Bad Doctor???

[sam smithers]

What is the name of your state? Texas
Here is the thing. Just to let you know my brother was a paraplegic and had been since he was eight years old, which was in 1967. I got a message that my brother was going to the hospital because he was sick. I met him and his daughter at the hospital that evening about 7:30 p.m. when they got there. He told me when I talked to him and helped him from his car into his wheelchair that he was afraid he had meningitis.
I told him to be sure and tell the E.R. staff of his worries. My brother knew his body and could usually tell what the problem was before he went to the doctor. After assisting him into the E.R. of the local hospital he had to go through admissions. While there, I could hear him from the waiting room, telling the nurse that he was having severe neck pain, neck stiffness, pain all down his back, and was unable to bend his neck from side to side or front to back. I also heard him tell them that he was afraid he had meningitis. After that they took him into the E.R.

After he was in the E.R. his daughter came out so I was able to go back there. I asked him if he had mentioned to the doctor about the meningitis and he said he had.. The doctor there had some blood drawn and was working it up. While in there the doctor came in and told me and my brother that he was anemic and that he needed some blood. This was no suprise to us because his blood work usually showed anemia. The doctor ordered a rectal exam to see where he was losing the blood and they did that. The doctor advised that they were going to admit him and give him the blood and go from there. They moved my brother upstairs and gave him some blood. The E.R. doctor had consulted with his regular doctor and told him of the amemia and his regular doctor agreed that he needed the blood. While in the E.R. my brother asked the doctor about the pain and the doctor told him at was due to the anemia. . They had ordered a pain patch for him and placed it on him.

I went up to see him the next morning and he was resting some but was still in pain when he was awake. By that afternoon he was sleeping more and more, we were figureing that he was probably tired. The next day he was still asleep, but more today than the day before. It appeared that he was beginning to have trouble breathing and his respirations were getting faster. After giving him the unit of blood they took out the I.V. and he wasn't on any oxygen. By that night it was getting harder and harder to wake him up, we thought it might be the pain patch so we had the hospital staff remove the patch about 11:00 p.m. By the next morning he was basicically unresponsive it was almost impossible to awaken him.

His breathing was even faster than the day before, he was breathing around 36 to 40 times per minute. Around 8:30 a.m. an other doctor came in to see him this time it was a surgeon that was sent to check on the possibility of an internal bleed. I told this doctor of what he, my brother, thought might be wrong with him when he was first admitted into the hospital, he reacted with a shocked look on his face and started doing an exam of him. He started trying to talk to him but there was no response and then he started trying to move his head around. With him lying on his back the doctor tried to move his head forward and back, when he moved his head forward it was lifting my brothers whole upper body off the bed without bending his neck at all, thats how stiff it was. After the exam he told me that we need to find out what this problem is first. About 9:00 a.m. his regular doctor came in to check on him and I told him of the surgeon coming in and what I told him and what he had done and what my brother had told me about the meningitis fear.

Once again there was a look of shock on the doctors face. He advised that we needed to find what was causing this unresponsiveness in him, and he thought they should do a "cat scan", I asked if he should have the oxygen on him and possibility of him needing the I.V. started back since he hadn't had any fluids in almost two days. The doctor ordered both the I.V. and the oxygen back on him. After a little time had passed I asked the nurse if she would come in and do a pulse oximeter on him, which would tell how much oxygen is in his blood. When the nurse came in to do the pulse oximeter she noticed that he had a temperature, upon taking it, it was 101 degrees. The nurse went and called the doctor and they decided that he needed moved into "The Unit" which is intensive care. About 10:00 they came to get him to do the "cat scan" amd I went with him down there. After returning to the room everything seemed to be going smoothly.

About 2:00 p.m. things went down hill fast, his blood pressure started to fall and so did his pulse. He went into respiratory arrest and they had to put him on a ventalator. They were also giving him medication to keep his blood pressure up. They kept telling us that they were unsure about what was causing this. They kept drawing blood but nothing was being decided. The nurses would come and check on him and kept checking his vital signs and checking his pupils for reactivity, which there was none. For the rest of that day they had to keep increasing the meds that kept his blood pressure up. On the next morning his regular doctor came in that morning and we talked and there was no change in his condition and the doctor told us that it didn't look good, but they had started antibiotics the day before when he went into respiratory arrest. At around noon the doctor came back and there was still no change and I asked about a test to check brain activity and he advised he would check on it. About an hour later the nurse told us that it was ordered. She told me that it might be the next morning, but later she said that it would be done about 4:00 p.m. At 4:00 they came into the room to do the test for brain activity and they were finished around 5:00 p..m. The doctor came back around 6:00 and they had gotten the results of the test. There was very little if any activity in the brain. We had a very hard decision to make at this point. After talking with my brothers daughters we decided that he would want the life support removed and we decided that the next morning was the time to remove the supports. I'm not sure what exactly happened but I feel as if there should have been a test for meningitis done at the start. Do you feel as if I have a case of malpractice or not?

 

[panzertanker]

The CT scan does not make sense if faced with a possible meningitis situation. An LP (lumbar puncture) with testing for cell count, pressure, color, etc. is used for dx. A CT or MRI would indicate a lesion, mass, shift, stroke, etc. that they were looking for.

