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”.
© 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 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 Patients Symptoms Associated with Pain Medication Withdrawal.
“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…” (Physician Documentation, 1/30/13, HPI, 15:35) “Back and Bilateral Extremity discomfort” ( Mather Hospital “Nursing Progress Note” dated 2/2/13 03:54, page 2)
Anxiety” (Mather Hospital Nursing Assessment, dated 1/30/13, page 5),
“Difficulty Falling Asleep”(Mather Hospital Nursing Assessment, 1/30/13
Withdrawal Symptoms of Other Medications that Mather Hospital had Documented to have been Discontinued at Home without Medical Supervision.
Are There Side Effects When You Stop Taking Metoprolol?
Last Updated: Mar 24, 2011 | By Kitsey Canaan, RN, CLNC
“Abrupt withdrawal from metoprolol may cause heart disease to get worse”.
Chest Pain “According to the FDA, patients who suddenly stopped metoprolol have experienced increases in chest pain.”
“Prednisone, If you abruptly stop taking the drug or taper off too quickly, you might experience prednisone withdrawal symptoms: Severe fatigue, Weakness, Body aches, Joint pain”. (Prednisone withdrawal: Why do I need to slowly taper down the dosage? Answers from April Chang-Miller, M.D.)
“Withdrawal of the levothyroxine would also lead to increased depression and anxiety among the patients.” (MD health.com)
“Stopping citalopram abruptly may result in one or more of the following withdrawal symptoms: irritability, nausea, feeling dizzy, vomiting, nightmares, headache, and/or paresthesias.”
(Celexa ® (citalopram) - NAMI: National Alliance on Mental ...
“You feel like you have theflu, or a stomach bug, or perhaps you find it hard to think and have disturbing thoughts.” You’re probably having antidepressant withdrawal.
“Antidepressant withdrawal, more correctly called antidepressant discontinuation syndrome, refers to a unique set of symptoms that can develop after you stop taking an antidepressant. It most often occurs in those who abruptly quit the medication”. (WebMD.com)
LOVENOX® helps reduce the risk of deep vein thrombosis
“Do not stop taking LOVENOX® without first talking to the doctor who prescribed it for you”.
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.
The findings shed light on “broken heart syndrome,” a still somewhat uncommon disorder first described in Japan 15 years ago that mimics a heart attack. 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.
Other Symptoms:
- Fatigue. Fatigue and tiredness are prevalent in Vicodin withdrawal. It doesn’t seem to matter how much you rest or sleep, you will still experience a low energy level.
- Headache. Vicodin is used for pain management, so when its use is stopped, a common reaction in the brain is severe headache.
- Emotional distress. As your body is searching for a new normal without the control of Vicodin, you may experience symptoms such as frustration, depression, rapid heartbeat and muscle jerking.
- Psychological reactions. Panic, anxiety, insomnia, paranoia, hyperactivity and a feeling of helplessness are possible with Vicodin withdrawal.
- Physical signs. Vomiting, diarrhea, abdominal cramps, excessive sweating, dilated pupils, runny nose, body chills and loss of appetite are common signs of Vicodin withdrawal.
Mather Hospital Documentation of Patients Symptoms Associated with All Medication’s Withdrawal and Rebound Effects .
“Chest Pain, Shortness of Breath” (Mather Hospital “Discharge Summary”, dated 1/30/13, page 1), “Pain Radiating down left arm” (Mather Hospital Nurse’s Notes, dated 1/30/13, page 1). She was admitted and later experienced “Depression” (Mather Hospital “Discharge Summary”, dated 1/30/13, page 1, “Back and Bilateral Extremity discomfort” ( Mather Hospital “Nursing Progress Note” dated 2/2/13 03:54, page 2)
Anxiety” (Mather Hospital Nursing Assessment, dated 1/30/13, page 5),
“Difficulty Falling Asleep”(Mather Hospital Nursing Assessment, 1/30/13), Loss of appetite, “Did not eat” (Mather Hospital Nursing Assessment, page 20, 1/30/13).] “Awake, Alert and Oriented X 3”, (Mather Hospital Discharge Summary, 2/1/13, under Neurological, Mather Hospital Physician Documentation, 1/30/13, page 2,`under NEURO, Alert GCS 15, (Mather Hospital Physician Notes, 1/30/13, page 2, under Neuro), “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). in 8 days, “Deceased” 3 days later ( Death Certificate 2/12/13).
