Although other “Assessment Indicators” of Elder Abuse were present simultaneously and documented such as, Restriction of Visitation/ Calls, Sudden Change in Living Arrangements, Sudden Change in Proxy Document and Sudden Change in Behavioral and Physical Condition. The Documented “Abrupt Discontinuance of Pain Medication” in itself confirms the Diagnosis of Abuse.
Confirming the Diagnosis of Elder Abuse is made by the Documentation of Abruptly Discontinued “Pain Medications”.
“Under utilization of prescription drugs” is a sign of physical abuse. (National Centers on the Elder Abuse Administration on Aging).
“Denial of Pain Medication is Elder Abuse”, Elder Abuse, the Pharmacist’s Role, Center on Elder Abuse.org,
“Denying Access to Pain Medication”, Elder Abuse, Center on Excellence on Elder Abuse & Neglect,
“Denying access to pain medication is physical abuse”, Laura Mosqueda, M.D., Director of Geriatrics, University of California, Irvine School of Medicine.
Documenting the Knowledge of Pain Medications being Abruptly Discontinued.
“At home are vitamin D, Valium, Remeron, vitamin B12, Tylenol, and Keppra. The patient apparently was also on high dose of vicodin, which she has been abruptly discontinued for the last three days.” (Mather Hospital, Consultation Report”, dated 1/30/13, page 1, heading Medications.)
Mather Hospital Documenting the Medically Unsupervised Discontinuation of Pain and other Medications.
The patient has not recently seen a physician…” (Physician Documentation, 1/30/13, HPI, 15:35)
AARP United healthcare Summary March 15, 2013, page 3 of 7, corroborates the accuracy of Mather Hospital’s knowledge that the “patient has not recently seen a physician” from the admission date 1/13/13, while taking all documented medications, till the admission date 1/30/13, when Vicodin, Levothyroxine, Lopressor, Celexa, Lovanox and Prednisone was discontinued.(Mather Hospital Nurse’s Notes, 1/13/13, page 1, Home Meds, Mather Hospital Physician Documentation, 1/30/13, page 1, Home Meds)
United Healthcare reports in it’s summary only 2 physician claims for this time period. Mather Hospital “ER Visit”, 1/13/13, #30572-803264-1, Doctor Services $2,532.19, and a Mather Hospital “Doctor Care in Hospital”, 2/1/13, #30582-426166-1, $199.00
“Confirming the Diagnosis” by Utilizing the “Direct Questioning” Method.
(Elder Abuse an Introduction for the Clinicians, Dr. Ronald A. Chez, Center on Elder Abuse . org)
“Are you or have you been threatened or abused?” The patient replied YES! (Mather Hospital Admission Profile, 1/30/13, page 6 under Self-Perception.)
Mather Hospital’s Policy Regarding Mandatory Reporting in Conduct and Compliance Manual
In Overview, Introduction, Page 2, B. “The importance of the compliance program moreover, compliance with state and federal rules and regulations is essential because of our potential civil or even criminal liability if we were found to have violated the applicable standards.”
Page 6, III section ,“Standards Related to Quality of Care”, DMandatory Reporting. “The hospital will ensure that all incidents and events that are required to be reported under federal and state mandatory reporting laws, rules and regulations are reported in a timely manner”.
Section D continued, Page 7, “The compliance officer or his designee will validate that appropriate systems are in place for identifying and reporting incidents that require reporting. “The compliance officer will conduct periodic reviews to monitor the hospital’s compliance with such requirements in connection with, but not limited to, the following”: #3, “Elder Abuse”.
WHY DISCONTINUING PAIN MEDICATION IS ABUSE!
Patient’s Pain, Suspected Multiple Myeloma
Mather Hospital Physicians “Recommendation/Plan: An 85-yar-old lady with past medical history of seizures and anemia secondary to chronic kidney disease who presents with an acute DVT. I will perform a hypercoagulable workup, as she does have a family history of DVT’S“however, she has Bence Jones protein suspicious for multiple myeloma.”( David Chu, Northshore Hematology/ Oncology Associates, Recommendation/ Plan, 1/23/12, page 3.) “Immunofixation, urine. Bence Jones Protein Positive Lamba Type.” (Joseph P. Boglia, M.D., P.C.)
Patient Pain of Suspected Multiple Myeloma
Memorial Sloan Kettering Cancer Center
Multiple Myeloma:
Pain Management
“A majority of patients with multiple myeloma report that they experience some pain related to the disease. The pain may be a result of a bone fracture or of a tumor pressing against a nerve.”
Treatment of Multiple Myeloma Pain
Memorial Sloan Kettering Cancer Center
Multiple Myeloma:
Pain Management
“Analgesics, or pain relievers, remain the mainstay of bone pain treatment. The strongest analgesics, called opioids or narcotics, are often prescribed to control pain in myeloma patients. The most commonly prescribed drugs are codeine, morphine, and morphine-like synthetic compounds.”
Medical Supervision; Universally Recognized Protocol for Discontinuing Vicodin not Recognized.
“You should never try to quit taking Vicodin on your own; reduction of the medication and detoxification must be supervised by a doctor. Addiction experts and clinicians recommend a gradual reduction of the medication, as sudden cessation can trigger severe withdrawal symptoms.”
“Withdrawal symptoms usually start within a day or two of stopping the medication”.
“Under utilization of prescription drugs” is a sign of physical abuse. (National Centers on the Elder Abuse Administration on Aging).
“Denial of Pain Medication is Elder Abuse”, Elder Abuse, the Pharmacist’s Role, Center on Elder Abuse.org,
“Denying Access to Pain Medication”, Elder Abuse, Center on Excellence on Elder Abuse & Neglect,
“Denying access to pain medication is physical abuse”, Laura Mosqueda, M.D., Director of Geriatrics, University of California, Irvine School of Medicine.
Mather Hospital Documenting the Knowledge of Pain Medications being “Abruptly Discontinued”.
“At home are vitamin D, Valium, Remeron, vitamin B12, Tylenol, and Keppra. The patient apparently was also on high dose of vicodin, which she has been abruptly discontinued for the last three days.” (Mather Hospital, Consultation Report”, dated 1/30/13, page 1, heading Medications.)
Mather Hospital Documenting the Medically Unsupervised Discontinuation of Pain and other Medications.
The patient has not recently seen a physician…” (Physician Documentation, 1/30/13, HPI, 15:35)
Mather Hospital “Confirming the Diagnosis” by Utilizing the “Direct Questioning” Method.
(Elder Abuse an Introduction for the Clinicians, Dr. Ronald A. Chez, Center on Elder Abuse . org)
“Are you or have you been threatened or abused?” The patient replied YES! (Mather Hospital Admission Profile, 1/30/13, page 6 under Self-Perception.)
Mather Hospital’s Policy Regarding Mandatory Reporting in Conduct and Compliance Manual
In Overview, Introduction, Page 2, B. “The importance of the compliance program moreover, compliance with state and federal rules and regulations is essential because of our potential civil or even criminal liability if we were found to have violated the applicable standards.”
Page 6, III section ,“Standards Related to Quality of Care”, D
Mandatory Reporting. “The hospital will ensure that all incidents and events that are required to be reported under federal and state mandatory reporting laws, rules and regulations are reported in a timely manner”.
Section D continued, Page 7, “The compliance officer or his designee will validate that appropriate systems are in place for identifying and reporting incidents that require reporting. “The compliance officer will conduct periodic reviews to monitor the hospital’s compliance with such requirements in connection with, but not limited to, the following”: #3, “Elder Abuse”.
WHY DISCONTINUING PAIN MEDICATION WHILE NOT MEDICALLY SUPERVISING TAPERING, IS ABUSE!
Patient’s Pain, Suspected Multiple Myeloma Mather Hospital Not Addressing Pain, Withdrawal and Rebound Effects.
“Complaint: Your Mother’s medications were not appropriately adjusted, causing her condition to be effected”.
“Response: Your mother’s medications were in fact appropriately adjusted in accordance with laboratory results.” (Letter, Maryanne B. Gordon, MA, RHIA, CHCQM, Administrative Director, Mather Hospital.)
Which of the following “Laboratory Test Results” done at Mather Hospital, (CMP, APTT, BNP, CBC W/DIFF, Magnesium, Prothrombin Time, Troponin, TSH, Urine Admission, Troponin, Basic Metabolic Panel, CBC, Phosphorus, John T. Mather Encounter Summary, 1/30/13, page 1, Orders:) based upon Medical Science, justifies the “Abrupt Discontinuance” of Vicodin and Prednisone for Cancer Pain, without a substitute, while not tapering off under Medical Supervision?
