that was deep to the bone. They did not put a wound vac on it until two weeks later after I complained about the sore not getting properly treated. The sore was also infected.

During this time in the ICU, doctors would make cavalier remarks saying things such as “he’s elderly, it’s his time, pull off the ventilator and let him go” to “no one ever leaves here alive” to “every one here gets infections and there is nothing we can do about it, they just die.” One note in the medical records from the dietician expresses extreme frustration that my father had been put on parenetal food for no reason, had lost 9 pounds in a week, and was in great need of nutrition.

My father passed away in August due to septic shock from multiple bacteria, none of which was the one that caused his endocarditis. While infections unfortunately are out-of-control in hospitals, getting five of the six deadliest and most antibiotic-resistant bacteria (source: CDC) seems to be very much out of the norm (he had pseudomonas aeruginosa , acinetobacter baumannii, c. difficile, MRSA, and Vancomycin-resistant enterococcus faecium, in addition to candida and Ventilator-acquired pneumonia).

From this, do we have a wrongful death and/or malpractice case? Failure to timely and properly diagnose even when blood tests and an echocardiogram in May revealed odd white blood cells, anemia, and a thickening heart valve? Failure to test for a stroke in April despite classic symptoms and a CABG history, thus no stroke therapy? Lack of proper infection control?

The above description, while long, is just a fraction of the experience.

Thank you for your time and response.

PS: if you are wondering why we did not transfer my father out of this place, we tried and the doctors would not authorize it.

[ellencee]

Originally Posted by seekinglegal

What is the name of your state? California

My father (age 75) became ill with a blood infection that entered his heart (endocarditis) a year ago. He showed classic symptoms starting in March (weight loss, fatigue, shortness of breath, a bloated look, back pain, ankle swelling, sweating, chills), but despite taking him to the ER several times and to a cardiologist, he was not properly diagnosed until June -- almost three months of having the symptoms – at which point he had become very weak.

In subacute endocarditis, this is descriptive of the usual course of illness, diagnosis, and initiation of treatment. No apparent professional negligence noted in your description of events.

He had also had a small stroke in April, which it turns out was caused by emboli from the endocarditis, but when he went to the ER with classic stroke symptoms (fell and could not get up, left-sided weakness, severe pain in neck area), he was sent home with a neck brace and no diagnostic tests were done (an MRI would have revealed he had had a stroke, and proper rehab could have been started and they may have found the endocarditis at that point – two months before they finally did. We finally were able to get him to an out-patient MRI in May – first available slot -- at which point it showed that he had had a stroke 3-4 weeks earlier, i.e., the April timeframe).

Strokes do not always show up on MRI, or CT scan, or any other diagnostic test. Strokes may never present on film or evidence of a stroke may be come apparent after a period of time during which changes in and on the brain show evidence of a stroke in either recent or distant history. A physical assessment was done in the ER and was done by at least two medical professionals. From this, I infer that dad has not been in good health for a number of years and on a good day has some thinking and performance difficulties or loss of normal function.

Once he finally was diagnosed with endocarditis in mid-June (after spiking a fever and getting his blood cultured), he was put on the correct antibiotic treatment and was responding well. He was then transferred from the hospital to a long-term care hospital for the last three weeks of antibiotic therapy. Here, he aspirated and ended up in the ICU on a ventilator. Because he had gotten pretty weak from the stroke and had had no rehab therapy to this point (despite our requesting it), he was a known aspiration risk and the nurses were told to have him drink or eat only in a forward-leaning position. He was not feeding or drinking himself, only with nurses aid, so we wonder why he was let to aspirate in the first place (a bronchoscopy showed that it was liquids and food he aspirated on).

Physical therapy wasn't started because it was not yet appropriate. It is not possible to stop someone from aspirating, so no person "let" him aspirate. He aspirated. Apparently, he received prompt and proper intervention after he aspirated but now his health takes a serious challenge from the lungs and the body's response to aspiration. Now, he's headed for pneumonia and sepsis because of his already weakened condition and because his body is loaded with antibiotics, the opportunistic organisms are waiting on an entry point into his body.

Once in the ICU, he began to get repeated infections of multiple bacteria. The pulmonologist told us my father could be weaned off his ventilator if he quit getting infections. I noticed little to no infection control in the ICU, and made a formal complaint about it. Medical personnel did not wash their hands when entering my father’s room; fans were blowing directly on my father, toward his throat; doctors did not use the dedicated stethoscope in his room, instead using their own that they had used on other patients and had not wiped off between patients (I watched them carefully and they did not); gloves and masks were not routinely used; trash being shaken up and down to get it to settle in the bag while also having whatever dust or bacteria was in it spread around the room; anybody being let into the ICU ward – entire families with kids were running around one day; and ICU room doors wide open.

