Physician Standard of Care / Not Reporting Life Threatening Xray Resul

[lesabre]

Last year I accompanied my mother to a visit with her cardiologist. My mother was elderly and not in very good health at all. While with the cardiologist, my mother and I let him know that my mother was having difficulty breathing. She had a history of a condition called flash pulminary edema where her lungs would fill with fluid quickly and it became life threatening. I suspected this was beginning to happen again and was very straight forward with the cardiologist that he needed to address her breathing problem ASAP. The cardiologist did listen to her lungs and believe he heard fluid in her lungs, he even tested her finger for her oxygen levels which turned out low. He did write orders for and X-ray and when leaving, I told him we needed to have he results reported back to us ASAP, as he had been lax previously. He assured me he would call if there was a problem. HE NEVER CALLED!

Three days later my mother suffocated because of that fuild in her lungs (as stated on her death certificate also) in her home and DIED! I got a copy of her complete medical record for the past year (huge HIPAA violation on the hospitals part because they never got permission from my mother or father to give me those records.) I looked for the X-ray report and found that the radiologist had read and written his report and it was available to the doctor 20 minutes after the X-ray had been taken. The radiologist found that she did have fluid in her lungs suggestive of pneumonia. The CARDIOLOGIST NEVER read and signed off on the X-ray report until AFTER MY MOTHER DIED! This is documented by the time stamp on the electronic medical record.

I have filed a complaint with the TEXAS MEDICAL BOARD and they are investigating. They have had this "case" for almost a year now and I am praying this means they see the same faults that I do. I truly feel that this doctor LET MY MOTHER DIE by his negligence! From a personal stand point, I see this as murder, but then again I am very invested emotionally.

This same cardiologist strongly encouraged my mother to have a cardiac surgery, obviously knowing her health history which was not very good at all. He still tried to strongly encourage my mother to have surgery even after i directly asked when what the odds were for my mother to get off the lung machine after the surgery and he answered "NOT VERY GOOD"! What kind of doctor is that? I feel he was very negligent in my mothers care and I pray the Texas Medical Board finds the same.

I know it can be a big deal for a physician to have an allegation such as this on his record. It's also a big deal that my mother had to suffer the way she did and to die. I have been told and have read that the repercussions for a physician even if found guilty are not really that severe....... a fine, which doesn't appear to be that much really, and some continuing ed classes. That hardly seem reasonable to me.

I strongly feel that I would like to take this further. I need to know if being in Texas with torte reform, if a medical malpractice case can be opened and what are the odds of an attorney even taking such a case? Thank you for your time, I appreciate it.

 

[KatDini]

Why did you not contact Mom's pulmonologist if you were worried about her lung function?

 

[Proserpina]

Honestly? Your mother was an elderly high-risk patient. I believe that you're not going to find an attorney to take this on contingency, for two reasons. First, her health was already precarious and you may find it difficult to actually prove that were it not for X, Y wouldn't have happened. The second is a touchy issue. To be blunt, even if the cause was carved in stone, a suit would cost too much to litigate compared to the eventual award.

I also have to ask you, when did you last communicate with the Board?

 

[Betty3]

Have you followed up with the Texas Medical Board though sometimes these investigations take time. Due to your Mother's age & health, you might not have much of a case but we can't say.

 

[lesabre]

Why did you not contact Mom's pulmonologist if you were worried about her lung function?

My mother did not tell me that she was having trouble breathing until I met up with her at the clinic for her appointment with the cardiologist. What caused her "flash pulmonary edema" was her heart condition. She had a leaky mitral valve.

In medicine, flash pulmonary edema (oedema in British English) (FPE), is rapid onset pulmonary edema. It is most often precipitated by acute myocardial infarction or mitral regurgitation, but can be caused by aortic regurgitation, heart failure, or almost any cause of elevated left ventricular filling pressures.

 

[Proserpina]

Which doesn't change my response (if anything, it enhances the point).

