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Is this a case of medical negligence? Acute renal failure requiring dialysis

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Oubliette331

Junior Member
What is the name of your state (only U.S. law)? CT
This situation involves my 26 year old sister.
On Christmas Day 2017, she was brought to the ER by ambulance for an accidental drug overdose. She is not addicted to heroin but had consumed a small amount by snorting, along with several other substances in larger amounts. She was administered Narcan twice prior to arriving at the hospital. She was told that her blood pressure was dangerously low. Drug overdoses are an epidemic in our area and the hospital staff was very cold toward her, not showing much concern or compassion. She was not given any form of counseling nor informed of any additional resources that she might want to utilize. They discharged her after about 7 hours of observation.

Her blood tests showed a slightly elevated creatinine level of 1.37 mg/dL, as well as several other abnormalities that were never discussed with her or addressed in the medical record. The cut off written on the test results is 1.3, but later doctors have told us that a level of 1.1 is more appropriate for an adult female. She was uninsured and does not have a doctor. The medical record states that she was discharged with instructions to follow up with her primary care physician, but they never actually said this to her and they knew that she doesn’t have a PCP- they didn’t give her any instruction for follow up at all, did not inform her of symptoms which should prompt her to return to the hospital, and never called her to follow up either. A doctor who treated her later in the same hospital network said that the standard policy for patients who are not insured and/or don’t have a doctor is to set them up with an appointment with one of the hospital doctors prior to discharge.

After being discharged, she felt unwell for two weeks. She was unable to keep food down and was throwing up quite a bit. Then her face and ankles became swollen. She returned to the ER two weeks after the overdose incident due to these symptoms building up. They were about to discharge her when the doctor looked over her test results again and realized she was in acute renal failure. Her creatinine levels were 33 mg/dL, which was a pretty dramatic decline in function as typically the levels rise by 1 per day during acute kidney failure. She was admitted to the hospital where she stayed for almost two weeks getting dialysis treatments. She has now been discharged and needs ongoing outpatient dialysis. The doctors think that the kidney failure was caused by the period of low blood pressure that occurred at the time of the overdose. A biopsy ruled out an autoimmune response as a possible cause.

Is this a case of negligence in her initial hospital visit for the drug overdose? She was given very minimal treatment IMO considering that she had just survived a life threatening ordeal. It is well known that sustained periods of low pressure can cause damage to organs, especially kidneys, and her test results at the time indicated that there might have been a developing issue. I feel that they should have kept her for longer observation, informed her of the possible future complications or health issues, educated her about resources for substance abuse, and set up a follow up appointment knowing that she is uninsured with no doctor or at least contacted her after a few days to check on her. If she had not returned to the hospital when she did, she could have died. And she was reluctant to go back after such dismissive treatment, being viewed as a “junkie.” Thankfully she is alive, but had to quit her job and needs to get dialysis 3 times a week, with the possibility of permanent kidney damage. If the kidney failure had been caught sooner that could’ve been avoided.
 
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PayrollHRGuy

Senior Member
Malpractice cases are costly to pursue and very hard to prove. While she did have elevated creatinine level on discharge 5.0 or higher is where danger really sets in and your sister wasn't close to this.
 

quincy

Senior Member
What is the name of your state (only U.S. law)? CT
This situation involves my 26 year old sister.
On Christmas Day 2017, she was brought to the ER by ambulance for an accidental drug overdose. She is not addicted to this drug and had only consumed a small amount by snorting, not that it is particularly relevant. She was administered Narcan prior to arriving at the hospital. She was told that her blood pressure was dangerously low. Drug overdoses are an epidemic in our area and the hospital staff was very cold toward her, not showing much concern or compassion. She was not given any form of counseling nor informed of any additional resources that she might want to utilize. They discharged her after about 7 hours of observation.

Her blood tests showed a slightly elevated creatinine level of 1.37 mg/dL, as well as several other abnormalities that were never discussed with her or addressed in the medical record. The cut off written on the test results is 1.3, but later doctors have told us that a level of 1.1 is more appropriate for an adult female. She was uninsured and does not have a doctor. The medical record states that she was discharged with instructions to follow up with her primary care physician, but they never actually said this to her and they knew that she doesn’t have a PCP- they didn’t give her any instruction for follow up at all, did not inform her of symptoms which should prompt her to return to the hospital, and never called her to follow up either. A doctor who treated her later in the same hospital network said that the standard policy for patients who are not insured and/or don’t have a doctor is to set them up with an appointment with one of the hospital doctors prior to discharge.

