Hospital nightmare. What the fuck is going on with healthcare in this country?

[Crunchy Frog]

This whole situation is too outlandish and bizzare not post about it.

My mother's boyfriend is in the hospital right now. He is quite a bit older than she is, has middle stage Alzheimer's, and has become quite frail. He has just gotten in to a program which provides an adult day care, further support as needed for the person in their home, and comprehensive healthcare through the program. He currently lives in the household and my mother is his caregiver.

Day before yesterday, he returned home from the program and it was evident that he had had an innoculation of some sort (turned out to be pneumococcus). His arm was bruised and swollen and painful, and he felt chilled and tired, but could walk and was coherent. A few hours later he became incoherent, unable to walk by himself, and unable to get to the bathroom. The program was notified and an ambulance summoned, and he was taken to the ER of a local hospital. He was eventually given a room, diagnosed with pneumonia (what the vaccination was for, it was too late and the reaction helped to mask earlier symptoms) and started on antibiotics.

My mother did not try to spend the night that night, but went down the next morning. She found him very much improved, quite lucid, and clearly responding to the antibiotics. She was in and out throughout the day and he continued to improve, was eating heartily, and looking like he would be ready for release the next day.

She was away for a few hours that evening and returned to the hopital at 9:30 pm to find him semi-delerious and unable to communicate verbally. It took my mother a while to piece together what had happened, and the wildly inappropriate "treatments" that had brought him to this state.

The apparently tested his blood sugar for no good reason. He is not diabetic and has no history of diabetes or any other blood sugar issues, and no blood sugar related symptoms. They found his blood sugar to be a few points above the official limit for normal, and so gave him an injection of fast acting insulin?!

After this he was having difficulty walking to the bathroom and getting confused about the urinal, so they placed a Foley catheter. Not a condom catheter which is non-invasive, or just using Depends. No, they had to place the Foley.

The Foley was uncomfortable and upsetting to him, so they decided to sedate him with a shot of Morphine?!

Morphine of course is a very powerful narcotic painkiller, but it is not a sedative. The effect of the Morphine on him was to make him completely disoriented and extremely agitated. Oh, and the one thing they hadn't given him was the Aricept and Nemenda that he has been on for years for the Alzheimer's. The runaround that my mother got in trying to get him those medications is a different story.

Finally, at around 11:00 that night, in order to counteract the extreme agitation from the Morphine and the catheter, he was given a drug called Zyprexa. At the time it was given, they told my mother that it was a substitute for the Aricept?!

My mother then came back home for a couple of hours and we did some rapid internet research. What we learned about Zyprexa is that it is a powerful antispychotic, and that Eli Lily has gotten into a shit load of trouble for encouraging doctors to prescribe it off label to treat agitation in elderly people with dementia, for which it is not effective.

We also learned that it is given every 24 hours because it has a half-life of 21 to 54 hours, and that the half-life is considerably longer in the elderly and that extreme caution in dosing is reccomended. It is not in any way, shape, or form a substitute for Aricept.

Oh, and they didn't know about his vaccination earlier the day before, so they gave him another one (for the illness he already had). This is the level of communication that exists between this program and the hospital with which it is affiliated.

At this point it was decided that he could not safely be left on his own at this hospital, and my mother went down to spend the night there with him and make sure they didn't do anymore damage, something whicht they apparently strongly discourage.

She has been there with him all day today. She has power of attorney and has told them not to give him anything besides his regular medicatication and his antibiotic without first informing her and getting her consent.

He has been knocked completely on his ass by this last drug. He is sleeping most of the time with only brief periods of semi-awakeness. He has been largely unable to either eat or drink. A person recovering from pneumonia needs fluids, and they apparently had not seen fit to place an IV. He has gradually been becoming a bit more coherent throughout the day, but a very slow process.

My mother has just been informed that they are no longer allowing overnight visitors, and she must leave him alone there tonight.

This is how things stand at this point. What the fuck is it with the healthcare system in this country? This man was given four different inappropriate medications in the space of a few hours, as well as being placed with an inappropriate urinary catheter. How many other people does this happen to? How many frail elderly people who have no one to advocate for them go into the hospital for something relatively simple and routine and never get out, or are sent to nursing home because they develop accutely worsened dementia symptoms? How many younger people does this happen to? How many people are there who think that hospitals are safe places to entrust their loved ones and end up with an unexplained tragedy on their hands? Is this another type of death panel that is operating in this country?

People who have more familiarity with hospitals than me, is this sort of scenario common? Is there any accountability for this sort of thing?

Is it any surprise that some of us are accutely mistrustful of the medical establishment in this country?

[NRaleighLiberal]

1. A lovely mix of greed and incompetence. And some smug oversatisfaction.

[Warpy]

3. More like extreme short staffing

and a hospital pharmacy that is subpar.

[annabanana]

2. What a horrifying story.

There should be lawsuits all around on this one.

(I hope you can garner enough recs in this forum to get your story on the greatest page.)

