Complaint Review: Palmetto Health Richland Hospital

On April 3, 2015, 80 year old female patient, J.B., who suffered from well managed congestive heart failure and emphysema, was admitted to Palmetto Health - Richland Hospital, Critical Care Unit, Room 540E, due to respiratory distress. J.B. was accompanied by her son and caregiver, G.L., who has J.B.'s Healthcare Power of Attorney. (G.L. remained with J.B. throughout the duration of her admission, except for brief absences to eat meals, or to sleep.) Shortly after admission, J.B., who was sedated and unconscious, was intubated, (placed on a mechanical ventilator) was partially covered with only a thin sheet with her chest fully exposed inside a frigid room, despite the risk of pneumonia. Subsequently, the nursing staff repeatedly left Butler fully uncovered without either sheets or blankets. A grievance was lodged with the Nurse Manager, "Pam", who assured that corrective action would be forthcoming. To make matters worse, J.B. was required to provide her own cancer medication (exemestane) from home. The hospital pharmacy refused to provide it, though it was available. On April 4th, while G.L. was in the cafeteria eating breakfast, a minor angio  procedure purportedly was performed to administer medication directly into J.B.'s pelvic artery to strengthen her heartbeat. Additionally, J.B. was removed from the ventilator (extubated), after which J.B. was disoriented and repeated her thoughts and words, according to medical staff, perhaps due to the residual effects of sedation. J.B. was re-intubated, due to disorientation only, though she was breathing well without it, and experienced no respiratory distress at that time, according to medical staff. (Note that no pulmonary or cardiac consults with specialists were requested, based on J.B.'s medical history and admitting condition. Why?) Attending physician, Brian A. Smith, MD assured G.L. that J.B.'s condition would be reassessed the following day, April 5th. According to medical records, on April 5th, at approximately 8:00 a.m., J.B.'s body temperature was 101.8, which was untreated. Additionally, there was no known physician reassessment of J.B. after April 4th. Certainly, no physician consulted with G.L. after April 4th, despite physician's acknowledgement of G.L. as having J.B.'s Healthcare Power of Attorney. On April 6th at approximately 6:29 a.m., while G.L. was asleep in the visitor waiting area, J.B.'s heart suddenly stopped and she expired. How long was J.B. in cardiac arrest before medical staff responded? Why was her apparent fever untreated? Why was J.B. re-intubated, though she was not in respiratory distress? And, most importantly, why wasn't J.B.'s condition reassessed after a critical procedure and reintubation in the Critical Care Unit? Does Palmetto Health Richland Hospital routinely abandon care of and discharge Medicare patients to save money, despite their condition? And, based on these and other questions, and issues, is Palmetto Health Richland Hospital guilty of criminally negligent homicide of J.B.?