Looking specifically at pain medications for cancer, due to it’s debilitating effects.
Mather Hospital Establishes Timeline of Discontinued Pain Medication.
“At home are vitamin D, Valium, Remeron, vitamin B12, Tylenol, and Keppra. The patient apparently was also on high dose of vicodin, which she has been abruptly discontinued for the last three days.”(Mather Hospital, Consultation Report”, dated 1/30/13, page 1, heading Medications.)
Withdrawal Symptoms Appear Exactly 2 Days As Would Be Expected.
“Withdrawal symptoms usually start within a day or two of stopping the medication”.
“Withdrawal symptoms typically begin within a day or two of stopping the medicine” “I urge anyone in this situation to stop their narcotic medication under their doctor’s supervision”. (Living Well Expert, Dr. Jennifer Shu)
“15:35 The patient reports chest pain that is located primarily in the substernal area. Onset Yesterday”, John T. Mather Hospital Physician Documentation, 1/30/13, page 1,)
Abruptly Discontinued 1/27/13, Symptoms 2 Days Later, 1/29/13.
Mather Hospital’s Knowledge of Vicodin Usage Confirmed.
“Apparently was on high dose of Vicodin” (Mather Hospital, Consultation Report”, dated 1/30/13, page 1, heading Medications.)
Prescription given at discharge of Mather Hospital ER, Discharge Instructions, 1/13/13, Vicodin 5-500 mg. Oral Tablet, take 1 tablet(s) by ORAL route every 6 hours as needed; Quantity: 20 tablet(s).
Vicodin 5 mg. 1q6h prn since 6/30/11, Prednisone 5 mg., 1 in AM and 2 at PM, since 5/31/11, (Primary Care Physician Face Sheet for patient, printed April 16, 2013.)
“Vicodin daily for 3 years”, (John T. Mather Memorial Hospital Admission Profile, 1/30/13, page 4, Street Drug/Medication/Inhalent Use, Frequency of Street Drug/Medication/Inhalent.)
Cancer Pain Established, “Symptoms and Laboratory Results” indicative of Multiple Myeloma.
“Generalized Bone Pain”, (John T. Mather Memorial Hospital Admission Profile, 1/30/13, page 2, Medical Surgical History.)
Mather Hospital Reference Lab Testing, 2/2/2013, 07:00, “Serum IFE reveals the presence of monoclonal free lamba light chains”.
Mather Hospital Affiliated Physician. “Recommendation/Plan: An 85-yar-old lady with past medical history of seizures and anemia secondary to chronic kidney disease who presents with an acute DVT. I will perform a hypercoagulable workup, as she does have a family history of DVT’S“however, she has Bence Jones protein suspicious for multiple myeloma.”( David Chu, Northshore Hematology/ Oncology Associates, Recommendation/ Plan, 1/23/12, page 3.)
Mather Hospital Physician. “Immunofixation, urine. Bence Jones Protein Positive Lamba Type.” (Joseph P. Boglia, M.D., P.C.)
Patient’s Pain was from Suspected Multiple Myeloma
Memorial Sloan Kettering Cancer Center
Multiple Myeloma:
Pain Management
“A majority of patients with multiple myeloma report that they experience some pain related to the disease. The pain may be a result of a bone fracture or of a tumor pressing against a nerve.”
Universally Accepted Treatment of Multiple Myeloma Pain
Memorial Sloan Kettering Cancer Center
Multiple Myeloma:
Pain Management
“Analgesics, or pain relievers, remain the mainstay of bone pain treatment The strongest analgesics, called opioids or narcotics, are often prescribed to control pain in myeloma patients. The most commonly prescribed drugs are codeine, morphine, and morphine-like synthetic compounds.”
Medically Supervised Tapering; Universally Recognized Protocol for Discontinuing Vicodin not Established at Mather Hospital.
“You should never try to quit taking Vicodin on your own; reduction of the medication and detoxification must be supervised by a doctor. Addiction experts and clinicians recommend a gradual reduction of the medication, as sudden cessation can trigger severe withdrawal symptoms.”
“Withdrawal symptoms usually start within a day or two of stopping the medication”.
“Clinical experts prefer it that you don’t get off hydrocodone cold turkey. They feel that withdrawal doesn’t have to be a painful and debilitating process. Instead, you can slowly lower hydrocodone doses over time to lower risk of severe symptoms of withdrawal. Always check with your prescribing doctor and ask for a hydrocodone tapering schedule when coming off hydrocodone. Tapered hydrocodone doses should be medically supervised in the case that tweaking and adjustments are required. In general, some guidelines for getting off hydrocodone include”:
1. A 2 to 3 week hydrocodone tapering regimen should be adequate in most cases
2. Reduce the hydrocodone dose by 10% at each interval
3. Reduce the hydrocodone dose by 20% every 3-5 days
4. Reduce the hydrocodone dose by 25% per week
5. Avoid reducing the daily dose by > 50% at any given interval
Painful Symptoms of Unsupervised Vicodin Withdrawal.
Stopping Hydrocodone Cold Turkey Risks
“Stopping hydrocodone cold turkey can be a unpredictable process. While opiates are known to provoke general symptoms during withdrawal, the fact remains that everybody is different. And depending on your current mental and physical health, stopping hydrocodone cold turkey can be more or less successful. The possible ricks you run quitting hydrocodone suddenly includes the following:”
coma
confusion
erratic and uncontrollable moods
hallucinations
increased heart rate/blood pressure
relapse do to inability to handle pain
seizures
tremors
Mayo Clinic Proceedings
Volume 81, Issue 6 , Pages 825-828, June 2006
“Broken Heart Syndrome” After Separation (From OxyContin)
“People who abruptly discontinue opiods may experience “Broken Heart Syndrome” increasing their risk of cardiac event. “Though most Broken Heart Syndrome patients regain full cardiac function some die and others suffer life-threatening complications.” (Mayo Clinics June issue of the Mayo Clinic Proceedings)
“Broken Heart Syndrome” Can Result From Opioid Withdrawal, Cocaine Use
• Heart Disease news • Jun 22, 2006
“People who experience abrupt withdrawal from high-dose opioids or use cocaine increase their risk of cardiac event, according to two new studies published in the June issue of Mayo Clinic Proceedings”.
“Patients may experience shortness of breath and chest pain and, upon hospital admission, go through extensive tests to determine a diagnosis and rule out heart attack.”
Mather Hospital Documentation of Sudden Onset of Cardiac Event Associated with Vicodin, Metroprolol and Prednisone Withdrawal and Rebound Effects and Characteristics of “Broken Heart Syndrome”.
“The patient was admitted for possible” acute coronary syndrome.”(John T. Mather Hospital Discharge Summary, 1/30/13, page 1, Hospital Course.)
“SAO2 41% @15% O2” (Terryville Fire Department, Hospital Patient Record Copy, 1/30/13)
”Rythym is atrial fibrillation With PVC’s” (John T. Mather Hospital Nurse’s Notes Cont, 1/30/13, page 2, Assessment:, Cardiovascular:)
“17:18 Notified ED physician of critical lab value positive troponin reported to dr. morgan 0.07. (John T. Mather Hospital Nurse’s Notes, 1/30/13, page 2, ED Course:)
Mather Hospital Confirming “Acute Coronary Syndrome” Associated with Withdrawal and Rebound Symptoms.
“1/30/13 17:38 Admit ordered for Kanakoudas, Dimos. Preliminary diagnosis are Chest Pain, Abnormal ECG. Problem is new.” (John T. Mather Hospital Physician Documentation Con’t., 1/30/13, page 4, Disposition:).
Mather Hospital Confirming “Acute Coronary Syndrome” as Withdrawal and Rebound Symptoms by Restoring Opiates and Relieving Symptoms.
“16:49, Morphine 2 mg., Sub-Q, upper left arm” (John T. Mather Hospital Nurse’s Notes Cont., 1/30/13, page 2, Administered Medications:)
“17:35, The Patients symptoms have improved, morphine markedly releived the patient’s pain. Symptoms have improved. Pain Meds Pain medication ordered, see orders”
“17:35 Moderately improved”, John T. Mather Hospital Physician Documentation Con’t., 1/30/13, page 2, Response to treatment:)
Mather Hospital Not Addressing the “Abrupt Discontinuation” of Pain Medications for Cancer and the need for Immediate Medical Supervision for the Continuation of Pain and Withdrawal.
“16:49, Morphine 2 mg., Sub-Q, upper left arm” (John T. Mather Hospital Nurse’s Notes Cont., 1/30/13, page 2, Administered Medications:)
“16:49, Morphine 2 mg., Sub-Q, ONCE” (John T. Mather Hospital Nurse’s Notes Cont., 1/30/13, page 2, Order Name.)