[Crunchy Frog]

5. Thank you. I wouldn't mind seeing a lawsuit on this

even though he wouldn't actually get any money from it. He's on Medicaid, and any money that he got would go to the state. I doubt that a lawsuit would be won. He's likely to make a "complete" recovery, so there would be no finding of permanent damage.

How does one even go about holding these people accountable? It seems like they can get away with pretty much anything. They usually have much better lawyers working for them then most ordinary mortals can get.

[hedgehog]

14. "He's on Medicaid" That one phrase probably explains everything else that

happened. I'd love to see the bill for all this.

If nothing else your story confirms Obama's contention that we need to go to electronic record keeping. I'm not entirely sure that'll help, though. My mother was sent to a neurologist and was seen by a nurse practitioner* who ordered test "A". She returned two weeks later, was seen by the neurologist who looked her over and ordered test "A". She pointed to her chart, he read it and more or less said, "Oh, yeah, well since you've already had test "A", I'm sending you for test "B".




*No knock on nurse practitioners, my husband and I see them all the time for routine check-ups. This was an intake appointment, though.

[PDJane]

4. No, it's not, to answer your question.

But I will tell you that it happens in for profit medical establishments everywhere, including here. It's not the medical establishment, it's the for profit part of the medical establishment that causes difficulties.

Here is a story; a true tale of misery. I'm all too familiar with this story, because I saved the woman's life. I was the one, have been the one, to call ambulances and demand health care and generally kick ass...and was accused of being abusive for my pains, because she was bruised (WTF???).

My mother's friend has a plethora of health problems; she's diabetic, claims to control her sugar with diet, has high blood pressure, low potassium, low thyroid, and has lost 1/2 of her body weight in just under a year. She fell in her apartment; a stroke, and she hit a very heavy, old-fashioned ornate oak table on the way down. This caused bleeding on the brain. She was sent to a rehab hospital to recover. These rehab hospitals are for profit, in a generally non-profit system. She fell there, and broke her hip. The hip remained unset and untreated, even after two x-rays should have shown, must have shown, that the hip was broken in two places. They had her trying to walk up and downstairs, cook and clean and remember stuff as part of her treatment. The hip is now beyond repair. She is barely eating. Part of this is damage from the stroke, part of it is the fact that standing or walking is painful. She needs a walker, and that is coming from a community programme. All of this could have been avoided if she had been sent back to the hospital. However, that would have shown culpability, so that wasn't done....because of the possibility of a lawsuit.

This is what happens when profit is put ahead of people's lives, and it's why I believe that the entire medical system should be run by the government, and provided on a not for profit basis.

This kind of thing will keep happening, the costs will continue to go up, and the patient will suffer for it otherwise.

[Crunchy Frog]

8. What a horrifying story. This hospital claims to be non-profit.

The elderly are very disposable in our society. At least once they've had all their money sucked off.

[GreenPartyVoter]

6. OMG! That's unreal, but not unheard of. A doctor tried to blame my brother and

me for recommending my dad not get his heart stents replaced in a timely manner, leading him to being unable to have that or bypass surgery done. Now, he did in fact take a short time to confer with his other doctors about a different surgery he needed to have, but it was not for the length of time that he wound up waiting for. That was due to the cardiologist giving him the run-around and putting him off. By the time they saw him it was too late to do anything about the stents. My dad gave them hell for falsely recording that my brother and I made the decision that he should wait as long as he did. To me it sounded like the doc was trying to cover his butt in case something happened to my dad due to his office not seeing him soon enough.

He also had some poor experiences the year before in the hospital. Basically he felt it was poor communication between the different departments with each other and also the patients. And the lack of having enough staff to care for everyone correctly was definitely a problem. They cared and they were competent, but they were stretched too thin to be as effective as possible.

Based on what you said in your OP I think your mom should be very cautious when dealing with these people. (Sounds like she has been, though, since she had the good sense to look up info on her own.) Document, document, document. Don't let anything stand in the record that is not true. (Like the lie about my brother and me preventing dad from getting his surgery.)

[Warpy]

7. I'm sorry this happened, but there are some things you need to do.

I've seen a few clusterfucks like this one. Usually it's good intentions gone horribly awry combined with short staffing.

I think they must've told Mom to go home because she was exhausted and they didn't want her to join him.

She needs to get morphine listed as a drug allergy tomorrow. It causes extreme delirium in some people, more commonly in the elderly. The nurses can do that for her. She also needs to talk to his doc (rounding is usually early in the AM) and try to get him his Aricept. If it's non formulary, the doc can write an order to use his own supply. Some on call doc just thought he could make a substitute with something in the hospital pharmacy. It didn't work. Spectacularly.

Once he's lucid, that catheter needs to come out.

It sounds like his mental status is clearing and once the pneumonia has responded, he'll go home on oral antibiotics.

It's really lousy timing for that pneumovax shot. I got mine on the heels of a pneumonia and reacted badly to it. However, the soreness will go away in a week or so and he will be protected against a lot of what causes pneumonia after colds or flu. Whoever gave it to him did him a favor, although you won't see the benefit for a while.