After being discharged, she felt unwell for two weeks. She was unable to keep food down and was throwing up quite a bit. Then her face and ankles became swollen. She returned to the ER two weeks after the overdose incident due to these symptoms building up. They were about to discharge her when the doctor looked over her test results again and realized she was in acute renal failure. Her creatinine levels were 33 mg/dL, which was a pretty dramatic decline in function as typically the levels rise by 1 per day during acute kidney failure. She was admitted to the hospital where she stayed for almost two weeks getting dialysis treatments. She has now been discharged and needs ongoing outpatient dialysis. The doctors think that the kidney failure was caused by the period of low blood pressure that occurred at the time of the overdose. A biopsy ruled out an autoimmune response as a possible cause.

Is this a case of negligence in her initial hospital visit for the drug overdose? She was given very minimal treatment IMO considering that she had just survived a life threatening ordeal. It is well known that sustained periods of low pressure can cause damage to organs, especially kidneys, and her test results at the time indicated that there might have been a developing issue. I feel that they should have kept her for longer observation, informed her of the possible future complications or health issues, educated her about resources for substance abuse, and set up a follow up appointment knowing that she is uninsured with no doctor or at least contacted her after a few days to check on her. If she had not returned to the hospital when she did, she could have died. And she was reluctant to go back after such dismissive treatment, being viewed as a “junkie.” Thankfully she is alive, but had to quit her job and needs to get dialysis 3 times a week, with the possibility of permanent kidney damage. If the kidney failure had been caught sooner that could’ve been avoided.
Your sister could have the medical records and facts reviewed by a medical malpractice attorney in her area. The initial consultations are often free. In addition, attorneys often take malpractice suits on a contingency basis.
 
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Oubliette331

Junior Member
Malpractice cases are costly to pursue and very hard to prove. While she did have elevated creatinine level on discharge 5.0 or higher is where danger really sets in and your sister wasn't close to this.
Thanks for the reply. Her levels would not have been that high because it takes time for that to fully develop. They could have tested her a few hours later to see if the levels were continuing to rise knowing that kidney failure is a common complication of prolonged hypotension.. Either way, my thought is that they should have at least recognized and informed her of that risk and made sure she had access to adequate follow up care. Her lab results were never even discussed with her before discharge. And they knew she had no insurance or doctor, as well as mental health or substance abuse issues that lead to her almost dying which they never counseled her on either.
 

quincy

Senior Member
Thanks for the reply. Her levels would not have been that high because it takes time for that to fully develop. They could have tested her a few hours later to see if the levels were continuing to rise knowing that kidney failure is a common complication of prolonged hypotension.. Either way, my thought is that they should have at least recognized and informed her of that risk and made sure she had access to adequate follow up care. Her lab results were never even discussed with her before discharge. And they knew she had no insurance or doctor, as well as mental health or substance abuse issues that lead to her almost dying which they never counseled her on either.
There are no doctor-members on this forum (to my knowledge) so no one here can tell you if the standard of care was met by the hospital in its initial treatment of your sister. For that, your sister should get the opinion of a doctor in her area.

Your sister can also consult with an attorney in her area, to determine if there is a legal action to pursue. She has a complicated history which also will complicate any legal action she considers.

Because she is an adult, there is little you can do other than point her in the direction of a malpractice attorney.

Here is a link to a FreeAdvice staff-written article with general information on medical malpractice contingency fees: https://law.freeadvice.com/malpractice_law/medical_malpractice/medical-malpractice-contingency-fee.htm

Good luck.
 
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justalayman

Senior Member
Thanks for the reply. Her levels would not have been that high because it takes time for that to fully develop.
They could have tested her a few hours later to see if the levels were continuing to rise knowing that kidney failure is a common complication of prolonged hypotension..
sure but do the standards of care demand such? There are other reasons for an elevated creatinine level as well. The tests and situation are taken as a whole. To determine if there was a substandard level of treatment involved you really do need to take all of her records to a lawyer who will have them reviewed by a medical professional. I can’t recall the fee quoted the last time I inquired but I’m sure it varies on locality so it would likely not be applicable to your area.