“The Patient was Discharged”, 2/2/13. (John T. Mather Hospital Discharge Summary, 1/30/13, page 2, DISPOSITION:)
FOLLOWUP: “Followup in one or two weeks with primary care physician”. (John T. Mather Hospital Discharge Summary, 1/30/13, page 2,)
MEDICATION: “As per medical reconciliation list.” (John T. Mather Hospital Discharge Summary, 1/30/13, page 2,)
Only 3 Medications on Reconciliation List Given In Hospital, Pain Medications Neglected for Cancer Pain at Home.
“Verified Keppra 500mg. orally 2 times a day, 1/30/13, continued as the inpatient order levetiracetam.” (John T. Mather Memorial Hospital Admission Reconcilliation, 1/30/13, Admit Date: 1/30/2013, Discharge Date: 2/2/2013, Att: Kanakoudas, Dimos).
“Verified Remeron 15mg. orally 2 times a day, 1/30/13, Remeron continued as the inpatient order mirtazapine.” (John T. Mather Memorial Hospital Admission Reconcilliation, 1/30/13, Admit Date: 1/30/2013, Discharge Date: 2/2/2013, Att: Kanakoudas, Dimos).
“Verified Valium 2.5 mg. tablet bid prn anxiety, 1/30/13, Valium continued as the inpatient order diazepam. (John T. Mather Memorial Hospital Admission Reconcilliation, 1/30/13, Admit Date: 1/30/2013, Discharge Date: 2/2/2013, Att: Kanakoudas, Dimos).
“diazepam (dispense as Valium) Give 5 milliGRAM(S) Oral 2 times per day for Moderate Pain PRN Special Instructions: HOLD FOR SEDATION Date Due to Review:01-Feb-2013 00:00 **Discontinued**(John T. Mather Memorial Hospital Admission Reconciliation, 1/30/13, Admit Date: 1/30/2013, Discharge Date: 2/2/2013, Additional Current Orders, Att: Kanakoudas, Dimos).
“levetiracetam (Dispense as Keppra) Give 500mgs. Oral 2 times per day Priority- Time:Routine Rx Date Due to review:01-Mar-2013 00:00 (John T. Mather Memorial Hospital Admission Reconciliation, 1/30/13, Admit Date: 1/30/2013, Discharge Date: 2/2/2013, Additional Current Orders, Att: Kanakoudas, Dimos).
Mirtazapine (Dispense as Remoron) Give 15 mgs. Oral 2 times per day Priority- Time:Routine Rx Date Due to review:01-Mar-2013 00:00 (John T. Mather Memorial Hospital Admission Reconciliation, 1/30/13, Admit Date: 1/30/2013, Discharge Date: 2/2/2013, Additional Current Orders, Att: Kanakoudas, Dimos).
Mather Hospital Documents the Knowledge of Discontinued Medications on Admission Dates 1/30/13 and 2/9/13.
Mather Hospital, “Nurses Notes”, 1/13/13, page 1, under “Home Meds”hospital staff document the patient as taking; Keppra, Vicodin, Lopressor, Remeron, Valium, Amitiza, Prednisone and Levothyroxine.
Mather Hospital “Admission Reconciliation”, dated 1/30/13 at 18:15, under “Home Medications”, again confirmed reduction to Keppra, Remeron and Valium.
Hospital “Admission Reconciliation”, 2/9/13, 5:15:46 AM hospital staff document just Valium.
“At home are vitamin D, Valium, Remeron, vitamin B12, Tylenol, and Keppra. The patient apparently was also on high dose of vicodin, which she has been abruptly discontinued for the last three days.” (Mather Hospital, Consultation Report”, dated 1/30/13, page 1, heading Medications.)
Hospital “Admission Reconciliation”, 2/9/13, 5:15:46 AM hospital staff document just Valium.
“Patient was not given aspirin… states patient no longer takes medications”. (Mather Hospital, Physician Documentation, 2/9/13, 21:08, page 2).
No Longer Taking, Home Medications:
acetaminophen HYDROcodone 325 mg. 5 mg. oral tablet 1 tab orally every 4 hours, as needed. (John T. Mather Memorial Hospital Admission Reconciliation, 2/9/13, Admit Date: 2/9/2013, Discharge Date: 2/12/2013, Additional Current Orders, Att: Kanakoudas, Dimos).
No Longer Taking, Home Medications:
prednisone 5 mg. oral tablet 1 tab orally once a day.
(John T. Mather Memorial Hospital Admission Reconciliation, 2/9/13, Admit Date: 2/9/2013, Discharge Date: 2/12/2013, Additional Current Orders, Att: Kanakoudas, Dimos).
No Longer Taking, Home Medications:
metoprolol succinate 25 mg. oral tablet, extended release 1 tab orally once a day.
(John T. Mather Memorial Hospital Admission Reconciliation, 2/9/13, Admit Date: 2/9/2013, Discharge Date: 2/12/2013, Additional Current Orders, Att: Kanakoudas, Dimos).
No Longer Taking, Home Medications:
levothyroxine 25 mcg (0.025 mg.) oral tablet 1 tablet orally once a day.
(John T. Mather Memorial Hospital Admission Reconciliation, 2/9/13, Admit Date: 2/9/2013, Discharge Date: 2/12/2013, Additional Current Orders, Att: Kanakoudas, Dimos).
No Longer Taking, Home Medications:
citalopram 20 mg. oral tablet 1 tab orally once a day.
(John T. Mather Memorial Hospital Admission Reconciliation, 2/9/13, Admit Date: 2/9/2013, Discharge Date: 2/12/2013, Additional Current Orders, Att: Kanakoudas, Dimos).
Verified, Valium 2.5 mg tablet bid prn anxiety(John T. Mather Memorial Hospital Admission Reconciliation, 2/9/13, Admit Date: 2/9/2013, Discharge Date: 2/12/2013, Additional Current Orders, Att: Kanakoudas, Dimos).
The Results.
1/14/13: While Patient was taking All Prescribed Medications: Vicodin, Prednisone, Levothyroxine, Lopressor, Keppra, Remeron and Valium Under my Care.
“Negative for Body Aches”, “Negative for Pain”,
( John T. Mather Hospital Physician Documentation, 1/13/13, page 1, ROS:, 32:31, Constitutional:)
“Negative for Pain with Movement”, “Negative for Chest Pain”,
( John T. Mather Hospital Physician Documentation, 1/13/13, page 1, ROS:, 32:31, Constitutional:)
“Negative for Shortness of Breath”, “Negative for Headache”,
( John T. Mather Hospital Physician Documentation, 1/13/13, page 1, ROS:, 32:31, Constitutional:)
“Negative for Anxiety, Depression” ( John T. Mather Hospital Physician
“The patient appears in no acute distress, alert, awake, (John T. Mather Hospital Physician Documentation, Constitutional Con’t., page 2)
“The patient does not display signs of respiratory distress, Respirations: normal, Breath sounds: are normal, clear throughout, no rales, rhonchi, no wheezing.” (John T. Mather Hospital Physician Documentation, Constitutional Con’t., 1/13/13, page 2, Respiratory:)
“Rate: normal, Rythym: regular, Heart Sounds: normal, normal S1 and S2.” John T. Mather Hospital Physician Documentation Physician Documentation, Constitutional Con’t., 1/13/13, page 2, Cardiovascular:)
”Pain, that is mild of the thoracic area, ROM normal”(John T. Mather Hospital Physician Documentation Con’t., 1/13/13, page 2, Back:)
“Orientation is normal, Cerebellar function: normal finger to nose testing, able to perform alternating rapid hand movements, Motor: is normal, moves all fours, strength is normal, Sensation is normal, Deep tendon reflexes are normal”(John T. Mather Hospital Physician Documentation, Constitution Con’t., 1/13/13, page 2, Neuro:)
“ROM : Intact in all extremities, Circulation: Circulation is intact in all extremities, Joints: All joints appear normal with full range of motion, neurovascular is intact distal to injury” (John T. Mather Hospital Physician Documentation, Constitution Con’t., 1/13/13, page 2, Musculoskeletal/extremity:)
“Behavior: appropriate for age, cooperative” (John T. Mather Hospital Physician Documentation, Constitution Con’t., 1/13/13, page 2, Psych:)
“Negative for Chest Pain, Palpatations”, (John T. Mather Hospital Physician Documentation, Constitution Con’t., 1/14/13, page 1, Cardiovascular)
“This is a well developed, well nourished patient who is awake, alert, and in no acute distress”, ” (John T. Mather Hospital Physician Documentation, Constitution Con’t., 1/14/13, page 2, Constitutional:)
While Patient was Known to be off Prescribed Medications: Vicodin, Prednisone, Levothyroxine and Lopressor, Not Under my Care, Just 16 Days Later
“SAO2 41% @15% O2” (Terryville Fire Department, Hospital Patient Record Copy, 1/30/13)
”Rythym is atrial fibrillation With PVC’s” (John T. Mather Hospital Nurse’s Notes Cont, 1/30/13, page 2, Assessment:, Cardiovascular:)
“17:18 Notified ED physician of critical lab value positive troponin reported to dr. morgan 0.07. (John T. Mather Hospital Nurse’s Notes, 1/30/13, page 2, ED Course:)
“Semi Comatose” (Mather Hospital Nursing Assessment, page 7, Cognitive/Perceptual/Neuro under level of consciousness, 2/12/13)
“Disoriented x 4” (Mather Hospital Nursing Assessment, page 7, Cognitive/Perception/Neuro under Orientation).