[Crunchy Frog]

13. Mom's 13 years younger than him

and healthier and more energetic than I am (by a long shot). She is also a PhD physicist. She is not some little old lady, and she is nowhere close to exausted. He had a similar hospitalization last Thanksgiving in a different hospital, and they encouraged her to stay with him the entire time. Without getting too much into our personal business, she also stayed with me for the entirety of my own hospitalization last winter for the c-section delivery of my twin boys. Her current life activities right now are far more exausting then sitting around in a hospital room with a sick old man.

He is getting his Aricept now. If the hospital didn't take care of it she was going to administer it herself.

My mom is documenting the Hell out of this incident and talking various people including lawyers. BTW, her best friend is an extremely experienced nurse who is livid about this, and is advising her as best she can.

I'm sure the pneumovax is a good thing, but I doubt that he's gotten any benefit from a second one.

Their policy on overnight visitors is apparently about controlling the H1N1 outbreak, or at least that's what they said.

I will pass on what you said about listing the morphine as an allergy.

[Warpy]

16. Good, I'm very glad to hear she's got a nurse advising her

Most of us are very tough patient advocates.

Unfortunately, unless he's got a permanent injury from this, there is no malpractice case. She really does need to let the staff of the other hospital know about the morphine allergy should he need to go there in the future. There are plenty of other pain drugs out there that work beautifully in the elderly, especially in elderly dementia patients.

I've had a pneumovax booster. The CDC guidelines waver a bit, some years saying one shot is enough, the next year saying a booster is needed 5-10 years down the line and that is enough for life. The booster was a hellavulot easier than the original shot since I hadn't had a pneumonia close to it!

His arm will be sore for a week or two when he gets home, and that will likely be the most lasting evidence of this collection of medical mishaps.

At least, I hope it's the case.

FWIW, that ban on overnight stays because of H1N1 is bullshit. The next time he gets sick, take him back to that first hospital.

[Crunchy Frog]

17. I probably need to clarify about the pneumovax that he recieved in the hospital.

He had already gotten one the day before through this program. The one in the hospital was not a booster unless a booster is normally given the day after the original. It was a lack of communication between the doctor with this program and the doctor at this hospital. They know perfectly well that they fucked up on that. In any event the main issue was not the shot but an entire string of disastrously wrong medication decisions (as well as the decision to use an unwarranted urinary catheter).

Unfortunately, he is now locked in to this hospital as a result of being in this program, and he can't get out of this program because he needs the services that it provides.

I'm well aware that there will be no grounds for a lawsuit. Even if there was some permanent damage, it would be impossible to prove in court. It's pretty sad that short of them causing death or glaring and blatant injury, there is no meaningful way to hold them accountable.

Just out of curiosity, in your experience is morphine frequently used as a sedative in patients who are not in pain? Len was not in any pain, just some discomfort from the catheter that I wouldn't think would warrant anything stronger than Tylenol.

Well, my mom is on her way down there again, to meet with the doctor and possibly knock some heads together about getting an IV placed. Len has a tendency towards dehydration anyway, and the drugs he was given rendered him practically unable to take any fluids by mouth.

[Warpy]

18. If he's not clear enough to be drinking much, he might need that catheter

because that's the best way to keep an accurate tally on his output and make sure his kidneys aren't running into trouble. Most hospital floors don't have accurate enough scales to weigh adult diapers, and those diapers contribute to skin breakdown and other things.

Pneumonia itself hurts and he might have complained of pain at the time, you just don't know. It's one of those "he said, she said" things. It's clear the morphine was a really bad idea, as was trying to calm him down chemically when he went wild.

For pain that's too much for Tylenol, I've found that frail elderly people respond quite well to Darvocet, a synthetic opiate like drug combined with Tylenol that does nothing for healthy younger people. I used it when they didn't react well to stronger pain killers after surgery. Many did well on the usual morphine and Percocet. When they didn't, Darvocet was my go-to drug.

Being sick is not for sissies, and I can't imagine the terror of being sick when you really can't remember what's happening to you and why. I hope he continues to clear and is able to go home as he was before this happened.

[Crunchy Frog]

23. He was definitely not in any pain at the time my mother left him.

However, your post has prompted me to tell my mother that she must get copies of all the nurses notes. He does like to joke, and it is possible that he said something that he intended as a joke that a nurse might have misinterpreted. It is a "he said she said" thing that can only be clarified by looking at the actual notes.

