Not sure who to ask about my Mom's death...

What is the name of your state? Wisconsin

Long story short...

My mom had some intestional surgery done and was sent home a week later. Less than two days later I had her back in ER for emergency surgery to clean out pertonitis infection. She spent 5 days in ICU (I stayed with her the whole time) and was moved into a regular hospital room. Antibiotics were evidently working...and she was starting to get up an walk, eat, talking....but tired. We thought she was out of the woods and doing good! Improving by the minute!

Then on her last thrusday, she was doing so well. That mid morning she started complaining about short breath. Nurses said it was becaue she had been bed ridden for two weeks.

Then she got some chest pains...again...nurses said because of being sick...just spasms. The checked blood pressure, and pulse. Nothing more.

Then the pain got worse......wheezing....short of breath...and they stated to mention anxiety attack, so they gave her some seditation. As they were giving her sedation...her heart stopped.

They never were able to get it started again.

I wonder if they could have saved her if they had even thought about her heart! I know she was full of infection...and possibly wouldnt have made it anyway, but I just cannot get it out of my head...the what if's.

She had even had a questionable EKG the week before and they didnt do one that day.

Is this malpractice? Or am I just having grief anger and directing that???

I am not sure where to begin to ask questions as I am afraid to ask her doctor...if he would even tell me if they did wrong.

Thanks in advance for any advice or suggestions anyone may offer

Connie

Hi! Just a newbie lurking through this thread and this caught my attention. I am an RN in a cardiovascular intensive care unit, so I can only discuss the medical/nursing angle, not the legal one, but here's some thoughts that immediately come to mind: You are perfectly within your rights to talk to the doctors involved in your mom's care, and to see what they think the official cause of death was. Was she autopsied? Or do they have at least have a pretty good suspicion of what happened? Someone should have talked to you when she died, for God's sake. I can imagine how upsetting it might be to have no clue as to why you lost your mom. There are many factors that could be considered here, at least from a nursing standpoint. Any history of heart attacks or congestive heart failure or valve trouble? Was she on anticoagulants (blood thinners) to prevent blood clots from forming and lodging in her lung? Or did she at least wear antiembolism stockings or leg-compression devices to prevent blood from pooling in her legs and clotting? Was she attached to a heart monitor at the time (telemetry)? Did they check how well she was oxygenating when she started having SOB? Did they do a chest X-ray? Did they try diuretics to clear her lungs? I have had a lot of patients that truly do have anxiety attacks that may mimic something more serious, but there is no excuse for these people if they did not try to rule out a physiological cause first, or at least aggressively treat the symptoms. That means cardiac-related blood tests, chest X-rays, frequent vital sign monitoring, oxygen support or timely intubation/mechanical ventilation, EKG at the onset of trouble, blood pressure support (IV medication), and on and on--I can tell you that most elderly people in my experience have some funky EKG results, and most of the time it ends up having no immediate bearing on the pt's condition. In this case, unless your mom had ongoing heart trouble, they would not have routinely ordered a daily EKG, but they should have done one immediately when her chest pain started--that's standard. Oh well, this is too long already, so I'll just say I'm sorry about the loss of your mother and I hope that you can find some answers that will help you come to terms with her death and allow you some peace. Good luck.

Oh thank you for the reply! Mom was young at 55. Her blood pressure was a little on the low/normal side...pulse within normal but they were having trouble with the finger oxygen meter registering. She was on IV treatment for her peritonitis and high white cell count from the infection, and potassium laced fluid IV also. Other than that, she wasnt on any blood pressure meds at all. In fact, she had high blood pressure most her life, and lost weight, then her pressure evened out, so that was not an issue. No murmers, ect.

She had been long term oxycoton user for chornic disabling back pain...she was on disablitiy for that, and one nurse attributed her "panic attack" to detox.

During the day, when the symptoms started, her blood pressure really didnt drastically change, nor did her pulse till the pain got bad. But, I did ask repeatedly what was causing the pain and one nurse DID ask mom if SHE thought it was her heart. Mom said she didnt think so, but due to high infection mom had been confused off and on. But that was getting much much better! All the nurses told me she had great hopes of recovery!

Anyway, after her death, I did request an autopsy so that I would know what it was, and there was no blood clot, no coronory disease, but still infection and some cirrosis. (she had quit drinking 7 years previously)

The autopsy priliminary report (doctor told me this, I havent seen it) was....

Minutes...Myocardial Infaarction
Days.......Sepsis
Days........peritonitis
Years.........Cirrhosis


I just cannot believe that out of three floor nurses, not one thought of the heart...

Shortness of breath upon exertion (ok..so it was her first day out of bed without a cathader)
later Wheezing...(ok, maybe fluid from all the bed rest)
Severe chest pain in the center of chest (did give her an anti acid incase it was heart burn)
and when she started getting panicky because she couldnt get her breath they gave her a seditive.

That is when her heart stopped. They began chest compression, and bagging her (I stayed in teh room the whole time...wasnt gonna get me out I DID stay completly out of the way too!) and THEN they drew blood, did chest x-ray, and EKG. But they couldnt get a good responsive beat.

After 30 - 40 minutes of chest compression/bagging they asked if they could stop because they didnt think it was going to do any good at that point and I said yes.

And that was that.

KatzanRatz
Somewhere out there is a post to you that I made earlier. Just in case it appears later, I'll make this one as brief as possible.