Did they do a post mortem?
What were the findings?
Did he have a fever upon arrival at ER?
give me a little more info, good background now expand the testing and results.
here is a link to tell you about the need/signs/symptoms for meningitis
http://www.emedicinehealth.com/articles/17401-5.asp

You can always have a med malpractice lawyer look at your case at anytime if you want.

 

[sam smithers]

no post mortum was done so no results. he may have had a low grade fever if any when he got to the hospital but he had taken tylenol for pain and fever about 2 hours before.
sam

 

[sam smithers]

also as I understand it the only true way to test for meningitis is to do a spinal tap which wasn't even mentioned untiln day 3
sam

 

[panzertanker]

also as I understand it the only true way to test for meningitis is to do a spinal tap which wasn't even mentioned untiln day 3
sam

But, did they ever DO an LP?

So far you don't sound like you have a case b/c you don't know WHY he died.
To prove malpractice you need to show standard of care was not followed. If he showed up and was feeling weak and found to be anemic, he received standard care through admission and subsequent blood administration.
Get the records and give us more info...

 

[sam smithers]

no a LP was never done because they were wanting to find the cause of the problem first, is what the doctors kept saying and that it probably wouldn't provide any help to the problem. This was said after he was on the vent and there was no brain activity.

 

[panzertanker]

no a LP was never done because they were wanting to find the cause of the problem first, is what the doctors kept saying and that it probably wouldn't provide any help to the problem. This was said after he was on the vent and there was no brain activity.

Then they were not looking for meningitis. The only true way to dx it is through an LP. If they stated that they did not need one, then they had other diagnoses they were under the assumption were causing the problems he was having.

"wanting to find the cause of the problem first" as you say, shows me there is more here than I am told or you may know...
keep me posted.

 

[sam smithers]

Everything I've read since his death has pointed to menigitis all the signs. With him telling them the possibilities of it being meningitis one would think they would at least do the test for it. The E.R. doctor didn't seem at all worried about that it was just the anemia that concerned him. I've also found that anemia causes no pain but usually causes weakness and sleepiness. I feel as if there was either neglict or just malpractice on the part of at least the E.R. doctor, if not both doctors involved.

 

[panzertanker]

Everything I've read since his death has pointed to menigitis all the signs. With him telling them the possibilities of it being meningitis one would think they would at least do the test for it. The E.R. doctor didn't seem at all worried about that it was just the anemia that concerned him. I've also found that anemia causes no pain but usually causes weakness and sleepiness. I feel as if there was either neglict or just malpractice on the part of at least the E.R. doctor, if not both doctors involved.

What were the results of the CT that you went with him for?
What EXACTLY was his H/H? (hemoglobin/hematocrit)
how many units of blood did he receive?

Again, I am no lawyer, but you will have to prove negligence or deviation from "standard of care"

Where is it?
If some one walked into my ER and told me they were tired/weak, didnt feel good,
bloodwork and vitals
if those showed anemia, then I have a culprit to attribute the weakness, lethargy, etc to.
if i admit said pt into hospital for blood and care, I have done my job correctly!
Where is your deviation from standards, or negligence?
I am not being mean, telling you the truth. You will face much harsher words than these if you continue to investigate, so be prepared for them. You must show that they KNEW they were doing wrong or NOT doing right by the standard of care.
Hindsight is 20/20.
I have one pt who came in feeling lightheaded and weak. Was winter and he smelled like kerosene. Sent him for carboxyhemoglobin at hospital which showed he had carbonmonoxide poisoning from faulty heater. Admitted him for 24 hours and he got better and went home. Wife called me at home 3 days later saying pt was getting worse. Admit to hosp, work up reveals aggressive glioblastoma cancer of the brain. Pt died, with me at his bedside at home, 3weeks later. Was I negligent? NO, His symptoms and my 1st dx were correct.

I use this as an example of how you can use hindsight to second guess. I could have caught that tumor earlier if I had done a CT, but he responded appropriately to tx for a condition he DID have; carbonmonoxide poisoning.

 

[rmet4nzkx]

I'm sorry for your loss.

You must understand that proving a case of malpractice is very difficult, more so in the case of chronically ill or disabled patients. You may feel it is negligence and it may in fact be negligence or unfair at least but proving that in a court of law is a different thing.

How old was your brother? What was the cause of him being a paraplrgic, did he have a spinal injury or another medical condition? What were his medical problems? What was his normal temp? Didn't they take his temp before it was 101? What was his temp upon admission? You said he had anemia, do you understand why that is important to address? Do you understand that without a firm diagnosis of meningitis and no autopsy the issue is moot. Also there is more than one type of meningitis, viral and bacterial, antibiotics don't help viral meningitis. If your brother was medically frail, any number of things could have contributed to his death including end organ damage from prolonged hypoxia? What did his PCP say? There may be something in his records that will point to a cause or confirm negligence, but that will take a review of his records, more than we can do here. The hospital and doctors can only work with what they have. You might ask his pcp to review for you or consult with a med mal attorney. What is the COD on the death certificate?