[barbtries]

9. good gawd what a nightmare

i can't answer your questions, but there was a movie made, in the 1970's i think. i'm gonna look it up for you.

found it "The Hospital" here's the summary from IMDB:

Herbert Block is chief of medicine in a major teaching hospital. His wife has left him, he is impotent and his children have both disowned him. He is toying with the idea of suicide when patients begin dying, not from complications, but from the erroneous treatments the Hospital is giving them. People in the wrong beds are given wrong medicines, sent to operating theaters for incorrect surgery, and found in waiting rooms dead of natural causes. Barbara Drummond has come to take her comatose father back to the Sioux reservation where he operates a clinic and they each reach out to each other for emotional support, as a shadowy figure stalks the patients and staff of the hospital.

http://www.imdb.com/title/tt0067217 /

and another from over 30 years ago:

"Such Good Friends"
Julie Messinger has it made. She is a New York housewife whose husband, Richard, is an editor for a prominent photography magazine. They have a small circle of friends, including well-meaning, but inept Dr. Timothy Spector, photographer Cal Whiting and Cal's live-in girlfriend Miranda. Julie's mother spends her days getting pedicures and manicures, applying make-up and fake eye-lashes and buying expensive clothes, all the while criticizing her daughter for her looks and behavior. When Richard goes into the hospital for a minor mole-removal surgery, Julie gets more than she bargained for. Richard suffers from complications and goes into a coma, supposedly caused by a rare surgical factor, and she gathers friends and family together, culminating in a hilarious "quasi-cocktail-party" scene in the blood donation center of the hospital. While dealing with red tape, hospital bureaucracy and clueless doctors, Julie discovers her husband's "little black book," which contains the names of her friends. She confirms that her husband had been sleeping around and proceeds to make a fool out of him by getting it on with his male friends. When the complications get more ominous, guilt opens the door to her liberation as a woman. A scathingly funny examination of the dirty rich partying while one of their number lies on the brink of death.

http://www.imdb.com/title/tt0067801 /

your friend's story brought both of these (good) movies to mind. apparently this kind of shit is not so new.

i hope he'll be bouncing back and out of that hellhole soon, and i hope you and your mother can make some noise so hopefully the next patient will be treated with more customary care.

[undergroundpanther]

10. I have had crazy crap happen to me

in hospitals,stuff that was damn dangerous,stuff I WARNED them not to do to me ,but they did it anyway.I hate going to a hospital,because once they find out you have issues, they ignore pain(assuming addictions which I have NO history of) They'll keep restraints()used for ambulance transport on far longer than necessary,I was injured and warned the ambulance guys,the nurses that I cannot stand the emotions restraints cause me,In a neck brace I wound up trying to get out of the restraints.I got half out before they bothered to take them off.

[turntxblue]

11. So sorry for what you're going through.

Your experience sounds just awful, and I extend my sympathies. I don't know what it's like for everyone, but I've been concerned for quite some time about leaving anyone by themselves that are either too sick or too confused to speak up for themselves. It seems like there are too many mistakes, and when in a severe health crisis, there's just not room for mistakes. I, too, would hesitate to leave him alone, unless he was in a situation where he was being monitored continuously...like the ICU wards do things. In most of the situations I've encountered recently with my own family, the hospital was willing to have me stay as long as I was quiet and my presence didn't bother my family member or other patients. In fact, they usually offered me blankets, pillows, or coffee. My experience has been that the staff knows it's their job to take care of the patient, but has welcomed knowing that someone was there to call for help if the patient was unable to do that for themselves...and I thought that was sensible. It's frustrating to feel like you have to be there, but sometimes people are sick or helpless enough that they almost need one-on-one attention. That's just my opinion, and I certainly don't presume to speak for others. Good luck to you and your family.

[Yunomi]

12. Oh, that is TOO familiar!

Either of my parents is constantly in the hospital, and always over (or wrongly) medicated. They both respond oddly to 'normal' hospital medications, and the response is to give them more of something else. It's a battle when one of them is hospitalized, both with the doctor, and with them. One will be incoherent, and the other will be totally freaked out. Yeah, I highly recommend power of attorney, and watching medications closely.

[Crunchy Frog]

15. Update.

Well, my mother is home for the night. She finally met with the doctor who is responsible for Len during his hospitalization. He is a hospitalist and was responsible for all of the medication decisions.

He is apparently very young and inexperienced; she doesn't think more than late 20's or 30 at the most. Not very knowledgeable about the elderly. Sort of well meaning, but wet behind the ears. She is scheduled to meet with him at 10:00 tomorrow to discuss Len's case.

She wrote up something for him to sign, basically listing which medications they are allowed to give him, which medications they are absolutely NOT allowed to give him, and instructing that any other medications must be OK'd by her before giving them to him.

She is in the process of writing up an account of what happened and figuring out who all to send it to. I've suggested she may wish to send it to some local elected officials as well as medical people and hospital administrators. I have also suggested to her that she write a letter to the editor of the local newspaper. I am a strong believer in the power of public embarrassment for medical institutions that fuck up in this fashion.

The charge nurse was apparently adamant that there were to be no visitors before noon tomorrow, however, the meeting with the doctor is at ten. The doctor confirmed this with the charge nurse, as he was apparently more afraid to cross my mother than he was to cross her. He is apparently under the impression that the professional way to address someone like my mom under these circumstances is "dear". My mom is currently working out how to best disavow him of that particular notion.

I will update again tomorrow. Thanks for all the support and the recs.

[Celebration]

19. yeah once my FIL was in the hospital a couple of days

And ended up with a bedsore on his heel the size of a silver dollar. He would have lost his foot if I hadn't used my low level laser therapy device on it.