The RNs failed to report a change in condition to the MD and thereby not only violated their Nurse Practice Act by exceeding the scope of their practice but when they administered medication for 'anxiety', they crossed over into practicing medicine without a license.

The signs and symptoms your mother exhibited should have been recognized as a possible embolism, either to the heart or to the lungs. The autopsy supports embolism to the heart.

In addition to your mother's complaints, the physical changes of lower blood pressure and pulse oxymeter's not registering the SaO2 are clear indications of cardiopulmonary deficits. The MD should have been notified immediately.

Once your mother developed chest pain, someone should have called the physician STAT and more likely than not should have called a code and let the code team evaluate her status.

By the time your mother exhibited signs and symptoms of agitation, it should have been abundantly clear to the nurses that a code needed to be called.

Your mother's signs and symptoms follow the teaching materials for BCLS and ACLS guidelines and the criteria for initiating a code or a response team. Any graduate RN should be able to recognize a change in condition as a need to notify the MD and any graduate RN should know to notify an MD STAT when BP drops or SaO2 drops or chest pain develops or a patient becomes agitated, especially in the presence of other physical complaints.

I suggest you consult with a medmal attorney at once. Your mother was denied the chance for early intervention by the nurses who exceeded their scope of practice and by the nurses who not only exceeded the scope of their practice, but practiced medicine without a license by diagnosing and prescribing/administering prescription-required medications.

I am sorry for the loss of your mother and for the professional negligence by RNs who should have known that failing to notify the MD would, more likely than not, result in significant damages to the patient.

Best wishes,
EC

The nurses did call the doctor on the phone, and I believe they asked to administer the seditive. An internist did see her in the early afternoon and she did complain about a little shortness of breath and a tightness of chest. He attributed it to all the bed rest and said that after two weeks in bed, the chest/lung muscles can spasm when you sit up.

At the time, it all seemed logical. I belive she had an EKG on Wed, but i never heard any results from that. She didnt have any symptoms that day. She started the symptoms Thursday.

Thank you for your reply. After two in a half weeks, I am not sure if I am just still grieving and directing it towards the medical profession, but I just cannot get that day out of my head....things just spiraled and no one did much. I do have to say, they did treat mom very caringly, just in my opinion, not medically enough.

Even if she still would have died from the infection, she may not have.

And by the way, the autopsy showed NO BLOOD CLOTS.

KatzanRatz
I stand by my original answer and add negligence on the part of the physician and the internist!

I sincerely doubt the nurses called the MD, reported a pt. with day-long complaints of shortness of breath, complaints of chest pain in the early afternoon, inability to measure SaO2 with the finger-tip analyzer, and onset of restlessness, and received the OK to give a sedative. If the nurses did report those signs and symptoms and still administered a sedative, it's still not appropriate care and it's still not OK for a nurse to follow an unacceptable order.

The pulse oxymeter probably couldn't measure the SaO2 because the level was below the lower limit on the analyzer. Another analyzer should have been obtained and respiratory therapy should have been notified to assist in the measurement and assessment. All the nurse had to do was put the analyzer on her own finger and if it didn't register a value, get another one! If it did register a value, then the nurse needed to call the MD STAT and, more likely than not, a respiratory code. Oxygen should have been started at once at the bedside and an ECG should have been obtained STAT.

An embolism is not always a blood clot. It can be a bolus of fat, or a chunk of infection, a piece of bone, an air embolism (bone and air are not likely here), or a blood clot that did not remain in the heart and was not detected on autopsy. The myocardial infarction came from somewhere!

It probably is too soon for you to consult with an attorney, but you should do so at your earliest convenience due to the statute of limitations.

Your mother was sick, with sepsis and with chronic cirrhosis, but she was recovering from the sepsis and the cirrhosis was a minor player except in making her a more likely candidate for associated significant risks of embolism and myocardial infarction.

I see a general breakdown in objectivity in the care she received and a consistent failure to assess for the cause of the change in status. This translates into sufficient reason to review the records and obtain expert review by an RN and by an MD of the same qualifications as her MD and by an Internist of the same qualifications as the Internist.

If I were screening this complaint for a medmal attorney, I would definitely recommend accepting the case for investigation and possible litigation.

EC

Thank you so much. Now I know why I couldnt quite thinking about this for the last two weeks.

You can never know what a relief you have provided me.


Now, is there a way to rate an attouney, or do I just open the yellow pages and pick a name that appeals to me???

KatzanRatz: Now, is there a way to rate an attouney, or do I just open the yellow pages and pick a name that appeals to me???

Click to expand...

The recommendation by a personal friend or associate is always a good idea. Some people suggest that you go to the courthouse and read the 'who won, who lost' list and go with the attorney with the most wins! I don't have time for that or any real faith in that method, either. If you don't have someone you trust who can make a recommendation, then check out the yellow pages and look for attorneys with experience. Don't go for the attorneys who say 'let us settle your personal injury claim' because that's what they do--settle; they don't go to trial. Interview several attorneys until you find an attorney with whom you feel comfortable and confident in his or her abilities. This will not be a short-term relationship between you and your attorney and you need someone in whom you can have faith. If an attorney promises you a big win in the near future, don't choose that attorney. Choose an attorney who lays out a reasonable timeline and reasonable expectations.

Best wishes,
EC

ellencee, again thank you!

You're welcome!