“Deceased” within a month, ( Death Certificate 2/12/13).
Mather Hospital Libel for 90 Year Old Patient’s Death Due to New York Health Care Proxy Law.
Mather Hospital Confirms Patient not Deemed Incapacitated During Dates in Question.
“A health Agent may only take over medical decisions when a Principal is deemed incompetent by two doctors. NYSHL S 2983 (A) 1, “To commence a proxy agents authority”, (Surrogate Decision Making in New York, Salvatore M Di Constanzo, McMillan, Constabile, Maker & Perone, LLP.).
“The confirmation sall be stated in writing and shall be included in the principal’s medical record.”NYSHL S 2983 (D) 6, “Confirmation of lack of capacity”.)
“Awake, Alert and Oriented X 3, (Discharge Summary, 2/1/13 under Neurological)
“Awake and alert, GCS 15, oriented to person, place, time and situation. (Physician Documentation Cont’. 1/30/13, page 2, Neuro:)
Awake, Alert and oriented x 3, (John T. Mather Hospital Discharge Summary Dis Date: 2/2/13, Physical Examination:)
No deficits noted, patient oriented X3, eyes open spontaneously and obeys commands. Level of consciousness is awake, alert. ( Mather Hospital Nurse’s Notes Con’t, 1/30/13, page 2, 17:06, Neuro:)
“Further, on admission, your mother was found to be ALERT, and ORIENTATED and fully concurred with the visitation restrictions ”. (Mather Hospital Administrative Director, Maryanne B. Gordon, letter, 7/17/13).
Mather Hospital Admits Not Having in Possession a Health Care Proxy Document From 1/15/13 through 7/17/13.
After a 2 month long hospital investigation, Maryanne B. Gordon, Administrative Director confirms the fact that Mather Hospital cannot verify the date of execution, an essential element of a legal HCP, by stating: “Therefore, we can only conclude that at some point, your mother revoked her prior proxy and executed a new one”.
Essential Elements- “Principal’s Signature and Date of signature, and execution”, signature of 2 witnesses, neither of which can be an agent or alternate agent”. (New York State Department of Health, “Filing a Healthcare Proxy” in the Medical Record, Essential Elements of a Health Care Proxy).
Mather Hospital Reaffirms That They “Routinely” Violate New York State Consolidated Laws Public Health.
New York State Consolidated Laws Public Health S 2984, Providers Obligations” 1: Requires a “Healthcare Provider who is provided with a health care proxy shall arrange for the proxy or a copy to be inserted in the principals record”.
“Further, hospitals do not routinely maintain copies of proxy documents for patients when they are executed, because patients often revoke and/or change agents over the course of time as circumstances change”. (Letter, Maryanne B. Gordon, MA, RHIA, CHCQM, Administrative Director, Mather Hospital, 1/17/13, page 1, Response to complaint #1, You were your mothers Health Care Proxy effective 2007 and were denied the right to act as her proxy agent during her final hospitalization.)
Mather Hospital Confirming No New Health Care Proxy Agent or Document Provided on Dates in Question.
“Your sister advised the staff upon your mother’s final admission that she was your mother’s Health Care Proxy and provided a copy of the proxy document”. (Mather Hospital Administrative Director, Maryanne B. Gordon, letter, 7/17/13), page 1, response to complaint: You were your mother’s Health Care Proxy effective 2007 and were denied the right to act as her proxy agent during her final hospitalization”.)
Final Admission Date Confirmed By Mather Hospital, 2/9/13-2/12/13.
“Hospital stay was uneventful. On February 13, 2013, the patient expired” (John T. Mather Hospital Discharge Summary, 2/9/13, page 1, HOSPITAL COURSE:)
Certificate of Death, 2/12/13, Mather Hospital Physician, Natalya Titakeuko certifies the immediate “Cause of Death” as “Cardio Pulmonary Arrest” due to or as a consequence of: “Coronary Artery Disease, COPD, Dementia and Failyure to Thrive”, Pronounced Dead at Mather Hospital, 2/12/13, 2:50PM.)
Remember it is the “End Which Unjustified the Means”.
The Center for Advocacy for the Rights and Interests of the Elderly (CARE), in solidarity, conferred the following statement to me, ”We wish you luck and fortitude in advocating for the rights of older adults”.
“Those who fail to learn the lessons of history are doomed to repeat them”. George Santayana
In light of the fact that Mather Hospital was aware that the patient had been on “High Dose“ of Vicodin for “3 Years” when it was known to have been “Abruptly Discontinued”, It’s obvious that Dr. Koumakodis and Mather Hospital were negligent in not identifying and alleviating the painful withdrawal symptoms.
Additionally it was negligent to discharge the patient without supervising the patient, tapering off of Vicodin and Prednisone.
Also not ordering medication for Cancer Pain and replacing them with a suitable replacement is another issue of concern.
With this knowledge, discharging the patient in this condition and instructing the patient to wait 1-2 weeks to “follow up” with her Primary Care Physician proved to be the inaction which was responsible for the patient to require Hospice Care on 2/7/13, just 5 days later. (2/10/2013, 12:36:03 AM, EMSCHARTS, History of Present Illness, Line 1 and 2.)
Evidently Valium could not mask the withdrawal symptoms and Tylanol was inadequate for the Bone Pain associated with Multiple Myeloma.
Unfortunately the frail 90 year old patient could not withstand the inevitable withdrawal symptoms and Pain and expired.
Mather Hospital Reviews
Hospitals Duty to Report “Confirmed Elder Abuse”,
A Lifesaver.
Although other “Assessment Indicators” of Elder Abuse were present simultaneously and documented such as, Restriction of Visitation/ Calls, Sudden Change in Living Arrangements, Sudden Change in Proxy Document and Sudden Change in Behavioral and Physical Condition. The Documented “Abrupt Discontinuance of Pain Medication” in itself confirms the Diagnosis of Abuse.
Confirming the Diagnosis of Elder Abuse is made by the Documentation of Abruptly Discontinued “Pain Medications”.
“Under treatment of pain equals elder abuse.” Chronic Neuroimmune Disease 1/13/13
“Under utilization of prescription drugs” is a sign of physical abuse. (National Centers on the Elder Abuse Administration on Aging).
“Denial of Pain Medication is Elder Abuse”, Elder Abuse, the Pharmacist’s Role, Center on Elder Abuse.org,
“Denying Access to Pain Medication”, Elder Abuse, Center on Excellence on Elder Abuse & Neglect,
“Denying access to pain medication is physical abuse”, Laura Mosqueda, M.D., Director of Geriatrics, University of California, Irvine School of Medicine.
Documenting the Knowledge of Pain Medications being Abruptly Discontinued.
“At home are vitamin D, Valium, Remeron, vitamin B12, Tylenol, and Keppra. The patient apparently was also on high dose of vicodin, which she has been abruptly discontinued for the last three days.” (Mather Hospital, Consultation Report”, dated 1/30/13, page 1, heading Medications.)
Mather Hospital Documenting the Medically Unsupervised Discontinuation of Pain and other Medications.
The patient has not recently seen a physician…” (Physician Documentation, 1/30/13, HPI, 15:35)
AARP United healthcare Summary March 15, 2013, page 3 of 7, corroborates the accuracy of Mather Hospital’s knowledge that the “patient has not recently seen a physician” from the admission date 1/13/13, while taking all documented medications, till the admission date 1/30/13, when Vicodin, Levothyroxine, Lopressor, Celexa, Lovanox and Prednisone was discontinued.(Mather Hospital Nurse’s Notes, 1/13/13, page 1, Home Meds, Mather Hospital Physician Documentation, 1/30/13, page 1, Home Meds)
United Healthcare reports in it’s summary only 2 physician claims for this time period. Mather Hospital “ER Visit”, 1/13/13, #30572-803264-1, Doctor Services $2,532.19, and a Mather Hospital “Doctor Care in Hospital”, 2/1/13, #30582-426166-1, $199.00
“Confirming the Diagnosis” by Utilizing the “Direct Questioning” Method.