In this case, I would tell them to stick their no visitor rule up their collective asses.

And you know what? All the health care reform debates in the world won't correct issues like this. I do NOT trust our health care system.

Good luck.

[Celebration]

20. Oh, and you have to be real cautious around here

Oh, and they didn't know about his vaccination earlier the day before, so they gave him another one (for the illness he already had). This is the level of communication that exists between this program and the hospital with which it is affiliated.

You must be one of those wacko antivac people.



Seriously, which is the worse harm--it is a tossup to me between the short acting insulin and the second vaccine for the disease that he has.

There's the story that I have where my sister spent the night in the hospital with my mom, and got no response from the nurse's station. When she went down there to check, it turns out the "accidentally" turned off all the lights for all the call buttons.

Uh, no wonder they don't want relatives spending the night.

[jdlaughead]

21. The Medical Industrial Complex

What is blocking medical health and care in the United States, and the World is The MEDICAL INDUSTRIAL COMPLEX! They are not interested in Curing anything, for once they cure the Disease, the money stops! The only thing they want to do is Doctor! Just think about it. If they Cure Diseases, the Research money ends, The Doctoring money ends, The Drug money ends, the Insurance money ends, the Hospital money ends, the profits on the stocks end, The money to the Lobbyist ends, The money to the media ends, just watch the 6:30 TV news, nothing but commercials on Drugs, that destroy your liver! The Center for Disease Control ends, and their 54 branch offices, The World Health Organization ends. but you have good health, and you don't END!

Now my Independent Research is in Respiratory Diseases, mainly the Flu and Cold, Is there a cure, I would say it has been around for about the last 50 years, Who developed it, why Merck did, It is called Cyanocobalamin, you might know it as Vitamin B-12. B-12 not only cures the Flu & Cold, It Destroys the Virus! Well how does it do that? B-12 is mainly composed of COBALT,Heavy metal,Element 27 A Virus, most all of them are mainly composed of Acids, a double outer shell of PROTEIN, and a nucleic Acid Center, Protein is composed of Amino acids. But what is acids, acids are basically Hydrogen molecules. Well why does Hydrogen attacks every thing and destroys it. Because Hydrogen is lonely, it only has one negative electron circling around it, and it wants to pair up, like all the other elements are, with positive electrons. The best way to explain this is to look at your car battery. What creates the Electricity is the sulfuric acids attacking the Lead and or COBALT Plates. Cobalt, lead have basically a positive charge, and acids a negative charge, and opposites attract.

This same process does this when you take NASAL B-12 and snort it down your nostrils, it coats the virus, virus attacks the Cobalt in the B-12 they synthesize at the same time creating Bioelectricity, which destroys the rest of the Viruses and converts them to water, H2O For full information, just go to www.popsci.com/node/22953 on how to make your own. There is no reason that America cannot be disease free by 2012-2014, if Medical research is directed in the right direction, Protein Management. If viruses don't have protein before 5 or 6 days, they die, If Bacteria doesn't have protein before 3 to 5 days it dies, the heart in Bacteria is protein.

That is where FASTING & SEMI-FASTING comes into play. I have seen many people go into Fasting retreats in Florida, that were really "Basket Cases" and after 2 or 3 weeks, came out a new person. I always wondered why, till I figured out, the bacteria and viruses, that caused their problem, starved to death. Gee I wonder why the Medical Industrial Complex couldn't figure it out?

I love Semi-Fasting, that is where you eat anything you want and as much as you want, you just chew the food till all the juice and flavor is out of the food, then just drop the bulk out of your mouth and into your Happy cup, Mine is a 32 ounce plastic cup, when it is full, I give it to the Dog, or throw it out to the birds. You won't believe how heavy that cup of BULK is, and that could be in your stomach. What happens as you do this your tongue taste buds, will get way more sensitive, and you will have never tasted food like you do now. I just had a 10 ounce bag of potato chips. Where I learned this from, was from my ant village, ants are a 100 million years civilization, and the never eat any whole food, they chew the food, and suck the juice out of it and drop the bulk out of there mouth, never saw a fat Ant.

[Crunchy Frog]

22. An update, dirt on the doc, and a really bizzare sounding hospital protocol.

Well, Len continues to gradually improve, though it is very slow going and he is nowhere near to where he was before being given all of these inappropriate medications. Apparently, for a patient of his age, we can expect the Zyprexa to take several days to completely clear from his system. It looks like he will probably be coming home tomorrow.

I was kind of curious about the doctor in charge of Len during this hospitalization, so I did a little bit of internet research and discovered some interesting info. At the doctor rating sites that I checked, his ratings were uniformly poor. I had jokingly wondered if he had gotten his medical degree out of a Cracker Jack box, and it turns out that I was not far off the mark. It turns out that he graduated from one of those Carribean medical schools that people go to because their grades and test scores are too low for them to get into a US medical school.

This doctor is a "hospitalist". Many hospitals are now moving towards the use of hospitalist. An interesting thing that I learned about hospitalists is that they are in such short supply that a hospital will pretty much hire anyone who applies, and it is virtually impossible to get fired. It looks like Len was assigned to a really bad and incompetent doctor. It looks like this may not be a terribly uncommon phenomenon.