(Incidentally, I'm a Brit, and I spent several years looking at damaged valves)

 

[lesabre]

I also have to ask you, when did you last communicate with the Board?

I submitted my complaint Late July 2014. On Aug. 14,2014 I received a letter from the first investigator stating they had reviewed my complaint, found it to be jurisdictional and they would be presenting it to the Texas Medical Board. On Nov. 14, 2014 I received a 90 day letter informing me that this investigation was still in process. I am supposed to have 90 day communications from them, so I expect to hear something again around Feb. 14, 2015.

Honestly? Your mother was an elderly high-risk patient. I believe that you're not going to find an attorney to take this on contingency, for two reasons. First, her health was already precarious and you may find it difficult to actually prove that were it not for X, Y wouldn't have happened. The second is a touchy issue. To be blunt, even if the cause was carved in stone, a suit would cost too much to litigate compared to the eventual award.

Sadly, I do understand that I most likely won't find an attorney to take this case. I am not personally looking to gain monetarily from my mothers death. I would however donate or even stipulate in the suit that if any monies were to be awarded, they should be donated to the American Heart Association. Money can't bring my mother back, nor take back the way she had to die.

I know I asked for your opinion and I do appreciate your response. I personally don't believe that it is too much of a stretch for anyone to prove or believe that my mother had this known condition, flash pulmonary edema, and known condition mitral valve regurgitation from her leaky mitral valve and in fact had been treated and hospitalized 2 previous time for the flash pulmonary edema from the same physician. The big symptoms is fluid retention and difficulty breathing. The physicians exam confirmed that heard fluid in her lungs, swollen legs and he also confirmed her low oxygen level in his office. Furthermore, the X-ray he ordered and ignored showed pneumonia or fluid in her lungs. The end result of not treating that is exactly what happened.......... flash pulmonary edema which caused her to die.

 

[cbg]

The difficulty, however, is in proving that but for the action ( or inaction) of the cardiologist, she would not have died. If she was in that bad condition, she might have died no matter what he did or didn't do. What is your plan for proving otherwise?

 

[lesabre]

The difficulty, however, is in proving that but for the action ( or inaction) of the cardiologist, she would not have died. If she was in that bad condition, she might have died no matter what he did or didn't do. What is your plan for proving otherwise?

Well cbg, you made me think on this one. I firmly believe that the inaction of the cardiologist, re: checking and reporting the X-ray report results to my parents and then admitting my mother for treatment, violates the Medical Practice Act.

My mother was not well at all and yes I also agree she was going to die at some point..... like all of us. To be honest with you, I don't believe she was going to live for many more years or even months. My parents had no idea how severe her condition was.

My biggest problem is that she complained of symptoms, life threatening symptoms and the doctor had an obligation to investigate and treat. He did order the X-ray, he did listen to her lungs, he did check her oxygen, but he DID NOT bother to check the X-ray report (until AFTER her death), report that information to my parents and admit and treat my mother. I'm pretty sure that is what the Medical Practice Act supports. Actually, that may have been the second biggest problem I have. The biggest would be that my mother had to sit in her living room fully alert, waiting for an ambulance while she suffocated to death. I cannot imagine that horror.

Had my mother been informed of the results and admitted and treated at the hospital based on clinical findings and later died.......... I feel certain I could go in peace with that and not have the ire I do with this cardiologist.

Does any of what I write make sense to anyone else (it makes perfect sense to me!) or are my emotions clouding my thinking?

I really do appreciate your feedback.

 

[Proserpina]

I know this is a terrifically awful situation for you. It really is, and there are no two ways about it.

There is a very important part of a medmal suit, and often it boils down to: "if it wasn't for X, Patient wouldn't have died when and how she did". That's going to be perhaps an insurmountable hurdle. Because PE is a symptom of many cardiac and pulmonary conditions, I would expect the most any medical expert is prepared to state will be "it can be..." and "that's possible, yes".

But as always nobody can guarantee what will or will not happen. By all means, take Mom's records to a med-mal attorney.