Symptoms Presented And Withdrawal Symptoms, the Same.
“When the dots are so numerous it creates a solid line, connecting them is no longer required, just the vision to know it exists”,
Other Assessment Indicators
“Assessment Indicator, Denial of Medical Care”.
Denial of Medical Care- (Elder Abuse an Introduction for the Clinician, Slide Presentation, Center on Elder Abuse.org.)
Requesting no “vital signs” being taken, “defers blood work and diagnostic work-ups” (Physician Documentation, 2/9/13, page 1)
“HCP states she does not want anything done to patient no labs, work up or anything that will “disturb” her”( Nurses Notes, 2/9/13, 20:10, page 1 and 2 under assessment).
“resistant to obtaining pt’s vital signs, I explained need for assessing vital signs and rationale for same”(Nursing Progress Note, 2/10/13, 12:33, page 1).
“declined a full body assessment” (Nurses Notes, 2/9/13. page 2)
“Patient was not given aspirin… states patient no longer takes medications”. (Mather Hospital, Physician Documentation, 2/9/13, 21:08, page 2).
“Assessment Indicator, Sudden Physical and Behavioral Changes.”
Physical and Behavioral Changes- (National Center on Elder Abuse Website: Physical Abuse. American Society on Aging, Recognizing the Behavioral Signs of Elder Abuse.)
(Elder Abuse an Introduction for the Clinicians, Dr. Ronald A. Chez, Center on Elder Abuse . org)
“Chest Pain, Shortness of Breath” (“Discharge Summary”, dated 1/30/13, page 1), “Pain Radiating down left arm” ( Nurse’s Notes, dated 1/30/13, page 1). She was admitted and later experienced “Depression” (“Discharge Summary”, dated 1/30/13, page 1, “Back and Bilateral Extremity discomfort” ( “Nursing Progress Note” dated 2/2/13 03:54, page 2),Anxiety” (Nursing Assessment, dated 1/30/13, page 5),
“Difficulty Falling Asleep”(Nursing Assessment, 1/30/13), Loss of appetite, “Did not eat” (Nursing Assessment, page 20, 1/30/13).]
“Awake, Alert and Oriented X 3”, (Discharge Summary, 2/1/13, under Neurological Physician Documentation, 1/30/13, page 2,`under NEURO, Alert GCS 15, (Physician Notes, 1/30/13, page 2, under Neuro), “Unresponsive”, ( Nursing Assessment, 2/9/13, page , under Coping,/Observed Emotional State. 2/10/13 09:00), “Non Verbal”, (Nursing Assessment, page 3 & 4, under Coping/ Verbalized Emotional State), “Semi Comatose” (Nursing Assessment, page 7, Cognitive/Perceptual/Neuro under level of consciousness, 2/12/13) “Disoriented x 4” (Nursing Assessment, page 7, Cognitive/Perception/Neuro under Orientation). in 8 days, “Deceased” 3 days later ( Death Certificate 2/12/13).]
“Assessment Indicator, Under Utilization of Prescription Medications.”
“Under Utilization of Prescription Medications”- Elder Abuse, The Pharmacist’s Role, Center on Elder Abuse.org.
(Elder Abuse an Introduction for the Clinicians, Dr. Ronald A. Chez, Center on Elder Abuse . org)
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”, Keppra, Remeron and Valium. Mather Hospital “Admission Reconciliation”, 2/9/13, 5:15:46 AM hospital staff document Valium.
“Patient was not given aspirin because daughter states patient no longer takes medications”. (Physician Documentation, 2/9/13, 21:08, page 2).
“Assessment Indicator, Sudden Change in Living Arrangements”
(Elder Abuse an Introduction for the Clinicians, Dr. Ronald A. Chez, Center on Elder Abuse . org) Sudden Changes in Living Arrangements- (Adult Meducation, Dimension 1, Social and Economic Factors, Elder Abuse).
“Further, she advised your mother resided with her, which you do not dispute”, Mather Hospital Letter, Maryanne B. Gordon, Administrative Director, 7/17/13, page 1. (Same Address that she was exposed to Carbon Monoxide, undiagnosed, untreated at Mather Hospital.)
“Assessment Indicator”, Restricting Visitors and Calls.