Either way, my thought is that they should have at least recognized and informed her of that risk and made sure she had access to adequate follow up care.
.Did they give her written discharge papers? Did she sign them? Does it say to follow up with any concerns with her doctor? Can she actually read?


And they knew she had no insurance or doctor, as well as mental health or substance abuse issues that lead to her almost dying which they never counseled her on either.
so they knew she didn’t have insurance yet they still treated her (yes I’m aware of the laws obligating them). Just curious as to why you believe that made any difference here.

They were aware she had no doctor; well, apparently she did source treatment at a later point. Isn’t the obligation to make sure somebody has a doctor. While they could have made appointments with their facility, the question is: were they obligated to?

What’s odd is that in your first post you stressed she is not an addict and snorted a small amount yet now you state she has substance abuse issues (which, to me, your first post attempted to allay just such a claim of abuse). While you specifically stated it is irrelevent in your first post, why do you attempt to make it relevant now?


Given the drug situation society faces today, expecting anything other than a cold reception is really unrealistic. Your sister chose to snort whatever it was that put her in the hospital. You seem upset because they didn’t make her feel warm and welcome because they had to treat her becaause she chose to do this to herself. Er’s are notoriously cold because they are there for a purpose; treat medical emergencies. The personnel quite likely never saw the patient before this time and hopefully won’t ever see them again. They don’t have the time nor need to become as acquainted with the patient as the patients regular doctor does. Their job is to save lives and especially because it all to often is not successful, you will find doctors and other staff that has a very cold bedside manner. It’s self preservation in some people. It’s just a matter of course because their job works better when they remain socially isolated from their patients.
 

xylene

Senior Member
What’s odd is that in your first post you stressed she is not an addict and snorted a small amount yet now you state she has substance abuse issues (which, to me, your first post attempted to allay just such a claim of abuse). While you specifically stated it is irrelevent in your first post, why do you attempt to make it relevant now?
Huhn? The OP pointed out her sister is not chemically dependent (an addict), a salient medical fact. She also pointed out that she was not referred to care for her drug problem. That's odd following an overdose and points to inadequate care. Having mental health and drug problems is not synonymous with chemical dependency and is often treated differently (for example methadone may not be appropriate)
 

justalayman

Senior Member
Huhn? The OP pointed out her sister is not chemically dependent (an addict), a salient medical fact.

And your point?

She is not addicted to this drug and had only consumed a small amount by snorting, not that it is particularly relevant
Later on she said she stated her sister obviously has mental issues or Substance abuse issues

And they knew she had no insurance or doctor, as well as mental health or substance abuse issues
So does op stand on “she’s not an addict” or “they were aware she has mental issues or substance abuse issues.

In my neighborhood you call a person with substance abuse issues an addict.

She also pointed out that she was not referred to care for her drug problem. That's odd following an overdose and points to inadequate care.
. So now the Er is mandated to refer a drug abuser to some sort of treatment program? Hmmm, I’m thinking you’re wrong. The Er is there to save their life. Once the emergency treatment has been dealt with and the patient stable, out the door you go if that is the er’s choice.

Having mental health and drug problems is not synonymous with chemical dependency
having If this is the first time the girl ever took drugs I would agree. If not, then yes having s Drug problem and chemical dependency are synomous.

and is often treated differently (for example methadone may not be appropriate)
methadone? Do you have some inside info like what drug was taken? Methadone isn’t used for all chemical dependency issues.
 

xylene

Senior Member
Well, check out the DSM V.

Also hospitals have to reduce 'frequent fliers', that doesn't mean they were not violating there own policy.

Methadone is a substitution drug. Its an example.
 

justalayman

Senior Member
Well, check out the DSM V.

Also hospitals have to reduce 'frequent fliers', that doesn't mean they were not violating there own policy.

Methadone is a substitution drug. Its an example.
Your inference was that methedone is used in all drug addiction situations. Obviously it is not appropriate nor does it provide benefits with all drugs.