 

[disagreeable]

If her breathing was so bad, she should have been taken to emergency, not dying at home. Many people that age die from from pneumonia. It is not a stretch that her cause was that. Even if caused by AC. HIPAA does not apply to the dead in the manner you think.

 

[lesabre]

If her breathing was so bad, she should have been taken to emergency, not dying at home. Many people that age die from from pneumonia. It is not a stretch that her cause was that. Even if caused by AC. HIPAA does not apply to the dead in the manner you think.

Disagreeable........... If you had read the previous posts, you would have seen that 911 was called and was enroute to my parents home. Nobody left her sitting to die. I suspect you have not been in this situation and I pray you don't have to watch your loved one go through what my mother did. My mother awoke for the morning, asked my father to help her to the living room as she was having difficulty breathing. He did as she asked and called 911. I guess what you don't understand is when someone experiences flash pulmonary edema, it happens VERY fast especially if they already had fluid in their lungs. What more could you have expected? Your response was callous.

While I agree with you that many elderly die from pneumonia, that is not the point in this situation. What matters if you had read what is written above, you would see that her cardiologist didn't bother to follow up on her X-ray report, whether that be to actually read it or inform my parents of the results or actually admit and treat her for the fluid in her lungs.

Thanks for the info regarding HIPAA and the deceased. I did need to know that.

 

[disagreeable]

I spent 2 year watching my father die, in and out of the hospital. He lived in my home, when not in the hospital. When she could not breath, she should have been taken to emergency, not after she stopped. I read your story. You said she died in her home. You also said she was having problems for 3 days.

 

[lesabre]

I spent 2 year watching my father die, in and out of the hospital. He lived in my home, when not in the hospital. When she could not breath, she should have been taken to emergency, not after she stopped. I read your story. You said she died in her home. You also said she was having problems for 3 days.

disagreeable, this is the last time I will address this with you. When my mother had her appointment with the cardiologist, she was not gasping for air, nor did she tell us she felt she was suffocating. There were no visible signs for me that said she was in huge distress. My mother was a very ill woman, but she did not complain. Even when her condition was severe, she did not complain loudly. She did tell me at the clinic before her appointment that it was more difficult for her to breath and I relayed that information to her doctor and let him know I wanted that addressed at that visit. He evaluated her, and ordered X-rays. We foolishly believed that he would uphold his medical obligation to follow up with the report and instruct my mother what to do.


This clinic was connected to the hospital and the doctor could have instructed her to go to the ER or have her admitted for treatment. He should have asked for STAT results on her X-ray and acted upon those results. I am not a physician, nor did I listen to her lungs with the medical training and perceived medical judgement any doctor should have. Her X-ray was completed and the radiologists report was completed and available within 22 minutes according to time stamps on their documents. This doctor didn't bother to read and sign off on the X-ray report from the radiologist until exactly one month later according to the time stamp on the electronic medical records.

The radiologist report read:
1. Congestive heart failure with bilateral pleural effusions.
2. Airspace opacities involving the left lung may represent asymmetric pulmonary edema or pneumonia

My mothers cause of death as listed on her death certificate: Respiratory Failure.

Her family did not let her sit at home for three days to die gasping for air. I feel that is what you are implying.

 

[Proserpina]

Alright guys, can we keep it civil please? There's plenty of time to fight over the game today

Now with that said...

The radiologist's report and the cause of death are what I'd expect in a patient with CHF. Once you get to a certain point, the eventual outcome would be the same and no amount of intervention would prolong the patient's life to any great degree.

I do not agree that you and your family hastened things along or did anything wrong at all. I know that's not exactly what disagreeable was getting at, though I can see how it could be misconstrued.

Disclaimer: I am not a nurse, or physician. My direct experience comes from nursing my late husband through diagnosis to his eventual death from CHF at 31.

Do you think a sit-down with your Mother's cardiologist might put your fears to rest?