(Elder Abuse an Introduction for the Clinicians, Dr. Ronald A. Chez, Center on Elder Abuse . org)
“Are you or have you been threatened or abused?” The patient replied YES! (Mather Hospital Admission Profile, 1/30/13, page 6 under Self-Perception.)
Mather Hospital’s Policy Regarding Mandatory Reporting in Conduct and Compliance Manual
In Overview, Introduction, Page 2, B. “The importance of the compliance program moreover, compliance with state and federal rules and regulations is essential because of our potential civil or even criminal liability if we were found to have violated the applicable standards.”
Page 6, III section ,“Standards Related to Quality of Care”, DMandatory Reporting. “The hospital will ensure that all incidents and events that are required to be reported under federal and state mandatory reporting laws, rules and regulations are reported in a timely manner”.
Section D continued, Page 7, “The compliance officer or his designee will validate that appropriate systems are in place for identifying and reporting incidents that require reporting. “The compliance officer will conduct periodic reviews to monitor the hospital’s compliance with such requirements in connection with, but not limited to, the following”: #3, “Elder Abuse”.
WHY DISCONTINUING PAIN MEDICATION IS ABUSE!
Patient’s Pain, Suspected Multiple Myeloma
Mather Hospital Physicians “Recommendation/Plan: An 85-yar-old lady with past medical history of seizures and anemia secondary to chronic kidney disease who presents with an acute DVT. I will perform a hypercoagulable workup, as she does have a family history of DVT’S“however, she has Bence Jones protein suspicious for multiple myeloma.”( David Chu, Northshore Hematology/ Oncology Associates, Recommendation/ Plan, 1/23/12, page 3.) “Immunofixation, urine. Bence Jones Protein Positive Lamba Type.” (Joseph P. Boglia, M.D., P.C.)
Patient Pain of Suspected Multiple Myeloma
Memorial Sloan Kettering Cancer Center
Multiple Myeloma:
Pain Management
“A majority of patients with multiple myeloma report that they experience some pain related to the disease. The pain may be a result of a bone fracture or of a tumor pressing against a nerve.”
Treatment of Multiple Myeloma Pain
Memorial Sloan Kettering Cancer Center
Multiple Myeloma:
Pain Management
“Analgesics, or pain relievers, remain the mainstay of bone pain treatment. The strongest analgesics, called opioids or narcotics, are often prescribed to control pain in myeloma patients. The most commonly prescribed drugs are codeine, morphine, and morphine-like synthetic compounds.”
Medical Supervision; Universally Recognized Protocol for Discontinuing Vicodin not Recognized.
“You should never try to quit taking Vicodin on your own; reduction of the medication and detoxification must be supervised by a doctor. Addiction experts and clinicians recommend a gradual reduction of the medication, as sudden cessation can trigger severe withdrawal symptoms.”
“Withdrawal symptoms usually start within a day or two of stopping the medication”.
Mather Hospital, Failure to Report, Failure to Intervene, Fails a 90 Year Old Patient.
Confirming the Diagnosis of Elder Abuse can be made Exclusively by Documenting “Abruptly Discontinued Pain Medications” without Medical Supervision.
“Under treatment of pain equals elder abuse.” Chronic Neuroimmune Disease 1/13/13
“Under utilization of prescription drugs” is a sign of physical abuse. (National Centers on the Elder Abuse Administration on Aging).
“Denial of Pain Medication is Elder Abuse”, Elder Abuse, the Pharmacist’s Role, Center on Elder Abuse.org,
“Denying Access to Pain Medication”, Elder Abuse, Center on Excellence on Elder Abuse & Neglect,
“Denying access to pain medication is physical abuse”, Laura Mosqueda, M.D., Director of Geriatrics, University of California, Irvine School of Medicine.
Mather Hospital Documenting the Knowledge of Pain Medications being “Abruptly Discontinued”.
“At home are vitamin D, Valium, Remeron, vitamin B12, Tylenol, and Keppra. The patient apparently was also on high dose of vicodin, which she has been abruptly discontinued for the last three days.” (Mather Hospital, Consultation Report”, dated 1/30/13, page 1, heading Medications.)
Mather Hospital Documenting the Medically Unsupervised Discontinuation of Pain and other Medications.
The patient has not recently seen a physician…” (Physician Documentation, 1/30/13, HPI, 15:35)
Mather Hospital “Confirming the Diagnosis” by Utilizing the “Direct Questioning” Method.
(Elder Abuse an Introduction for the Clinicians, Dr. Ronald A. Chez, Center on Elder Abuse . org)
“Are you or have you been threatened or abused?” The patient replied YES! (Mather Hospital Admission Profile, 1/30/13, page 6 under Self-Perception.)
Mather Hospital’s Policy Regarding Mandatory Reporting in Conduct and Compliance Manual
In Overview, Introduction, Page 2, B. “The importance of the compliance program moreover, compliance with state and federal rules and regulations is essential because of our potential civil or even criminal liability if we were found to have violated the applicable standards.”
Page 6, III section ,“Standards Related to Quality of Care”, D
Mandatory Reporting. “The hospital will ensure that all incidents and events that are required to be reported under federal and state mandatory reporting laws, rules and regulations are reported in a timely manner”.
Section D continued, Page 7, “The compliance officer or his designee will validate that appropriate systems are in place for identifying and reporting incidents that require reporting. “The compliance officer will conduct periodic reviews to monitor the hospital’s compliance with such requirements in connection with, but not limited to, the following”: #3, “Elder Abuse”.
WHY DISCONTINUING PAIN MEDICATION WHILE NOT MEDICALLY SUPERVISING TAPERING, IS ABUSE!
Patient’s Pain, Suspected Multiple Myeloma Mather Hospital Not Addressing Pain, Withdrawal and Rebound Effects.
“Complaint: Your Mother’s medications were not appropriately adjusted, causing her condition to be effected”.
“Response: Your mother’s medications were in fact appropriately adjusted in accordance with laboratory results.” (Letter, Maryanne B. Gordon, MA, RHIA, CHCQM, Administrative Director, Mather Hospital.)
Which of the following “Laboratory Test Results” done at Mather Hospital, (CMP, APTT, BNP, CBC W/DIFF, Magnesium, Prothrombin Time, Troponin, TSH, Urine Admission, Troponin, Basic Metabolic Panel, CBC, Phosphorus, John T. Mather Encounter Summary, 1/30/13, page 1, Orders:) based upon Medical Science, justifies the “Abrupt Discontinuance” of Vicodin and Prednisone for Cancer Pain, without a substitute, while not tapering off under Medical Supervision?
Looking specifically at pain medications for cancer, due to it’s debilitating effects.
Mather Hospital Establishes Timeline of Discontinued Pain Medication.
“At home are vitamin D, Valium, Remeron, vitamin B12, Tylenol, and Keppra. The patient apparently was also on high dose of vicodin, which she has been abruptly discontinued for the last three days.”(Mather Hospital, Consultation Report”, dated 1/30/13, page 1, heading Medications.)
Withdrawal Symptoms Appear Exactly 2 Days As Would Be Expected.
“Withdrawal symptoms usually start within a day or two of stopping the medication”.
© 2014 Addiction Vicodin. All Rights Reserved. Home | XML Site Map | RSS
“Withdrawal symptoms typically begin within a day or two of stopping the medicine” “I urge anyone in this situation to stop their narcotic medication under their doctor’s supervision”. (Living Well Expert, Dr. Jennifer Shu)
“15:35 The patient reports chest pain that is located primarily in the substernal area. Onset Yesterday”, John T. Mather Hospital Physician Documentation, 1/30/13, page 1,)
Abruptly Discontinued 1/27/13, Symptoms 2 Days Later, 1/29/13.
Mather Hospital’s Knowledge of Vicodin Usage Confirmed.
“Apparently was on high dose of Vicodin” (Mather Hospital, Consultation Report”, dated 1/30/13, page 1, heading Medications.)
Prescription given at discharge of Mather Hospital ER, Discharge Instructions, 1/13/13, Vicodin 5-500 mg. Oral Tablet, take 1 tablet(s) by ORAL route every 6 hours as needed; Quantity: 20 tablet(s).
