I recently met with a man who unexpectedly lost his wife because of medical malpractice.
The lady, in her late 60s, was active and in good shape for her age. She had an accidental fall that caused worsening intense pain around her tailbone.
She went to an urgent care center and then to a hospital in northwest Houston, Texas. She was diagnosed with a fractured sacrum (tailbone), probably because of age-related osteopenia, and a urinary tract infection. The pain was so bad that she was admitted to the hospital to try to get it under control. It hurt to move, so she stayed in bed and wore a diaper.
Pushed out of the hospital door
Medicare has limits on how long it will pay for someone to stay in the hospital. Under its rules, it doesn’t matter whether you need to stay longer. It wasn’t long until hospital administrators told her it was time to go, even though she couldn’t walk. They transferred her to a rehabilitation facility near the Gleannloch Farms neighborhood in northwest Harris County.
At first, the rehab care seemed to help. About a week into her stay, though, she stopped eating and became depressed. Her husband thought she was delirious and that she may have been given too much pain medication. He explained that doctors and nurses weren’t really offering treatment options. Instead, he had to ask lots of questions and push to get his wife the care and testing that she needed.
Because the doctors were seldom around—which is almost invariably the case at facilities like this—he spoke with the nurses and asked if they could take her off some pain medications, particularly a fentanyl patch.
When that didn’t help, he asked that they test her for a urinary tract infection. After all, she had recently been diagnosed with one and was spending a lot of time in bed in a diaper. The results came back positive for an infection, but rather than starting her on an antibiotic, as her husband requested, the doctor wanted to order another urinalysis test first.
Unfortunately, this dear lady’s condition plummeted. When her husband came to see her the next morning, she looked nearly comatose in her bed, with her arms drawn up to her chest and mouth wide open. She didn’t recognize or respond to anyone. The nurses weren’t around, so he frantically ran down the hall and asked someone to call 911. When the ambulance arrived, the emergency medical technicians (EMTs) said that her condition was so severe that she might not make it to the hospital.
As soon as they arrived at the hospital, they intubated her (inserted a breathing tube) and sent her to the intensive care unit (ICU). She had gone into septic shock and her organs were already failing. A CT exam showed multifocal pneumonia. The hospital physicians felt that the source of her sepsis and septic shock was likely the urinary tract infection, but it could also be pneumonia.
Within a few days, this lady sadly and needlessly passed away. The death certificate recorded her cause of death as aspiration pneumonia.
The risk of overmedication
As a Houston, Texas medical malpractice attorney, I’ve handled lots of cases where elderly patients were overmedicated in nursing and rehabilitation facilities.
One of the earliest signs of overmedication with painkillers is that the patient begins behaving in an unusual way. Health care providers call this altered mental status. Family members are typically the first people to notice these things, and I always recommend that they immediately inform the nurses and physicians when this happens.
Aspiration pneumonia poses a huge risk to the elderly in the context of overmedication. There are two reasons for this. First, many opioid and narcotic painkillers have the side effects of nausea and vomiting. Second, too much pain medication can cause patients to become somnolent or sleepy. The combination of these two factors is deadly.
When pain medication causes patients to drift away to sleep, they lose control of their airway. If they vomit while in this condition, they aspirate or breathe in the vomitus, which goes to the lungs where it causes pneumonia. In many elderly patients, it’s physically impossible to recover from aspiration pneumonia. That’s why it’s so important for physicians and nurses to monitor patients closely to make sure they are not overmedicated in the first place, which starts this dangerous cascade.
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Robert Painter is a medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits against hospitals, physicians, surgeons, anesthesiologists, and other healthcare providers. A member of the board of directors of the Houston Bar Association, he was honored, in 2018, by H Texas as one of Houston’s top lawyers. Also, in 2018, the Better Business Bureau recognized Painter Law Firm PLLC with its Award of Distinction.