VMC

VMC
VMC Renton, Washington: where death happens and no one seems to care

My letter to VMC for causing Mark's death

My letter to VMC for causing Mark's death

As we all know, health care costs escalate for a number of reasons. One of those reasons is when hospitals do not follow infectious disease protocols and give their patients diseases they didn’t have when they arrived at the hospital. We all assume that when we go to a hospital we will get better, not die from hospital errors. Last year (per legal discussion) 96,000 people died from hospital errors; the population of Auburn, Washington (according to the 2010 census) is 70,180. This is a staggering amount of taxpayers.


Also of note is if you are over the age of 18, single with no dependents, you are at the mercy of the hospital even though you may still be on your parent’s employer health insurance plan. Hospital legal staff and risk management teams are fully aware that the family will have difficultly suing because of current Washington State Law (with a few exceptions) therefore the patient is at risk for complacency and sub-quality/third world health care. It appears to me that
UW Valley Medical Center (VMC) did not want Mark to live (hence not giving Mark the correct drugs identified on 2 susceptibility lab reports) because Mark could have sued VMC for medical negligence/malpractice. What my family, friends, coworkers, internet counterparts and I have observed is that hospitals operate with complete immunity under these and many other conditions.

My son, Mark David Turnage Jr., fell victim to 4 hospital acquired bacterial infections (aka HAIs - MRSA, Enterobacter, Burkholderia and Pseudomonas) that resulted in his death at
Valley Medical Center in Renton, Washington on January 16. Mark acquired these bacteria in his lungs (which resulted in pneumonia) and later his gastrointestinal track (through a peg tube then G-tube incision) as a result of VMC not following industry blood borne pathogen standards, VMC internal processes, federal (OSHA/CDC) regulations and VMC doctors not prescribing the recommended antibiotics discovered through susceptibility studies. Ironically, Mark had pneumonia on 9/15/09 and didn’t get these bacteria in his lungs and also had his pneumonia vaccine in September.

Back on November 9, Mark was taken to the VMC emergency room (ER) for classic symptoms of gallbladder distress (acid reflux, pain in upper right abdomen, nausea, couldn’t eat that day). On November 10 around 2:30 am VMC admitted him after identifying pancreatitis through blood work. While I was in the ER with Mark early that morning, UW VMC performed what appeared to be the MRSA nasal swab test. UW VMC
later said this test was never performed and/or they lost those records. Dr. Suzanne Krell cancelled this MRSA nasal swab test order (along with other ICU doctors) multiple times.

When the hospital heavily-sedated Mark on November 12 they had to "intubate" him (gave him a respirator to breathe). Within 4 days, per the death certificate signed by VMC
Dr. Wynne Chen, VMC found 4 antibiotic resistant bacteria growing in his lungs (initially MRSA and Enterobacter then Burkholderia and Pseudomonas) ~ obviously from the intubation/respirator and no infectious disease controls being followed (hospital acquired). VMC blamed this on Mark being in the Intensive Care Unit (ICU) and said this occurs when patients are in the hospital for a long duration. Being in the hospital for 4 days before these are discovered does not constitute a long hospital stay. I would like to know what strain of MRSA VMC discovered (community versus hospital acquired are different) and if the other bacteria also have strains.

We (the family) personally witnessed and documented the lack of infectious disease controls and processes on many occasions (no gloves, putting on gloves but not washing hands first, gloves not being changed after cleaning the tracheotomy, gowns not being used, bathing techniques, etc.). I have outlined these in a separate report (cross-contamination). Just a few examples of further incompetency are described below (my full report will be sent to the compliance organizations on the distribution list):

On November 26
VMC performed an ultrasound and detected 1 or 2 gallstones, however, the VMC doctors didn’t review the report because this information was never mentioned in daily rounds or family conference meetings. I discovered this information after reviewing some of Mark’s medical records I received on January 13 (which I pointed out to the Gastrointestinal [GI] Dr. Christopher DiRe the next day). Dr. Christopher DiRe had no clue and was surprised to hear this (I pointed him to the November ultrasound report so he could look it up on the computer in Mark’s room).

