VMC

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

THE ERRORS BEGIN: MEDICATION WITHDRAWAL = DELIRIUM

Mark had no complaints with his health on November 9; we talked many times this day. By 8:28 pm Mark calls me and is in pain. Mark is taken to the VMC Emergency Room (ER).

I go to the VMC Emergency Room (ER) and pancreatitis is confirmed through blood work. Mark is given Morphine and the toxic drug interactions with MAO inhibitors begin.

Mark knew his medications and doses and was coherent in the ER (I was with him) – the ER nurse didn’t write the medications down correctly. Dr. Michael Mena, the hospitalist the ER doctors hands Mark's care over to requests they order records from Swedish, 3 times, and this never happens. These medications were also reviewed with the 3rd floor nurse, Desiree, as I made her put them in the computer system. I asked Desiree to contact Swedish or Northwest Kidney Centers to confirm the proper doses. Dr. Fatime Goda, the hospitalist Dr. Mena hands off to should have ensured the Swedish records are ordered - VMC had full access to these records. Days later the doctors still don't know the correct medications and doses Mark was taking; I still cannot locate any records that show VMC contacted Swedish about this even though Dr. Mena ordered these.

Note: November 8 (prior to VMC hospitalization) is the last evening Mark takes his Parnate (MAO inhibitor – 50 mg at night [also 50 mg morning]), Lisinopril (10 mg), Famotidine (20 mg) and Triazolam (.25 mg). Mark only receives partial doses of Sensipar 30 mg (was taking 90 mg), Gabapentin 900 mg (was taking 2400 mg) and Norvasc 5 mg (was taking 10 mg) on November 10.

Mark is hospitalized (on November 10 at 2:30 am). CCU/Med/Surg Patient Care Record states patient is cooperative and calm. VMC abruptly discontinues Mark’s previous medications and drug withdrawal begins.

November 11 at 8:00 am the CCU/Med/Surg Patient Care Record states patient is cooperative but gets restless at times; sleepy and moaning.

9:45 am: I arrive at VMC and Mark is worse. He seems to be out of it mentally. They have given him Dilaudid (at 8:30 am). Desiree (the 3rd floor nurse) says that she has been giving him Dilaudid every 2 hours because he is being “agitated.” Mark cannot form sentences only can say a single word or two, he is continuously moaning, and doesn’t want to stay in the bed. He is now saying things that do not make sense. I ask him what’s wrong, is it the drugs he says “yes”. I have the doctor paged 2 times.
Dr. Fatime Goda finally arrives and we agree that maybe he is having an allergic reaction (she suggests giving him Benadryl). I should have taken Mark out of VMC at this very moment.

Confusion and hallucinations (delirium) begin

Delirium is often caused by a disease process outside the brain, such as infection (UTI, pneumonia) or drug effects, particularly anticholinergics or other CNS depressants (benzodiazepines and opioids). Drug withdrawal is a common cause of delirium. Medications including psychotropic medications, opiates and benzodiazepines can cause delirium or worsen it.

Abrupt Drug Withdrawal: The side effects (Delirium) begin

VMC should have gradually reduced Mark’s previous medications; literature recommends reduction over a period of weeks or months to help minimize or prevents the withdrawal syndrome. Withdrawal symptoms (for 2 of the above medications) can include but are not limited to aggression, anxiety, balance issues , blurred vision , brain zaps, concentration impairment, confusion, constipation, crying spells, depersonalization, diarrhea, dizziness, electric shock sensations, fatigue, flatulence, flu-like symptoms, hallucinations, hostility, highly emotional, indigestion, irritability, impaired speech, insomnia, jumpy nerves, lack of coordination, lethargy, migraine headaches / increased headaches, nausea, nervousness, over-reacting to situations, paranoia, repetitive thoughts or songs, restlessness, sensory and sleep disturbances, severe internal restlessness, stomach cramps, tremors, tinnitus (ear ringing or buzzing), tingling sensations, troubling thoughts, visual hallucinations / illusions, vivid dreams, weakness, speech and visual changes, worsened depression, restlessness, agitation, , disorientation, , light sensitivity, diaphoresis (sweating), headaches, palpitations, hypertension, and chest pain.

November 11: At 8:00 pm VMC straps Mark down to the bed because he is delirious. Mark’s color is very yellow. Mark thinks his name is “Calvin” and yells for us to “cut him loose and he will tell us where she is” and “I need to run to the forest it’s the only place I’m safe.” If only we had listened to him and cut him loose.

November 11: At 15:00 pm the CCU/Med/Surg Patient Care Record states patient is restless, cooperative, and majority of time moans and cries; confused, hallucinates at times (there is a cat under his bed).