Handwashing on entering a room is redundant if the person washed their hands or used disinfectant solution when leaving the prior patient. Where would you like the fan to blow? It was there to cool your father, so having it blow on him seems appropriate. Many ventilator patients consider a fan to be a great comfort measure. The CDC does not require stethescopes to be routinely cleaned between patients because stethescopes are only placed on clean and intact skin. In certain isolation settings, equipment does not enter or leave the room; in those settings, disposable stethescopes are used. I disinfect my stethescope or slip the head of it into a glove before placing it on a patient's chest, but that's my choice; I'm not required to do so. Shaking the trash? Oh, come on.

The nurses were also supposed to keep my father turned every two hours. I would have to go out and remind them. One day, my father was lying in a pool of feces for almost an hour. He developed a large bedsore the size of a saucer that was deep to the bone. They did not put a wound vac on it until two weeks later after I complained about the sore not getting properly treated. The sore was also infected.

C-diff does that and there is not much that can be done other than to prevent C-dif from occurring and that's a real challenge. I insist the docs put my patients on bacteria-restoring products such as lactinex granules or active-culture yogurt and, or buttermilk, even if I put it through a feeding tube. It helps; but, it won't totally prevent C-diff if the patient's overall health and resilience is poor. An hour in feces is, unfortunately, not unusual unless the patient ratio is 1:1. A wound vac cannot be applied to an area that cannot yeild a complete seal. You have no idea of the challenge of a wound vac in the presence of diarrhea or of the potential damage to the patient if the wound vac is placed before the wound is appropriate for the treatment. Wound Vac treatment places an enormous stress on the body. [For those of you who don't know about Wound Vac therapy, it is a miracle healer of wounds and works applying constant (or intermittent) suction to a wound. I usually explain it as a "hickey maker" as one of its primary functions is to "suck" the blood into the wound, continuously. This clean, moist, well-fed (blood), wound environment speeds healing in a phenominal manner.]

During this time in the ICU, doctors would make cavalier remarks saying things such as “he’s elderly, it’s his time, pull off the ventilator and let him go” to “no one ever leaves here alive” to “every one here gets infections and there is nothing we can do about it, they just die.” One note in the medical records from the dietician expresses extreme frustration that my father had been put on parenetal food for no reason, had lost 9 pounds in a week, and was in great need of nutrition.

Parenteral feedings aren't necessary for a ventilator patient? In what world? The docs may have been thoughtless in their remarks but what they said may have been true. Perhaps the unit in which your father was placed is a unit for those with equipment (ventilator) that prevents placement on a med-surg floor and the prognosis for patients in that unit may be that most of them die from one infection after another as their bodies lose the ability to recover from any infection and the opportunistic infections invade and ultimately result in patient death. The loss of nine pounds in a week is not unusual for someone in your father's condition. Nutrition is a challenge for someone like your father. A vein that can support total parenteral nutrition would have been needed in order to give all his nutrition via IV and in the presence of such infections, it would have been asking for more trouble and providing the trouble with a mainline into the heart. It probably wasn't a realistic option.

My father passed away in August due to septic shock from multiple bacteria, none of which was the one that caused his endocarditis. While infections unfortunately are out-of-control in hospitals, getting five of the six deadliest and most antibiotic-resistant bacteria (source: CDC) seems to be very much out of the norm (he had pseudomonas aeruginosa , acinetobacter baumannii, c. difficile, MRSA, and Vancomycin-resistant enterococcus faecium, in addition to candida and Ventilator-acquired pneumonia).

That is exactly the outcome I would have expected.

From this, do we have a wrongful death and/or malpractice case? Failure to timely and properly diagnose even when blood tests and an echocardiogram in May revealed odd white blood cells, anemia, and a thickening heart valve? Failure to test for a stroke in April despite classic symptoms and a CABG history, thus no stroke therapy? Lack of proper infection control?

No, you most likely have no viable claim of any significant damage from negligence/malpractice. Diagnosis was timely. Your father's health was poor before this began; his ability to recover from endocarditis was very low and he did not recover.

The above description, while long, is just a fraction of the experience.

Thank you for your time and response.

PS: if you are wondering why we did not transfer my father out of this place, we tried and the doctors would not authorize it.

I'm sorry for the loss of your father and not surprised that you are looking for someone to blame for his death. In time, you will realize that his health was leading to this kind of an exit.

Best wishes,

EC