November 27 Dictation from
Dr. Mary J Vancleave states “The patient was initially started on broad-spectrum antibiotics. Numerous respiratory and blood cultures have been done, and all have been negative except for tracheal aspirate on November 14, which grew out Enterobacter cloacae and MRSA, and was maintained on the appropriate antibiotics…Tracheal aspirate on November 21 grew out the MRSA and Burkholderia cepacia, which is sensitive to ceftazidime.” Mark was not given ceftazidime until January 12; I discovered this information after Mark’s death while reviewing his medical records. Of note is the fact that I am not told about the Burkholderia until December 4 by Dr. Lindy Klaff (the intensivist), not Dr. VanCleave (the hospitalist).

What happened over the 68 days in the VMC ICU was horrific and an experience no one, patient or patient advocate, should ever have to go through. We saw everything from medication errors, arrogance to 2nd opinions and family knowledge, denied patient advocate 2nd opinion requests, a lack of tie-in of the staff (mainly VMC doctors), limited and conflicting communication with the doctors, infection disease controls not being followed, medical errors/procedures that had to be repeated (not done correctly the first time, and I was not notified, I discovered during medical record review), and the list goes on. All of these issues have been extensively documented in my own separate audit report.

On January 4 the VMC doctors removed a peg tube and replaced that with a G-tube. By January 7 massive amounts of bile were oozing/bubbling out of my son’s G-tube incision. Three days later
(on January 10) Pseudomonas was identified in the incision from a swab test (traveled from his tracheotomy ~ again infectious disease processes, controls and regulations were not followed) and Pseudomonas was now growing in his abdomen. Mark went through massive pain, belching, foaming of the mouth, rectal tube collection bag was totally inflated with gas (not feces), and the feces that escaped the rectal tube and was on the bed between his legs was gurgling like a geyser from all the gas. What I was never told (and I found on March 10 while doing a medical record review) was that VMC knew on December 14 that Mark had Pseudomonas growing in his feces. This information should have been discussed with me, Mark’s patient’s advocate (Dr. Wynne Chen was on call ~ Mark’s fever went to 105 on this day). How dare the doctors for keeping this type of information from us, obviously a medical error the VMC doctors didn’t want to disclose to me. On January 14 we were told by Dr. Duane Carlson (GI) that those symptoms (described above) explain that a bacteria population could have caused this (as the bacteria eat through Mark’s GI tract they produce gas). This was a horrendous amount of pain for Mark.

We requested a 2nd opinion on January 11 (definition below for VMC doctors and staff), however,
Dr. Suzanne Krell’s presentation to Dr. Robert Driscoll (Swedish GI) was about Pancreatitis and not the horrific GI issues Mark was facing (belching massively, foaming at the mouth, massive leakage oozing/bubbling out of G-tube incision, the gurgling sound from the G-tube incision…all these listed in my previous paragraph). We are later told Dr. Suzanne Krell presented Mark’s case to Dr. Driscoll as Pancreatitis with uncontrollable Pseudomonas (we assumed the Pseudomonas was in his lungs). Of course, Dr. Driscoll had no “advice or consult” to add. I have discussed this matter further with Dr. Driscoll on my March 11 appointment with him.

A second opinion is a third party unbiased opinion of the facts and data presented to them. The second opinion is an independent review of the patient, symptoms and drugs given. A second opinion request is not a conversation between doctors about the patient.

A consult is a doctor calling another doctor and asking for advice
.

My son eventually died from the bacteria causing pneumonia and the hospital not giving him the VMC and University of Washington (UW) recommended antibiotics (from the sensitivity studies
[November 21 and January 1 respectively] which are attached) to treat the bacteria. The Valley sensitivity report from November 21 identified Ceftazidime (which Mark wasn’t given until January 12) and the UW sensitivity report from January 1 identified Ticarcillin/Clavulanic Acid as the best antibiotics to give Mark. The UW study said Ticarcillin was susceptible in 64 Pseudomonas and 64 intermediate Burkholderia. Mark was given Zyvox (Linezolid) which wasn’t even listed as being an antibiotic to be considered; Mark never received Ticarcillin. According to Dr. Wynne Chen’s Discharge Summary Dr. Michael Hori was the doctor dictating the antibiotics given to Mark. Dr. Michael Hori actually stopped all antibiotics on December 10 when Pseudomonas was found; when I questioned Dr. Fong about this he called Dr. Michael Hori and had the antibiotics started again. 