 

[ellencee]

sam smithers
It is my understanding that your concern is the physicians and nurses did not attempt to diagnose meningitis because they failed to consider valid your brother's concern of having meningitis, which was the reason he sought medical treatment at that time.

The ER physical assessment and the receiving floor's nurse's assessment should include your brother's own words/reason given for seeking medical treatment at that time. The same nurses and the physicians should have included in their admission notes your brother's accounting of where he had pain, where he had stiffness (*his neck*). The plan of care, whether formal or informal, should document attempts to rule in or rule out causes of his complaints and physical findings. An MRI or CT scan, or both, of the brain is considered an acceptable diagnostic tool for meningitis (reference Yahoo health, meningitis, signs and tests); neither is equal to the lumbar puncture in providing quick test results and neither will provide a measurement of cerebrospinal pressure.

So why wasn't a lumbar puncture done in the ER? I think it is safe to say the physicians have asked themselves this question and have been asked this question by their peers during a review of in-hospital deaths.

I think you should consult with a medmal attorney in your area and find out if an attorney is willing to look further into your claim and find out more about the legal process involved and time limits (statute of limitations).

Best wishes,
EC

 

[panzertanker]

sam smithers
It is my understanding that your concern is the physicians and nurses did not attempt to diagnose meningitis because they failed to consider valid your brother's concern of having meningitis, which was the reason he sought medical treatment at that time.

The ER physical assessment and the receiving floor's nurse's assessment should include your brother's own words/reason given for seeking medical treatment at that time. The same nurses and the physicians should have included in their admission notes your brother's accounting of where he had pain, where he had stiffness (*his neck*). The plan of care, whether formal or informal, should document attempts to rule in or rule out causes of his complaints and physical findings. An MRI or CT scan, or both, of the brain is considered an acceptable diagnostic tool for meningitis (reference Yahoo health, meningitis, signs and tests); neither is equal to the lumbar puncture in providing quick test results and neither will provide a measurement of cerebrospinal pressure.

So why wasn't a lumbar puncture done in the ER? I think it is safe to say the physicians have asked themselves this question and have been asked this question by their peers during a review of in-hospital deaths.

I think you should consult with a medmal attorney in your area and find out if an attorney is willing to look further into your claim and find out more about the legal process involved and time limits (statute of limitations).

Best wishes,
EC

Unfortunately, Ellen, A CT or MRI is only used for advanced cases to ascertain if there is brain involvement.
Yahoo health has it WRONG, I did not bother to go to their site.
The CDC, NIH, WHO, and respected meningitis organizations all agree:

The ONLY definitive diagnostic tool that will tell me if you have meningitis (absent a brain lesion or such classic s/s that I tx you for it regardless) IS AN LP!!!!

go to my first link, and here are others.:

http://www.cdc.gov/ncidod/dbmd/diseaseinfo/meningococcal_g.htm#How is meningitis diagnosed

http://www.nmaus.org/about/index.htm

http://www.cdc.gov/ncidod/dvrd/revb/enterovirus/viral_meningitis.htm

 

[ellencee]

Let me make myself as clear as possible--a lumbar puncture should have been performed. An MRI or CT scan could have shown areas of inflammation or swelling. If the MRI or CT scan failed to show a brain bleed or cause for the symptoms, the need for a lumbar puncture is even more.

A lumbar puncture was not done; therefore the brother has reason to suspect if the lumbar puncture had been done the outcome could have been different. I think he should consult with a medmal attorney and find out if one is interested in his claim.

You tell Yahoo health they are wrong; if you read the topic, you know it did not put MRI or CT scan as definitive over the lumbar puncture.

EC

 

[panzertanker]

Let me make myself as clear as possible--a lumbar puncture should have been performed. An MRI or CT scan could have shown areas of inflammation or swelling. If the MRI or CT scan failed to show a brain bleed or cause for the symptoms, the need for a lumbar puncture is even more.

A lumbar puncture was not done; therefore the brother has reason to suspect if the lumbar puncture had been done the outcome could have been different. I think he should consult with a medmal attorney and find out if one is interested in his claim.

You tell Yahoo health they are wrong; if you read the topic, you know it did not put MRI or CT scan as definitive over the lumbar puncture.

EC

Thanks for your clarification, I responded b/c you said:

"An MRI or CT scan, or both, of the brain is considered an acceptable diagnostic tool for meningitis (reference Yahoo health, meningitis, signs and tests);"

And that is NOT true.

As for telling Yahoo they are wrong....I just do not cite them as they are not in the medical field...and neither should you.

 

[ellencee]

Signs and tests

Lumbar puncture with CSF glucose measurement and CSF cell count.
Gram-stain and culture of CSF (cerebral spinal fluid).
Chest X-ray to look for other sites of infection.
Head CT scan looking for hydrocephalus, abscess or deep swelling.

panzertanker
Above is the text from Yahoo health. I do not believe you will disagree with their information, at least not from a medical viewpoint. As stated above, it is an acceptable diagnostic tool, part of the work-up, not a replacement for a lumbar puncture.

EC