Vicodin 5 mg. 1q6h prn since 6/30/11, Prednisone 5 mg., 1 in AM and 2 at PM, since 5/31/11, (Primary Care Physician Face Sheet for patient, printed April 16, 2013.)
“Vicodin daily for 3 years”, (John T. Mather Memorial Hospital Admission Profile, 1/30/13, page 4, Street Drug/Medication/Inhalent Use, Frequency of Street Drug/Medication/Inhalent.)
Cancer Pain Established, “Symptoms and Laboratory Results” indicative of Multiple Myeloma.
“Generalized Bone Pain”, (John T. Mather Memorial Hospital Admission Profile, 1/30/13, page 2, Medical Surgical History.)
Mather Hospital Reference Lab Testing, 2/2/2013, 07:00, “Serum IFE reveals the presence of monoclonal free lamba light chains”.
Mather Hospital Affiliated Physician. “Recommendation/Plan: An 85-yar-old lady with past medical history of seizures and anemia secondary to chronic kidney disease who presents with an acute DVT. I will perform a hypercoagulable workup, as she does have a family history of DVT’S“however, she has Bence Jones protein suspicious for multiple myeloma.”( David Chu, Northshore Hematology/ Oncology Associates, Recommendation/ Plan, 1/23/12, page 3.)
Mather Hospital Physician. “Immunofixation, urine. Bence Jones Protein Positive Lamba Type.” (Joseph P. Boglia, M.D., P.C.)
Patient’s Pain was from Suspected Multiple Myeloma
Memorial Sloan Kettering Cancer Center
Multiple Myeloma:
Pain Management
“A majority of patients with multiple myeloma report that they experience some pain related to the disease. The pain may be a result of a bone fracture or of a tumor pressing against a nerve.”
Universally Accepted Treatment of Multiple Myeloma Pain
Memorial Sloan Kettering Cancer Center
Multiple Myeloma:
Pain Management
“Analgesics, or pain relievers, remain the mainstay of bone pain treatment The strongest analgesics, called opioids or narcotics, are often prescribed to control pain in myeloma patients. The most commonly prescribed drugs are codeine, morphine, and morphine-like synthetic compounds.”
Medically Supervised Tapering; Universally Recognized Protocol for Discontinuing Vicodin not Established at Mather Hospital.
“You should never try to quit taking Vicodin on your own; reduction of the medication and detoxification must be supervised by a doctor. Addiction experts and clinicians recommend a gradual reduction of the medication, as sudden cessation can trigger severe withdrawal symptoms.”
“Withdrawal symptoms usually start within a day or two of stopping the medication”.
© 2014 Addiction Vicodin. All Rights Reserved. Home | XML Site Map | RSS
Get Off Hydrocodone (Not Cold Turkey)
“Clinical experts prefer it that you don’t get off hydrocodone cold turkey. They feel that withdrawal doesn’t have to be a painful and debilitating process. Instead, you can slowly lower hydrocodone doses over time to lower risk of severe symptoms of withdrawal. Always check with your prescribing doctor and ask for a hydrocodone tapering schedule when coming off hydrocodone. Tapered hydrocodone doses should be medically supervised in the case that tweaking and adjustments are required. In general, some guidelines for getting off hydrocodone include”:
1. A 2 to 3 week hydrocodone tapering regimen should be adequate in most cases
2. Reduce the hydrocodone dose by 10% at each interval
3. Reduce the hydrocodone dose by 20% every 3-5 days
4. Reduce the hydrocodone dose by 25% per week
5. Avoid reducing the daily dose by > 50% at any given interval
Painful Symptoms of Unsupervised Vicodin Withdrawal.
Stopping Hydrocodone Cold Turkey Risks
“Stopping hydrocodone cold turkey can be a unpredictable process. While opiates are known to provoke general symptoms during withdrawal, the fact remains that everybody is different. And depending on your current mental and physical health, stopping hydrocodone cold turkey can be more or less successful. The possible ricks you run quitting hydrocodone suddenly includes the following:”
coma
confusion
erratic and uncontrollable moods
hallucinations
increased heart rate/blood pressure
relapse do to inability to handle pain
seizures
tremors
Mayo Clinic Proceedings
Volume 81, Issue 6 , Pages 825-828, June 2006
“Broken Heart Syndrome” After Separation (From OxyContin)
“People who abruptly discontinue opiods may experience “Broken Heart Syndrome” increasing their risk of cardiac event. “Though most Broken Heart Syndrome patients regain full cardiac function some die and others suffer life-threatening complications.” (Mayo Clinics June issue of the Mayo Clinic Proceedings)
“Broken Heart Syndrome” Can Result From Opioid Withdrawal, Cocaine Use
• Heart Disease news • Jun 22, 2006
“People who experience abrupt withdrawal from high-dose opioids or use cocaine increase their risk of cardiac event, according to two new studies published in the June issue of Mayo Clinic Proceedings”.
“Patients may experience shortness of breath and chest pain and, upon hospital admission, go through extensive tests to determine a diagnosis and rule out heart attack.”
Mather Hospital Documentation of Sudden Onset of Cardiac Event Associated with Vicodin, Metroprolol and Prednisone Withdrawal and Rebound Effects and Characteristics of “Broken Heart Syndrome”.
“The patient was admitted for possible” acute coronary syndrome.”(John T. Mather Hospital Discharge Summary, 1/30/13, page 1, Hospital Course.)
“SAO2 41% @15% O2” (Terryville Fire Department, Hospital Patient Record Copy, 1/30/13)
“Chest Pain” …” (John T. Mather Hospital Discharge Summary, 1/30/13, page 1, Chief Complaint.)
“Chest pain… the pain radiates down left arm…”
“Pertinant positives:shortness of breath”.
“Modifying factors: The Symptoms are alleviated by nothing. The symptoms are aggravated by nothing.”
“The patient has not experienced similar symptoms in the past”.
The patient has not recently seen a physician…” (John T. Mather Hospital Physician Documentation, 1/30/13, HPI, 15:35)
“S1 and S2 Positive”. …” (John T. Mather Hospital Discharge Summary, 1/30/13, page 1, Heart.)
“Abnormal ECG” (John T. Mather Hospital Nurse’s Notes, 1/30/13, page 1, Diagnosis:)
”Rythym is atrial fibrillation With PVC’s” (John T. Mather Hospital Nurse’s Notes Cont, 1/30/13, page 2, Assessment:, Cardiovascular:)
“17:18 Notified ED physician of critical lab value positive troponin reported to dr. morgan 0.07. (John T. Mather Hospital Nurse’s Notes, 1/30/13, page 2, ED Course:)
"CARDIAC MARKERS, Troponin 1, 0.06 H, 1/31/13 11:27, BNP 260 H, 1/31/13 09:01”.
(John T. Mather Hospital Chemistry, Cardiac Markers, 1/31/13, page 2.)
15:39 “abnormal EKG, acute myocardial infarction, acute pericarditis, anxiety, atypical chest pain, coronary artery disease chest wall pain. (John T. Mather Hospital Physician Documentation Con’t., 1/30/13, page 2, Differential diagnosis:)
Mather Hospital Confirming “Acute Coronary Syndrome” Associated with Withdrawal and Rebound Symptoms.
“1/30/13 17:38 Admit ordered for Kanakoudas, Dimos. Preliminary diagnosis are Chest Pain, Abnormal ECG. Problem is new.” (John T. Mather Hospital Physician Documentation Con’t., 1/30/13, page 4, Disposition:).
Mather Hospital Confirming “Acute Coronary Syndrome” as Withdrawal and Rebound Symptoms by Restoring Opiates and Relieving Symptoms.
“16:49, Morphine 2 mg., Sub-Q, upper left arm” (John T. Mather Hospital Nurse’s Notes Cont., 1/30/13, page 2, Administered Medications:)
“17:35, The Patients symptoms have improved, morphine markedly releived the patient’s pain. Symptoms have improved. Pain Meds Pain medication ordered, see orders”
(John T. Mather Hospital Physician Documentation Con’t., 1/30/13, page 2, Medication Response.)
“17:35 Moderately improved”, John T. Mather Hospital Physician Documentation Con’t., 1/30/13, page 2, Response to treatment:)
Mather Hospital Not Addressing the “Abrupt Discontinuation” of Pain Medications for Cancer and the need for Immediate Medical Supervision for the Continuation of Pain and Withdrawal.
“16:49, Morphine 2 mg., Sub-Q, upper left arm” (John T. Mather Hospital Nurse’s Notes Cont., 1/30/13, page 2, Administered Medications:)
“16:49, Morphine 2 mg., Sub-Q, ONCE” (John T. Mather Hospital Nurse’s Notes Cont., 1/30/13, page 2, Order Name.)