I found out later (after reviewing the VMC detailed hospital bill) that they also gave Mark an immunosuppressive (Dexamethasone from December 26 to January 7) while his body was trying to fight all these bacteria. At this same time I am being told by Dr. Richard Wall, VMC ICU Medical Director, that Mark’s immune system isn’t responding; imagine that. Dexamethasone is a steroid 4 to 5 times stronger than Prednizone and also causes elevated liver enzymes. With the amount of drugs they gave Mark during his hospital stay at VMC, I am surprised that liver failure was not also mentioned on the death certificate. There was no reasoning and systems thinking for the prescriptions ordered and given to Mark. The amount of drugs administered would have caused any healthy persons liver to fail. At Swedish, where all of Mark’s doctors were, we hired a psychiatrist to manage Mark’s medications to ensure there were no interactions and that his liver could metabolize those. I showed this same genetic drug metabolism study to Dr. Wall, Dr. Park, Dr. Nunez, Dr. Krell and Dr. Hori ~ they either didn’t comment (Krell/Nunez), told me the study had to do with psychiatric drugs (Hori), showed no interest in reading it (Park), or told me it had to do with Mark being immunocompromised (Wall). I know what a CYP2C9 inhibitor study is, why didn’t they? The VMC doctors ended up prescribing a drug Mark’s liver couldn’t metabolize; and as soon as I thought about it I called the nurse, had her stop the iv and call the doctor. It appears that I am the one that should be a VMC doctor.

The inability and rejection (Medicare DRG codes) to have Mark transferred to Swedish, which I aggressively tried to work, and I even agreed to pay all the transportation costs, is yet another issue and letter that will be addressed and follow this letter.

Because of all the hospital errors; conflicting information and lack of communication between doctors, staff and family; the lack of daily tie-ins (many doctors were “missing in action”); and literally no one “driving the bus” for Mark’s coordinated care plan we requested formal family meetings to discuss Mark’s health care plan, we wrote our expectations of the doctors and staff on Mark’s ICU room whiteboard, and discussed VMC processes, methodologies and failures of the VMC healthcare quality system. Communication between the doctors – the staff – and the family should be seamless. Communication at VMC became a “pull” from the family versus a “push” from the doctors.

Through the course of Mark’s hospital stay at VMC I have extensively documented daily notes (80+ pages) of our interactions between doctors and staff. I also have documented my “audit” findings from the above (28+ pages and growing) and will forward to the appropriate oversight organizations. I can count the number of times we were told that “Mark is not the only person here” ~ “I don’t have time for this” ~ “I have 26 patients and don’t have 30 minutes to spend with each of them” ~ “I don’t know...go ask (insert other doctors name here)” ~ all from doctors in an ICU. Isn’t an ICU supposed to have the most cutting edge, educated leaders for doctors? I can also count the number of times we had to track down doctors. I will make it a personal life mission to get the word out on how important it is for all families to assign a patients advocate and to be at VMC at all times when your loved one is hospitalized. I will encourage the advocate/family to get actively involved in reviewing the medical records up front, asking a ton of questions and not to believe anything a VMC doctor tells you.

As final solidification of all of my comments, please read
Dr. Wynne Chen’s “Discharge Summary” ~ a true example of the lack of commitment, tie-in, or even reading what was really going on with Mark (his patient or any other patient at VMC for that matter). While I liked Dr. Wynne Chen’s forthcoming attitude, he clearly wasn’t “on the boat with the team.” Mark did not grow Pseudomonas in a pseudocyst (as Dr. Chen states was in the paracentesis fluid). Did Dr. Wynne Chen even read the lab work? I did. Also is of note is that we never requested a second opinion from the University of Washington. Where did Dr. Wynne Chen read this because this wasn’t what happened or what was requested. Obviously Dr. Wynne Chen (like all your other ICU doctors) didn’t read Mark’s medical chart or tie-in with the other doctors. Dr. Wynne Chen also mentions that no gallstones were seen; again Dr. Wynne Chen didn’t read the ultrasound report from November; a private autopsy revealed that Mark did have gallstones. This is a classic example of how out of touch VMC doctors are.