 

[Proserpina]

Somehow I missed this:

This clinic was connected to the hospital and the doctor could have instructed her to go to the ER or have her admitted for treatment. He should have asked for STAT results on her X-ray and acted upon those results. I am not a physician, nor did I listen to her lungs with the medical training and perceived medical judgement any doctor should have. Her X-ray was completed and the radiologists report was completed and available within 22 minutes according to time stamps on their documents. This doctor didn't bother to read and sign off on the X-ray report from the radiologist until exactly one month later according to the time stamp on the electronic medical records.

The problem is that even if the cardiologist read the report immediately, there was quite literally nothing more they could do short of getting her back to the ER and stabilizing her - but truly, that wouldn't have helped much (if at all). She wouldn't be a candidate for transplant or LVAD and she was, unfortunately, already on borrowed time. I honestly don't think the outcome would have been different.

 

[disagreeable]

That is the key Pro, borrowed time. I remember when my dad redetermined his initial change of mind and decided he did not want to just pass in peace, which resulted in the race to southern Mexico to pick him up and get him to Cleveland Clinic. then after the 2 year battle, he made it clear to me, while I was visiting he no longer thought the borrowed time was such a good deal for him. I expected him to die that night and the next morning, I received a call from the hospital saying he had a major stroke, but they wanted permission to try out a new technique of lowering the body temperature of a patient showing no brain activity for 48 hours. I knew dad would have thought it was a hoot they were going to try and raise the dead, in addition to his being one of the first to volunteer for a treatment that might save others in the future. After their 48 was up, I came back to the hospital to sit with dad, on the offbeat chance they did bring back the dead. After he was back up to temperature, with no brain activity, they wanted permission to pull the plug. I knew my uncle, who was still in Mexico and my dad would want to say goodbye, so I sat with him for 2 days, waiting for my uncles flight to get to OH. After they had time to say goodbye, I told them to pull the plug and sat with dad until his last breath was gone. Then after everyone else left, I kissed him and said my goodbye.

He tried so hard to make a recovery so he could go back to his girlfriend and her kids in Mexico. Of the two years he cheated death, he was only able to go back and visit them for 3 weeks. I just wanted OP to hear this story because it might aide him in closure and recognizing she was on borrowed time also.

 

[army judge]

Lesabre, please accept my condolences upon the passing of your mother.

I have no words of wisdom, other than what I lived.

One of our son's was injured while riding his motorcycle one evening after work.
Before I continue, let me share some things about James.
James was our joker. His hijinks, shenanigans, and schoolboy pranks remain legendary within our family.
James was the most pleasant, happiest, and calmest child we raised.
He developed a habit that drove my wife insane, motorcycles.
He went to all the rallies, even the big one in the Dakotas.
James was a warden at a Texas state prison.
I worried more about his job causing him harm than did my wife.

James had even co-founded a motorcycle club comprised of law enforcement and corrections officers in his area. One summer evening a few of the members came over, so my daughter-in-law tells the story, and asked James to join them in a short, impromptu ride. It had been a longer than usual day for him, so at first he said no. They persisted, he gave in, and off they rode.

That little group was all about motorcycle safety. Safety can only go so far, and that's what worried my wife. As fate would have it, James was struck in an intersection by an uninsured, unlicensed, undocumented Chinese national, and extremely drunken driver. The offender blew .29 at the station.

James was battered, broken, bruised, and endured several surgeries over the next six months. Now hold on, because contrary to what some say, things can get worse. He was intubated for anesthesia for a surgery on his pelvis. The anesthesiologist proceeded to release the sleep agent down the incorrect passageway, then waited 10-15 minutes before telling anyone about his "mistake"!

James lapsed into a coma from which he never revived. He was taken off life support, but lived in a vegetative state for 10 years. During the ensuing 10 years he went through numerous medical episodes, succumbing to his injuries quietly one night.

My point? No one knows, no one can say when we will leave this life. My wife and I visited James regularly. Seeing the pain of watching our son lying there through no fault of his own wore her down daly, but she never gave up hope. Life can be hard, but we press on for many reasons.