We are working very hard to try to piece together the sequence of events that led to this clusterfuck. Among other things, we have been trying to figure out why he would have been given insulin. My mother spoke to one of the nurses about it at length, and apparently there is a protocol in place to give Insulin Glulisine to any elderly patient who is acting confused on admittance if their blood sugar before a meal registers above 70. They do this after the meal, and apparently without even testing the after meal blood sugar first. This is because they believe that the confusion may be the result of high blood sugar. This protocol is at the discretion of the doctor.

This protocol seems too bizzare to me to even be possible and I suspect my mother may have misheard or misinterpreted something. Is there anyone here in the medical field who has ever heard of any policy similar to this? I have searched online for information about giving insulin to non-diabetic hospital patients, and I have only seen information on its use in critically ill ICU patients in whom they are trying to maintain "tight glycemic control"

Everything that I have read about Insulin Glulisine says that it has a very high risk of causing dangerously low blood sugar, and I know that the symptoms of low blood sugar include confusion and weakness.

I would appreciate any opinions on this from knowledgeable medical people. We will continue to try to clarify this.

[Celebration]

24. I'm not a medical professional

but I know this......

"My mother spoke to one of the nurses about it at length, and apparently there is a protocol in place to give Insulin Glulisine to any elderly patient who is acting confused on admittance if their blood sugar before a meal registers above 70."

That couldn't be right, unless the hospital is in......The Twilight Zone.

[Celebration]

25. Questions:

What was his blood sugar number and when did they test for it?

When was the insulin ordered and who ordered it?

When was the insulin given?

How many units of insulin were given (and what type)?

When did he eat, and how much did he eat? What was the carb content?

When was the next time the blood sugar was tested?


I mean, your probably don't know all of this at this point, but these are some of the facts that you need to gather to try to get to the bottom of this.

I am editing this again just because I want to reiterate how bizarre this all sounds. Of course any institution who can give a patient two successive pneumonia vaccines, while he has pneumonia is capable of almost anything.

[Crunchy Frog]

26. I have told my mother in very strong terms

that she absolutely must obtain copies of the nursing notes, and get them before there is a chance to rewrite them.

Only the nursing notes can give an accurate sequential account of actual minute by minute events.

The "doctor" in charge of the case prescribed the insulin.

[Celebration]

27. yes, they will rewrite those

I have seen so called "respectable" hospitals destroy evidence.

[Why Syzygy]

28. What is a Hospitalist?

What is a Hospitalist?
Who is the doctor? Why isn't my physician coming to see me in the hospital?

http://healthfieldmedicare.suite101.com/article.cfm/wha...

Len is being treated to a trending method of health services delivery. He is considered a 'case manager'. He should be in contact with Len's PCP.

I keep thinking about the insulin. Couldn't that have induced a coma? And then the Zyprexa! Doesn't someone have to give consent for each and every medication given?

This poor man. I hope he is well enough to go home and fully recover.

[Celebration]

29. you do NOT lightly mess around with insulin in someone without diabetes

I do think there may be very particular sets of circumstances where insulin is used in people without diabetes--after heart surgery, as an example, if the blood sugar is over a certain amount. But, if it is used the blood sugars HAVE to be monitored carefully.

The "70" number is laughable too. Out of everyone reading this thread, I doubt if a single person has a blood sugar of 70 or below. That is the very lower end of normal.

Yeah, there have been a few high profile spousal murder/assault cases where people get convicted of giving their spouses insulin. People can go into a permanent coma/die, etc.

[Crunchy Frog]

30. I just spoke briefly with my mom.

She had a very long talk with the doctor on this case, and he apparently was not aware that his patient was being given insulin and was not aware that this protocol exists at this hospital.

This just keeps getting wierder and wierder.

[Celebration]

31. unless you are wrong about these facts

this is a ROGUE hospital.

Could at least the cutoff number of 70 be wrong?

People who have diabetes are generally told not to drive unless their blood sugar is over 90, for example--there is too much of a risk of it getting low from insulin.

Even so, a patient being given insulin without the doctor's knowledge is so out of whack that I can't even begin to make any sense out of it.

[uppityperson]

33. Unless they are mentally ill, they used to give high doses insulin in the past to

throw them into a hypoglycemic event, rather like zapping them.

This sounds very wrong.

[uppityperson]

32. As a RN, wtf "the confusion may be the result of high blood sugar"? Wrong

that is backwards. People get confused with low blood sugar. High blood sugar affects things like eyes and kidneys and neuro stuff and healing. LOW blood sugar gets you confused. Sometimes people are considered drunk, stoned, drugged when they actually have low blood glucose levels. Had 1 local guy drive off the road, deputy tazed him because he thought he was drugged out, actually was hypoglycemic.

I am sure some may act weird with high levels, but good grief and good lord that is WRONG.

LOW causes confusion. High causes other issues.

Been an RN for over 30 yrs. Talk with your doctor as that is wrong.