VMC failure to follow industry standard protocols and regulations for preventing hospital acquired infections (HAIs) is totally unacceptable. Because of this, I have also started the process of filing a formal complaint with the CMS Quality Improvement Organization for their doctors to review all of Mark’s medical records and VMC processes. I have also contacted CMS to begin the formal process for all medical bills to be rejected since the hospital was at fault for the massive amount of bills (the hospital bill only is over $1.2M) mainly due to these bacteria. I am also performing a separate audit of the detailed/itemized VMC hospital bill; those questions will be arriving at VMC Patient Accounts within a couple of weeks. I have also contacted the Office of Quality Monitoring (formerly JCAHO) to file a formal complaint. I am in the process of petitioning the State of Washington to have the death certificate changed to reflect what actually happened based on documentation, medical records and my discussion with
Dr. Suzanne Krell on January 12 “that GI issues would not kill Mark, the pneumonia and sepsis from the pneumonia would,” all caused by VMC incompetence and complacency.

Finally, for all the VMC ICU “doctors,” Mark’s sepsis was from the bacteria in his lungs and GI track (all caused by VMC). There was no mystery infection (or infection in his pancreas) as you all kept looking for and telling me about; hence, 42 blood cultures and every one of them came back negative. I’ve only begun my review of Mark’s medical records and found enough to horrify any mother in the small amount I have reviewed. My son Mark did not deserve to die like this; Mark’s death was not “natural.”

I am anticipating your reply,


Karie Turnage (Mark’s mom)
Renton, WA

10 comments:

  1. Anonymous9:50 PM

    Mom

    Did you get a response from Valley Medical?

    ReplyDelete
  2. I received a response (to my letter) from Valley dated 4/11/11. The Director of Risk Management said "Valley has processes for evaluating patient concerns and that they are conducting a thorough review." I haven't had any other response. I have also contacted Valley numerous times trying to find out what "non-formulary" drugs were given to Mark (from the hospital bill) because of discrepancies between the bill and the medication administration summary. Patient Accounts (billing) told me to contact Medical Records. Medical Records told me to contact Risk Management. Risk Management said they needed their Director's approval to release that information. I received a letter from another Risk Management employee dated 6/22/11 saying she is working with Pharmacy to identify what those drugs were. I have drafted another communication to Valley asking for status, records that indicate Swedish Hospital was really contacted for Mark’s transfer (whom Valley talked to because this is not in Mark’s medical records), along with other requests of records I made but still haven’t received; that letter will be sent tomorrow (7/26/11). I also am in the process of updating Mark’s blog to reflect additional medication errors I just uncovered after reviewing the Valley staff “focus notes” from the first few days Mark was hospitalized. It’s now very clear what happened.

    ReplyDelete
  3. Anonymous10:16 AM

    YOU FRUITCAKE - GIVE UP THE FIGHT ALREADY. HINDSIGHT IS ALWAYS 20/20.

    ReplyDelete
  4. Anonymous10:16 AM

    YOU FRUITCAKE - GIVE UP THE FIGHT ALREADY. HINDSIGHT IS ALWAYS 20/20.

    ReplyDelete
  5. Anonymous10:16 AM

    YOU FRUITCAKE - GIVE UP THE FIGHT ALREADY. HINDSIGHT IS ALWAYS 20/20.

    ReplyDelete
  6. Anonymous10:17 AM

    YOU FRUITCAKE - GIVE UP THE FIGHT ALREADY. HINDSIGHT IS ALWAYS 20/20.

    ReplyDelete
  7. Anonymous10:17 AM

    YOU FRUITCAKE - GIVE UP THE FIGHT ALREADY. HINDSIGHT IS ALWAYS 20/20.

    ReplyDelete
  8. Doctor, You are not well and have psychiatric issues (i.e. you are either a doctor or a teenager – a teenager would never put this type of energy into a blog about medical errors). I have a recommendation for you. You need to contact one of your own - UW Valley Medical’s neurologists Dr. Joy Zhao – the same neurologist you all picked for Mark. Scared? Why? Don’t worry as I’m sure she will do a “fine job” with you just as she did for Mark. Per Dr. Joy Zhao, you are “brain dead” and need to be put on “Comfort Care.” Just talk to your nurses and “doctors” and I’m sure they will work out a personalized plan for you. You need help.
    And you are right about 1 thing – all doctors see medical errors as 20/20 in hindsight – how can you live with yourself?

    ReplyDelete
  9. Anonymous7:27 AM

    I just saw this thru his obit in paper ..I am sorry for your loss.

    ReplyDelete
  10. Thank you so much for your kind words. The world has lost yet another very kind and wonderful person due to preventable medical errors.

    ReplyDelete