“The Patient was Discharged”, 2/2/13. (John T. Mather Hospital Discharge Summary, 1/30/13, page 2, DISPOSITION:)
FOLLOWUP: “Followup in one or two weeks with primary care physician”. (John T. Mather Hospital Discharge Summary, 1/30/13, page 2,)
MEDICATION: “As per medical reconciliation list.” (John T. Mather Hospital Discharge Summary, 1/30/13, page 2,)
Only 3 Medications on Reconciliation List Given In Hospital, Pain Medications Neglected for Cancer Pain at Home.
“Verified Keppra 500mg. orally 2 times a day, 1/30/13, continued as the inpatient order levetiracetam.” (John T. Mather Memorial Hospital Admission Reconcilliation, 1/30/13, Admit Date: 1/30/2013, Discharge Date: 2/2/2013, Att: Kanakoudas, Dimos).
“Verified Remeron 15mg. orally 2 times a day, 1/30/13, Remeron continued as the inpatient order mirtazapine.” (John T. Mather Memorial Hospital Admission Reconcilliation, 1/30/13, Admit Date: 1/30/2013, Discharge Date: 2/2/2013, Att: Kanakoudas, Dimos).
“Verified Valium 2.5 mg. tablet bid prn anxiety, 1/30/13, Valium continued as the inpatient order diazepam. (John T. Mather Memorial Hospital Admission Reconcilliation, 1/30/13, Admit Date: 1/30/2013, Discharge Date: 2/2/2013, Att: Kanakoudas, Dimos).
“diazepam (dispense as Valium) Give 5 milliGRAM(S) Oral 2 times per day for Moderate Pain PRN Special Instructions: HOLD FOR SEDATION Date Due to Review:01-Feb-2013 00:00 **Discontinued**(John T. Mather Memorial Hospital Admission Reconciliation, 1/30/13, Admit Date: 1/30/2013, Discharge Date: 2/2/2013, Additional Current Orders, Att: Kanakoudas, Dimos).
“levetiracetam (Dispense as Keppra) Give 500mgs. Oral 2 times per day Priority- Time:Routine Rx Date Due to review:01-Mar-2013 00:00 (John T. Mather Memorial Hospital Admission Reconciliation, 1/30/13, Admit Date: 1/30/2013, Discharge Date: 2/2/2013, Additional Current Orders, Att: Kanakoudas, Dimos).
Mirtazapine (Dispense as Remoron) Give 15 mgs. Oral 2 times per day Priority- Time:Routine Rx Date Due to review:01-Mar-2013 00:00 (John T. Mather Memorial Hospital Admission Reconciliation, 1/30/13, Admit Date: 1/30/2013, Discharge Date: 2/2/2013, Additional Current Orders, Att: Kanakoudas, Dimos).
Mather Hospital Documents the Knowledge of Discontinued Medications on Admission Dates 1/30/13 and 2/9/13.
Mather Hospital, “Nurses Notes”, 1/13/13, page 1, under “Home Meds”hospital staff document the patient as taking; Keppra, Vicodin, Lopressor, Remeron, Valium, Amitiza, Prednisone and Levothyroxine.
Mather Hospital “Physicians Documentation”, 1/30/13, under “Home Meds”, Hospital staff documented; Valium, Remeron, Keppra.
Mather Hospital “Admission Reconciliation”, dated 1/30/13 at 18:15, under “Home Medications”, again confirmed reduction to Keppra, Remeron and Valium.
Hospital “Admission Reconciliation”, 2/9/13, 5:15:46 AM hospital staff document just Valium.
“At home are vitamin D, Valium, Remeron, vitamin B12, Tylenol, and Keppra. The patient apparently was also on high dose of vicodin, which she has been abruptly discontinued for the last three days.” (Mather Hospital, Consultation Report”, dated 1/30/13, page 1, heading Medications.)
Hospital “Admission Reconciliation”, 2/9/13, 5:15:46 AM hospital staff document just Valium.
“Patient was not given aspirin… states patient no longer takes medications”. (Mather Hospital, Physician Documentation, 2/9/13, 21:08, page 2).
No Longer Taking, Home Medications:
acetaminophen HYDROcodone 325 mg. 5 mg. oral tablet 1 tab orally every 4 hours, as needed. (John T. Mather Memorial Hospital Admission Reconciliation, 2/9/13, Admit Date: 2/9/2013, Discharge Date: 2/12/2013, Additional Current Orders, Att: Kanakoudas, Dimos).
No Longer Taking, Home Medications:
prednisone 5 mg. oral tablet 1 tab orally once a day.
(John T. Mather Memorial Hospital Admission Reconciliation, 2/9/13, Admit Date: 2/9/2013, Discharge Date: 2/12/2013, Additional Current Orders, Att: Kanakoudas, Dimos).
No Longer Taking, Home Medications:
metoprolol succinate 25 mg. oral tablet, extended release 1 tab orally once a day.
(John T. Mather Memorial Hospital Admission Reconciliation, 2/9/13, Admit Date: 2/9/2013, Discharge Date: 2/12/2013, Additional Current Orders, Att: Kanakoudas, Dimos).
No Longer Taking, Home Medications:
levothyroxine 25 mcg (0.025 mg.) oral tablet 1 tablet orally once a day.
(John T. Mather Memorial Hospital Admission Reconciliation, 2/9/13, Admit Date: 2/9/2013, Discharge Date: 2/12/2013, Additional Current Orders, Att: Kanakoudas, Dimos).
No Longer Taking, Home Medications:
citalopram 20 mg. oral tablet 1 tab orally once a day.
(John T. Mather Memorial Hospital Admission Reconciliation, 2/9/13, Admit Date: 2/9/2013, Discharge Date: 2/12/2013, Additional Current Orders, Att: Kanakoudas, Dimos).
Verified, Valium 2.5 mg tablet bid prn anxiety(John T. Mather Memorial Hospital Admission Reconciliation, 2/9/13, Admit Date: 2/9/2013, Discharge Date: 2/12/2013, Additional Current Orders, Att: Kanakoudas, Dimos).
The Results.
1/14/13: While Patient was taking All Prescribed Medications: Vicodin, Prednisone, Levothyroxine, Lopressor, Keppra, Remeron and Valium Under my Care.
“Negative for Body Aches”, “Negative for Pain”,
( John T. Mather Hospital Physician Documentation, 1/13/13, page 1, ROS:, 32:31, Constitutional:)
“Negative for Pain with Movement”, “Negative for Chest Pain”,
( John T. Mather Hospital Physician Documentation, 1/13/13, page 1, ROS:, 32:31, Constitutional:)
“Negative for Shortness of Breath”, “Negative for Headache”,
( John T. Mather Hospital Physician Documentation, 1/13/13, page 1, ROS:, 32:31, Constitutional:)
“Negative for Anxiety, Depression” ( John T. Mather Hospital Physician
Documentation, 1/13/13, page 1, ROS:, 32:31, Constitutional:)
“The patient appears in no acute distress, alert, awake, (John T. Mather Hospital Physician Documentation, Constitutional Con’t., page 2)
“The patient does not display signs of respiratory distress, Respirations: normal, Breath sounds: are normal, clear throughout, no rales, rhonchi, no wheezing.” (John T. Mather Hospital Physician Documentation, Constitutional Con’t., 1/13/13, page 2, Respiratory:)
“Rate: normal, Rythym: regular, Heart Sounds: normal, normal S1 and S2.” John T. Mather Hospital Physician Documentation Physician Documentation, Constitutional Con’t., 1/13/13, page 2, Cardiovascular:)
”Pain, that is mild of the thoracic area, ROM normal”(John T. Mather Hospital Physician Documentation Con’t., 1/13/13, page 2, Back:)
“Orientation is normal, Cerebellar function: normal finger to nose testing, able to perform alternating rapid hand movements, Motor: is normal, moves all fours, strength is normal, Sensation is normal, Deep tendon reflexes are normal”(John T. Mather Hospital Physician Documentation, Constitution Con’t., 1/13/13, page 2, Neuro:)
“ROM : Intact in all extremities, Circulation: Circulation is intact in all extremities, Joints: All joints appear normal with full range of motion, neurovascular is intact distal to injury” (John T. Mather Hospital Physician Documentation, Constitution Con’t., 1/13/13, page 2, Musculoskeletal/extremity:)
“Behavior: appropriate for age, cooperative” (John T. Mather Hospital Physician Documentation, Constitution Con’t., 1/13/13, page 2, Psych:)
“Negative for Chest Pain, Palpatations”, (John T. Mather Hospital Physician Documentation, Constitution Con’t., 1/14/13, page 1, Cardiovascular)
“This is a well developed, well nourished patient who is awake, alert, and in no acute distress”, ” (John T. Mather Hospital Physician Documentation, Constitution Con’t., 1/14/13, page 2, Constitutional:)
While Patient was Known to be off Prescribed Medications: Vicodin, Prednisone, Levothyroxine and Lopressor, Not Under my Care, Just 16 Days Later
“SAO2 41% @15% O2” (Terryville Fire Department, Hospital Patient Record Copy, 1/30/13)
“Chest Pain” …” (John T. Mather Hospital Discharge Summary, 1/30/13, page 1, Chief Complaint.)