[Crunchy Frog]

34. As someone with a bit of exposure to the nursing field,

I had the same thought. I have taken some pre-nursing courses and nurse's aide training courses and had that info drummed into me.

[Warpy]

40. You have the right to fire that doctor

and I suggest you do so if you haven't already. Someone else in the practice will assume Len's care. You don't need a screwball who writes insulin orders for an elderly person with a BG of 75.

That doc is eventually going to kill someone.

Docs prepared in the Caribbean are not all bad and most have adequate grades for US medical schools. The problem is that there are too few slots in US medical schools to take all comers.

This guy, however, sounds like a crackpot.

[Celebration]

42. turns out he didn't write the prescription

and didn't realize that Len had been given insulin.



There is so much more wrong with all this than the doctor, although that is a decent start.

[Crunchy Frog]

35. Update.

Well, my mother had a long and uncomfortable (for him) discussion with the doctor on Len's case. He was surprised to hear that Len had been administered insulin. He didn't order it, didn't know about it, and doesn't know about the protocol under which it was administered.

He was the doctor in charge of Len's case, but he never even saw Len prior to the point at which he became delirious. That is a period of approximately 8 hours. He was unfamiliar with Len's medical history and chart. He had no idea that Len had ever been lucid, let alone that he had been lucid just two hours earlier.

He didn't know much of anything about the drug Zyprexa. He did not know that it stays in the system for a long time, and for a longer time in elderly persons. He did not know that it is contraindicated in elderly patients with dementia.

He did not have any reason for neglecting to put Len on his regular Alzheimer's medications. He said that he didn't know the correct dosage, but he couldn't say why he never bothered to ask anyone who did know (like my mother who was present most of the time and was trying and trying to get the information across to them).

For him, Len was just some crazy dementia patient who needed to be drugged.

From the timeline of events, it's looking like Len most likely did have a bad reaction to the insulin, and that was what precipitated everything else. My mother left him at ~5:45. He was lucid and in good spirits, conversational and joking, and had just finished a substantial meal. The insulin was given to him at 6:15 (outside of the timeframe in which this insulin is supposed to be administered). By 8:00 he was completely delirious.

Nobody in this family will ever sign a blanket hospital consent form again. The next time Len needs to be hospitalized, every treatment decision and medication will have to be individually and separately consented to by my mother.

Len seems to be back in the land of the living, and will probably be discharged tomorrow.

[Celebration]

36. So glad your family's nightmare is over

Can you just imagine what this has been like for other elderly patients in the hospital, who do not have advocates?

When people talk about saving health care costs, the FIRST place I would start would be the overdrugging of the elderly.

[Crunchy Frog]

38. I want to blow the fucking lid off of this fucking hospital

and drag their name through the mud.

Len had a roomate who was dilerious for several days. He came out of it briefly, then lapsed back into it after his wife left him. He's now been moved to a more critical area of the hospital I wonder what they've been doing to him.

Len would have left on Saturday if they hadn't of fucked him up. He's not coming home until tomorrow (they're keeping him in an extra day). That's three extra hospital days. That's a fuck load of money, especially when you multiply it by the number of times something like this must be happening in a hospital like this.

[Celebration]

41. yeah, do you think your mom will go for it?

This is EXACTLY why "tort reform" is not a good idea. Sometimes hospital behaviour is so egregious that punitive damages are the only thing standing between the hospital patient and outright murder.

Your mom should consult a lawyer, if only to get assurances of changes in hospital policy. The insulin guideline needs to be deep sixed, for one thing. But that would only be a start.

No doubt this incident took its toll on the patient, even if it will be hard to document the degree of harm.

[Crunchy Frog]

44. Correction. He would have come home on Friday afternoon.

Instead he will be coming home today (Tuesday). That's four extra hospital days for what should have been a two day hospitalization. And we wonder why our healthcare costs are so high.

[Why Syzygy]

45. She may want to re-evaluate

his vaccine schedule; and set up new lines of communication with his new program. She should be informed of any planned inoculations or changes in medications.

Seasonal flu/pneumonia do have rather high mortality rates. After hearing this story, one wonders... is the treatment partially responsible? Our medical system is a cluster-f***.

We need Wall Street out of our examination and hospital rooms.

Day before yesterday, he returned home from the program and it was evident that he had had an innoculation of some sort (turned out to be pneumococcus). His arm was bruised and swollen and painful, and he felt chilled and tired, but could walk and was coherent. A few hours later he became incoherent, unable to walk by himself, and unable to get to the bathroom. The program was notified and an ambulance summoned, and he was taken to the ER of a local hospital. He was eventually given a room, diagnosed with pneumonia (what the vaccination was for, it was too late and the reaction helped to mask earlier symptoms) and started on antibiotics

[newfie11]

37. Never ever leave a loved one to fend for themselves in a hospital

There are great doctors and horrible ones, great nurses and horrible ones, great hospitals and horrible ones. There are many problems that can be averted if a family member is there with the patient. Always ask questions on what drug is being given and why.What procedure is being done and why. If your mom has the legal right she can and should refuse anything being done until talking to the doctor. Emergency aside of course.
I assume his routine doctor was not the doctor he has in the hospital. Now many hospitals are hiring on staff physicians that care for patients. Another step away from the family physician.