We later sued the physicians and the hospital. A surgical nurse observed the entire event, tried to alert the anesthesiologist, but he silenced her. He later threatened and bullied her, but she eagerly told me the entire story when James' surgeon advised me to speak with her. She had told the surgeon what transpired.

Assisting our lawyers kept my mind off of James' suffering for five years. We were able to ensure
James' two daughters (two of our grands) received some compensation in the way of a trust fund they can't touch until they're 25.

All I can add is what you're pursuing, just keep engaged in the pursuit. The true success for YOU, is in the endeavor. That's what it was for us. You win by simply being persistent, not giving up, because the pursuit of justice for your mother helps you grieve. It surely did for me. Remember, it's always about the journey, never the destination.



Lesabre, I apologize for posting this lengthy, boring missive.
Rereading I see I could have posted just the paragraph above. LOL
I wish you well.

 

[lesabre]

ou're pursuing, just keep engaged in the pursuit. The true success for YOU, is in the endeavor. That's what it was for us. You win by simply being persistent, not giving up, because the pursuit of justice for your mother helps you grieve. It surely did for me. Remember, it's always about the journey, never the destination.


Thank you so much army judge. I feel you are the first one to actually understand what I am asking.

Yes I definately feel that I am fighting for my mothers honor. Yes my mother was ill and yes she was living on borrowed time. I understand all of that.

I guess what I was unable to convey is that even though my mother was ill and elderly, her physician that she trusted, to care for her medical needs, did not uphold the medical standard of care by following through and reading her X-ray report in a timely manner. Had she been afforded medical care they could have administered lasix to get the fluid off as was done in the past. This doctor had such a big ego and it disturbs me greatly that *he* chose when she would die. For my mother, I have to stand up for her!

I am so sorry for the loss of your son, I couldn't imagine. Thank you again for your response.

 

[army judge]

ou're pursuing, just keep engaged in the pursuit. The true success for YOU, is in the endeavor. That's what it was for us. You win by simply being persistent, not giving up, because the pursuit of justice for your mother helps you grieve. It surely did for me. Remember, it's always about the journey, never the destination.


Thank you so much army judge. I feel you are the first one to actually understand what I am asking.

Yes I definately feel that I am fighting for my mothers honor. Yes my mother was ill and yes she was living on borrowed time. I understand all of that.

I guess what I was unable to convey is that even though my mother was ill and elderly, her physician that she trusted, to care for her medical needs, did not uphold the medical standard of care by following through and reading her X-ray report in a timely manner. Had she been afforded medical care they could have administered lasix to get the fluid off as was done in the past. This doctor had such a big ego and it disturbs me greatly that *he* chose when she would die. For my mother, I have to stand up for her!

I am so sorry for the loss of your son, I couldn't imagine. Thank you again for your response.

Thank you, Lesabre, we did all we could.
My son told my wife the day they destroyed his life, "Mom, if anything happens, fight for me."
That's why she never gave up, until the very last day.
Then she continued to fight for him and our grands.
We've always thought he had a premonition.
I observed and heard such things decades ago in the jungles of Viet Nam.



We were told many times by "physicians", why don't we just let him go.

One day my wife asked, "Are you saying we should euthanize him?"

One once answered, "Of course not, we're just wondering why you don't instruct us to just take his feeding and hydration tube out."
My wife said, "Oh, you mean authorize you to remove the feeding tube, so you can starve him to death or allow him to die from lack of hydration. Sorry, we won't make you feel better about killing our son. Plus, we never authorized you to take him off of life support years ago."

Texas law allows physicians to make that determination without the family's approval.
In some cases, the brain may die, but the body doesn't.
We discussed it many times, and just couldn't see it the way they wanted us to see it.

No two struggles are the same, but we operated in the same space.
Even relatives said we should just instruct his physicians to stop feeding him.
It never made us angry at them, it only strengthened our resolve and my wife's obligation to do what she promised James, "fight for him".

Hang in there, just keep persevering, and focus on doing all that you can until you're satisfied there's nothing more to be done.
You make that call, you alone.