“Chest pain… the pain radiates down left arm…”
“Pertinant positives:shortness of breath”.
“Modifying factors: The Symptoms are alleviated by nothing. The symptoms are aggravated by nothing.”
“The patient has not experienced similar symptoms in the past”.
The patient has not recently seen a physician…” (John T. Mather Hospital Physician Documentation, 1/30/13, HPI, 15:35)
“S1 and S2 Positive”. …” (John T. Mather Hospital Discharge Summary, 1/30/13, page 1, Heart.)
“Abnormal ECG” (John T. Mather Hospital Nurse’s Notes, 1/30/13, page 1, Diagnosis:)
”Rythym is atrial fibrillation With PVC’s” (John T. Mather Hospital Nurse’s Notes Cont, 1/30/13, page 2, Assessment:, Cardiovascular:)
“17:18 Notified ED physician of critical lab value positive troponin reported to dr. morgan 0.07. (John T. Mather Hospital Nurse’s Notes, 1/30/13, page 2, ED Course:)
“CARDIAC MARKERS, Troponin 1, 0.06 H, 1/31/13 11:27, BNP 260 H, 1/31/13 09:01”.
(John T. Mather Hospital Chemistry, Cardiac Markers, 1/31/13, page 2.)
15:39 “abnormal EKG, acute myocardial infarction, acute pericarditis, anxiety, atypical chest pain, coronary artery disease chest wall pain. (John T. Mather Hospital Physician Documentation Con’t., 1/30/13, page 2, Differential diagnosis:)
“Unresponsive”,(Mather Hospital Nursing Assessment, 2/9/13, page , under Coping,/Observed Emotional State. 2/10/13 09:00),
“Non Verbal”, (Mather Hospital Nursing Assessment, page 3 & 4, under Coping/ Verbalized Emotional State),
“Semi Comatose” (Mather Hospital Nursing Assessment, page 7, Cognitive/Perceptual/Neuro under level of consciousness, 2/12/13)
“Disoriented x 4” (Mather Hospital Nursing Assessment, page 7, Cognitive/Perception/Neuro under Orientation).
“Deceased” within a month, ( Death Certificate 2/12/13).
Mather Hospital Libel for 90 Year Old Patient’s Death Due to New York Health Care Proxy Law.
Mather Hospital Confirms Patient not Deemed Incapacitated During Dates in Question.
“A health Agent may only take over medical decisions when a Principal is deemed incompetent by two doctors. NYSHL S 2983 (A) 1, “To commence a proxy agents authority”, (Surrogate Decision Making in New York, Salvatore M Di Constanzo, McMillan, Constabile, Maker & Perone, LLP.).
“The confirmation sall be stated in writing and shall be included in the principal’s medical record.”NYSHL S 2983 (D) 6, “Confirmation of lack of capacity”.)
“Awake, Alert and Oriented X 3, (Discharge Summary, 2/1/13 under Neurological)
“Awake and alert, GCS 15, oriented to person, place, time and situation. (Physician Documentation Cont’. 1/30/13, page 2, Neuro:)
Awake, Alert and oriented x 3, (John T. Mather Hospital Discharge Summary Dis Date: 2/2/13, Physical Examination:)
No deficits noted, patient oriented X3, eyes open spontaneously and obeys commands. Level of consciousness is awake, alert. ( Mather Hospital Nurse’s Notes Con’t, 1/30/13, page 2, 17:06, Neuro:)
“Mild Dementia”. (John T. Mather Hospital Admission Profile, 1/30/13, page 4, Neurological Comment.)
“Further, on admission, your mother was found to be ALERT, and ORIENTATED and fully concurred with the visitation restrictions ”. (Mather Hospital Administrative Director, Maryanne B. Gordon, letter, 7/17/13).
Mather Hospital Admits Not Having in Possession a Health Care Proxy Document From 1/15/13 through 7/17/13.
After a 2 month long hospital investigation, Maryanne B. Gordon, Administrative Director confirms the fact that Mather Hospital cannot verify the date of execution, an essential element of a legal HCP, by stating: “Therefore, we can only conclude that at some point, your mother revoked her prior proxy and executed a new one”.
Essential Elements- “Principal’s Signature and Date of signature, and execution”, signature of 2 witnesses, neither of which can be an agent or alternate agent”. (New York State Department of Health, “Filing a Healthcare Proxy” in the Medical Record, Essential Elements of a Health Care Proxy).
Mather Hospital Reaffirms That They “Routinely” Violate New York State Consolidated Laws Public Health.
New York State Consolidated Laws Public Health S 2984, Providers Obligations” 1: Requires a “Healthcare Provider who is provided with a health care proxy shall arrange for the proxy or a copy to be inserted in the principals record”.
“Further, hospitals do not routinely maintain copies of proxy documents for patients when they are executed, because patients often revoke and/or change agents over the course of time as circumstances change”. (Letter, Maryanne B. Gordon, MA, RHIA, CHCQM, Administrative Director, Mather Hospital, 1/17/13, page 1, Response to complaint #1, You were your mothers Health Care Proxy effective 2007 and were denied the right to act as her proxy agent during her final hospitalization.)
Mather Hospital Confirming No New Health Care Proxy Agent or Document Provided on Dates in Question.
“Your sister advised the staff upon your mother’s final admission that she was your mother’s Health Care Proxy and provided a copy of the proxy document”. (Mather Hospital Administrative Director, Maryanne B. Gordon, letter, 7/17/13), page 1, response to complaint: You were your mother’s Health Care Proxy effective 2007 and were denied the right to act as her proxy agent during her final hospitalization”.)
Final Admission Date Confirmed By Mather Hospital, 2/9/13-2/12/13.
“Admit Date: 2/9/2013 22:08, Discharge Date: 2/12/2013 19:42 (John T. Mather Hospital Admission Reconciliation, 2/13/2013,page 1, 5:46, Visit ID: 135994275.)
ADM DATE: 2/9/13, DIS DATE:2/12/13. (John T. Mather Hospital Discharge Summary, 2/9/13, page 1,)
“Hospital stay was uneventful. On February 13, 2013, the patient expired” (John T. Mather Hospital Discharge Summary, 2/9/13, page 1, HOSPITAL COURSE:)
Certificate of Death, 2/12/13, Mather Hospital Physician, Natalya Titakeuko certifies the immediate “Cause of Death” as “Cardio Pulmonary Arrest” due to or as a consequence of: “Coronary Artery Disease, COPD, Dementia and Failyure to Thrive”, Pronounced Dead at Mather Hospital, 2/12/13, 2:50PM.)
Remember it is the “End Which Unjustified the Means”.
The Center for Advocacy for the Rights and Interests of the Elderly (CARE), in solidarity, conferred the following statement to me, ”We wish you luck and fortitude in advocating for the rights of older adults”.
“Those who fail to learn the lessons of history are doomed to repeat them”. George Santayana
In light of the fact that Mather Hospital was aware that the patient had been on “High Dose“ of Vicodin for “3 Years” when it was known to have been “Abruptly Discontinued”, It’s obvious that Dr. Koumakodis and Mather Hospital were negligent in not identifying and alleviating the painful withdrawal symptoms.
Additionally it was negligent to discharge the patient without supervising the patient, tapering off of Vicodin and Prednisone.
Also not ordering medication for Cancer Pain and replacing them with a suitable replacement is another issue of concern.
With this knowledge, discharging the patient in this condition and instructing the patient to wait 1-2 weeks to “follow up” with her Primary Care Physician proved to be the inaction which was responsible for the patient to require Hospice Care on 2/7/13, just 5 days later. (2/10/2013, 12:36:03 AM, EMSCHARTS, History of Present Illness, Line 1 and 2.)
Evidently Valium could not mask the withdrawal symptoms and Tylanol was inadequate for the Bone Pain associated with Multiple Myeloma.
Unfortunately the frail 90 year old patient could not withstand the inevitable withdrawal symptoms and Pain and expired.