Hospitals are busy places and many are now understaffed.

in 1968 when I took my first job out of x-ray school the hospital had 2 techs for every x-ray room. Fast forward to 1988 in a level 1 hospital where we had 5 techs to cover 8 rooms. It is worse today, the phrase work smarted not harder is bullshit. When I retired 3 years ago I was doing 30-45 mammograms a day where as in the not to distant past 20 was a very busy day.


If I was your mom I would have him transferred to another hospital where she can stay with him 24-7.

[Crunchy Frog]

39. There are practical reasons that are going to make it impossible

for my mother to be with him 24/7, as there probably are with most people.

I guess we all just have to accept the fact that going to the hospital is like playing Russian roulette.

[newfie11]

43. Well all I can say is make the time.

When my husband was in the hospital I stayed in his room, slept in his room. Yes I stopped him from being given insulin until his doctor was notified. It was not given. If the patient is lucid enough to ask what is going on thats fine but if not they are a sitting duck for a hospital accident of one kind or another. Maybe she can have someone else stay with him while she does what she needs to do.

[Celebration]

48. I agree it is a good idea to do that

But nobody should have to be in a hospital room to prevent insulin being given to a person whose blood sugar is essentially normal.

[Crunchy Frog]

46. Update, he's home.

He's horribly gaunt and weak. Most of his speech is a sort of rambling "word salad". He's in diapers. He can only walk with someone holding on to him, but he frequently tries to get up. If he were to actually make an attempt to walk on his own he would instantly fall. He requires continuous one on one care. His needs are at nursing home level.

He had 4 extra days in the hospital, 2 where he was almost completely out, and two coming out (but not all the way). I don't know that he will ever get back to where he was before they hit him with the insulin.

[Celebration]

47. soooo very sorry

Nobody deserves to be treated like this, and to have this happen.

I hope and pray that he gets back to where he was before this incident.

[Crunchy Frog]

49. He's much much better today.

He's talking pretty much coherently and he's able to walk on his own. He's really not able to walk unaccompanied, but he's doing it anyway because we can't just be sitting with him every second. He just had a fall, but he's okay. It's really difficult to explain to him why he can't walk on his own, and I'm hoping he doesn't have a more serious fall and end up there again.

Mom was telling more about the "insulin protocol". It looks like they hit him with 3 units of fast acting insulin 1/2 hour after finishing a mean. He's extremely thin; 132 lbs and well over 6 feet. The "protocol" only has three different size categories, obese, medium, and thin. They hit you with the insulin if your pre-meal bg is anything above the clinical cutoff for hypoglycemia.

Sorry for the rambling. I'm still boggling over this.

[Celebration]

50. and they think that is okay?

Their protocol is horrendous IMHO and they made it worse in Len's case by giving it to him after a meal.

Honestly, every day that you wait before you do something about this means more and more elderly are going to be injured.

I'm glad he is better, though.

[Crunchy Frog]

51. I guess I spoke too soon. He had a relapse last night

and is in the hospital again ( different one, Thank God). The lung that was affected before is clear, but the other one is cloudy on X-ray. I'm now wondering if the antibiotic he was given was not the best (it apparrently was the most expensive. He's getting something more broad spectrum now.

[Celebration]

52. oh dear

Sorry about that. I don't know as much about antibiotics as I do about blood sugar levels and insulin. However, I would have to agree that anything that first hospital did is suspect. Their insulin policy has no justification that I can tell, and is very, very harmful.

I take it that you suspect that they are trying to maximize profits by giving the types of treatments that rake in the most money, rather than what is best for the patient. I can't dispute that. I've always felt that the elderly are preyed upon. Ordinary patients who have their faculties are not going to allow a nurse to give them an insulin injection, sans diabetes. They give someone the wrong drug, or too much of one, and when there is a reaction, just drug them with something else. There is nothing new about that. What is new is adding insulin into that mix. I would really, really, like to know who came up with that policy, and their stated justification for it. Again, we do NOT need so called "tort reform" with crap like this happening. What we need is a policy of returning some of the money from lawsuits to the individuals that blow the whistle on practices like this. You guys have no financial incentive to sue, and you should have at least a small one. If more people sued for stuff like this, the hospitals would lose the incentive to injure patients for money.

[Crunchy Frog]

53. Given their track record on other medications,

I would not be surprised at all if they gave him an antibiotic that was not the best for his illness.

My mother discussed all the medications with her nurse friend and she was shocked both at the antibiotic and blood thinner (to prevent blood clots) because she said that they were the absolutely most expensive available, and that there were much cheaper meds that are just as effective.

It sounds like maybe they've got some little scam going that involves using the most expensive drugs possible.

There's nothing I wouldn't put past them at this point, and this would be among the less egregious things that they've done.

BTW, thank you for all the supportive posts. It helps being able to unload.