Violating their own policy doesn’t mean their action would necessarily be illegal or malpractice.

And you’ll have to fill me in on what the dsm v has to do with this. Are you suggesting the patient should have been subjected to involuntary confinement for some reason? If not, please explain why it would apply to the patients kidney condition.
 

quincy

Senior Member
If someone goes to the ER for emergency treatment, they are evaluated, treated for the emergency as needed, and told to see their own personal physician for a follow up appointment.

If the patient is not admitted to the hospital, the patient should be given by the hospital written instructions on what to do once released. The instructions they receive will depend on what brought them to the ER in the first place.

The ER does little more than that. Although some who are uninsured might treat an emergency room as their personal physician, that is not the purpose of an ER.
 

Oubliette331

Junior Member
To clarify for the above poster, she is not addicted to heroin or opiates. She is not physically dependent on narcotics. She does have depression and often self medicates, usually with alcohol. In this incident, she was discovered by her roommate unresponsive in bed and told the Hospital that she had taken alcohol, Xanax, cocaine, and heroin (noted in her record). The Hospital assumed she was a heroin addict and diagnosed it as an “intentional heroin overdose.” Despite labeling it as intentional, they did no psych evaluation to find out whether she was suicidal or a danger to herself and offered no mental health or rehab resources, which I believe they ususally would in that kind of situation. They didn’t run a toxicology to find out what levels of what substances were in her system at a toxic level.

The medical record includes zero commentary or diagnosis for the blood results which included abnormal levels for WBC, HGB, HCT, RDW, GRANULOCYTES, IMM GRAN, LYMPHS, ABS NRBC, and ABSOLUTE GRAN. Plus low CO2, high glucose, high creatinine, and low GFRE. No toxicology, no urinalysis. Additional lab tests had been ordered but were cancelled before the results came back after they discharged her. She doesn’t have a primary care physician. We were told by another doctor at the hospital that they are supposed to provide a contact for an on-call hospital doctor for follow up care in that situation. The discharge instructions actually have “fill in the blank” sections where the physicians names are supposed to be and were left blank. They didn’t explain her lab results to her, didn’t inform her of any symptoms which should warrant a return to the ER or possible complications that could develop.
 

Zigner

Senior Member, Non-Attorney
You (likely plural, as in your whole family) need to come out from behind the shield of denial that you have built up. One does not go from a tea-sipping stand-up member of society directly to a speedball with a bit of Xanax and booze thrown in for good measure. Your sister has a HUGE problem and she doesn't need folks trying to shift the blame away from her, such as you (again, likely plural) seem to be doing. She didn't only consume a "small amount", nor can you say she is not addicted. In fact, I now realize that you aren't claiming she was a "tea-sipping stand-up member of society." You are clearly indicating that she does the drugs, you just don't feel she's an addict.

You (yes, again plural) need help. Serious family and individual counseling is in order.
 

Oubliette331

Junior Member
I’ve written a couple replies and they aren’t showing up so hopefully I’m not repeating myself. But I was stating that she is not PHYSICALLY DEPENDANT on heroin and that a small amount was ingested and not by IV, which makes it unlikely to be the sole cause of her overdose and becoming unresponsive. That’s medically relevant to the situation. Pure heroin overdoses are less medically serious and have shorter recovery time than when combined with other substances.
“Me and my family” are well aware of her problems and are very concerned, but thanks for the judgemental lecture. She still deserves adequate medical treatment.
 
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Just Blue

Senior Member
You (likely plural, as in your whole family) need to come out from behind the shield of denial that you have built up. One does not go from a tea-sipping stand-up member of society directly to a speedball with a bit of Xanax and booze thrown in for good measure. Your sister has a HUGE problem and she doesn't need folks trying to shift the blame away from her, such as you (again, likely plural) seem to be doing. She didn't only consume a "small amount", nor can you say she is not addicted. In fact, I now realize that you aren't claiming she was a "tea-sipping stand-up member of society." You are clearly indicating that she does the drugs, you just don't feel she's an addict.

You (yes, again plural) need help. Serious family and individual counseling is in order.
Love this post ^.
 

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