(Elder Abuse an Introduction for the Clinicians, Dr. Ronald A. Chez, Center on Elder Abuse . org)
“The intentional prevention of the elder from receiving telephone “calls or visitors”, California Advocates for Nursing Home Reform, “What is Elder Abuse”, “The caretaker may refuse visitors or not allow the elder to be alone with visitors”, American Society on Aging, Recognizing the Behavioral Signs of Elder Abuse.
Confirming this issue, Hospital staff utilize the “Direct Questioning” Method and ask; “Does anyone try to keep you from having / contacting other friends or doing things outside the home?” My mother replied YES! (Mather Hospital Admission Profile, 1/30/13, page 6 under Self-Perception.)
“Assessment Indicator, Sudden Change in Proxy Document”
(Elder Abuse an Introduction for the Clinicians, Dr. Ronald A. Chez, Center on Elder Abuse . org) Sudden Change or False Claim of a Change in Health Care Proxy, Power of Attorney. (American College of OBGYN, Committee Option # 568, 713- Elder Abuse and Womens Health)
“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.” (Mather Hospital Letter, Maryanne B. Gordon, Administrative Director, 7/17/13, page 1.)
On 1/13/13 Mather Hospital Staff Document, “Patient has a Health Care Proxy. Name of Health Care Proxy; Frank Amato” ( Mather Hospital Nurse’s Notes, 1/13/13, page 1, under Historical)
Response: “Your documentation about you acting as your mother’s Proxy Agent since 2010 at another hospital is thus irrelevant to this current complaint. Your sister advised the staff upon your mother’s final admission (2/9/13) that she was your mother’s Health Care Proxy and provided a copy of the proxy document, which revoked and superseded her prior proxy.” (Mather Hospital Letter, Maryanne B. Gordon, Administrative Director, 7/17/13, page 1.)
Plausible Deniability and Contradiction to New York Law
When I made the inquiry in my complaint regarding the legitimacy of a “New” Health Care Proxy Agent, Mather Hospital’s Administrative Director, Maryanne B. Gordon, letter, 7/17/13, stated: ”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”.
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”.
As with the Quantum Physics Law “that two particles of matter cannot occupy the same location at the same time”,
The appropriate response at this time would have been for the Administrative Director to ask, is the “Abrupt” Denial of Pain Medication for Multiple Myeloma and Prescription Drugs, in the known absence of Medical Supervision, acceptable conduct of a Health Care Proxy Agent that Mather Hospital should recognize, enable and endorse?
Mandatory Reporting Benefits
Mather Hospital did not document in the records I have been given, that they diagnosed or treated my mother’s Carbon Monoxide Exposure. Records however show the contrary (Requesting no “vital signs” being taken, “defers blood work and diagnostic work-ups” (Physician Documentation, 2/9/13, page 1)“HCP states she does not want anything done to patient no labs, work up or anything that will “disturb” her”( Nurses Notes, 2/9/13, 20:10, page 1 and 2 under assessment).“resistant to obtaining pt’s vital signs, I explained need for assessing vital signs and rationale for same”(Nursing Progress Note, 2/10/13, 12:33, page 1). “declined a full body assessment” (Nurses Notes, 2/9/13. page 2)
In addition Carbon Monoxide Exposure was not listed on the Certificate of Death as a contributing cause. In the Certificate of Death, 2/12/13, 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 Failure to Thrive”.
Carbon Monoxide Exposure Confirmed
My mother resided at the exact same residence at the exact same time as the 4 individuals who were exposed to Carbon Monoxide, diagnosed and treated for poisoning at Mather Hospital. Additionally the family residing directly above my mother was likewise diagnosed, treated and hospitalized for Carbon Monoxide Poisoning.
Confirmation of the address can be done by examining the records of individuals Hospitalized at Mather Hospital for Carbon Monoxide Poisoning, 2/7-9/13. Confirmation of my mothers residence is found in a Mather Hospital letter dated 7/17/13, where the Hospital Administrative Director Maryanne B. Gordon, states: “Further, she advised your mother resided with her, which you do not dispute”.
Port Jefferson Volunteer Ambulance Corps. Invoice, 2/11/13, for services rendered for my mothers transport to Mather Hospital on 2/9/13, confirms this address as well as the Certificate of Death.
In contrast to reporting confirmed Elder Abuse, Mather Hospital instead communicated the following: “We were entitled to accept in good faith the request of the proxy agent and your mother to implement appropriate visitation restrictions in order to provide your mother with a calm and safe environment”. (Mather Hospital Administrative Director, Maryanne B. Gordon, letter, 7/17/13)
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