At 16:21 pm VMC gives Mark Fentanyl – the toxic drug interactions escalate.

At 20:25 pm the CCU/Med/Surg Patient Care Record states patient is restless, (I can’t read the note) bed and cries out; inappropriate verbalization.

At 20:56 VMC gives Mark both Fentanyl and Versed – now Mark receives 2 drugs known to cause toxic interactions with the MAO inhibitors.

November 12: At 00:00 am the CCU/Med/Surg Patient Care Record states elevated agitation, prn order to properly sedate, mom and dad at beside; alert, confused and extreme agitation, inappropriate communication, clear speech.

November 12: At 1:30 am
Dr. Mary J Vancleave calls the house and says they have heavily sedated Mark because he was being agitated. They had to put him on a respirator because of the sedation; Mark’s breathing was very shallow. Dr. Mary J Vancleave never mentions that Mark was going through medication withdrawal and toxic drug interactions.

Why didn’t Dr.’s
Fatime Goda, Mary J Vancleave, Richard Wall (the “ICU Medical Director”), Michael Mena and Arthur Sullivan (along with other VMC doctors and the Renal team) contact Mark’s primary care doctors (at Swedish) those first days for the correct medications and doses Mark was taking prior to hospitalization at VMC?

While the VMC doctors question medication withdrawal in their focus notes no one follows through to review the meds, address possible toxic interactions or to help Mark with the symptoms.

What happens to Mark next? Because Mark stopped breathing and his blood pressure dropped VMC intubates him - THE HOSPITAL ACQUIRED BACTERIAL SHOW UP WITHIN DAYS IN HIS LUNGS FROM THE UNSTERILE EQUIPMENT. To this day, VMC will not admit this even though a whistleblower has come forward and it's in the medical records other patients acquired the same bacteria at VMC.

Other toxic drug interactions that occurred: those first few days:

Opiods drug interactions

Dilaudid (hydromorphone) and MAO’s: CONTRAINDICATED Do not use if you have used an MAO inhibitor in the last 14 days. Dangerous side effects may result; may rarely result in hypotension, respiratory depression, or coma.

Dilaudid (Hydromorphone and Isovue-300: GENERALLY AVOID.

Fentanyl and MAO’s: Do not use Fentanyl if you have used an MAO inhibitor in the last 14 days.
Side effects: agitation, headache, diaphoresis, hyperpyrexia, rigidity, hypertensive crisis, hypotension, seizures, respiratory depression, hypotension, and coma. Death has occurred in some cases.

Fentanyl and Neurontin (Gabapentin): MONITOR the patient. Side effects: Central nervous system and/or respiratory-depressant effects may be additively or synergistically increased in patients taking multiple drugs that cause these effects, especially in elderly or debilitated patients.

Opiate drug interactions

Morphine and MAO’s: Avoid taking Morphine if you have used an MAO inhibitor within the past 14 days. Side effects: confusion; disorientation; fainting; fast, slow, or irregular heartbeat; hallucinations; mental or mood changes (eg, agitation, exaggerated sense of well-being).

Gabapentin and Morphine: Tell your health care provider if you are taking any medicines, especially Morphine because it may increase the risk of Gabapentin's side effects, including drowsiness.

Benzodiazepine drug interactions (Central Nervous System [CNS] depressants)

Lorazepam and MAO’s: MONITOR: Central nervous system and/or respiratory-depressant effects may be additively or synergistically increased in patients taking multiple drugs that cause these effects, especially in elderly or debilitated patients.

Midazolam: A small minority of patients feel agitated, hyperactive or combative when taking Versed, rather than the anxiety relief and relaxation that is intended. Severe allergic reactions; agitation; chest pain; combativeness; irregular breathing patterns; pain, swelling, or redness at the injection site; slow or difficult breathing; unusual or involuntary muscle movements or muscle tremor. Versed can slow breathing, so close monitoring is essential when the drug is being used. Versed can also increase the respiratory depression effects of other medications, including opioids.

Midazolam/Versed and MAO’s: Among the medications that may potentially cause drug interactions with Midazolam are seizure medications, antidepressants, and antipsychotic medications. Side effects: drowsiness, confusion, memory loss, or difficulty breathing.


4 comments:

  1. Anonymous11:18 AM

    Why would anyone be on all these different medications; This is crazy, and the first opportunity to question the medical profession and why all this is being prescribed.

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  2. Anonymous8:13 PM

    After reading this, I can only see stupid after every medical decision.

    What really stands out to me (because I am on it for chronic pain) is the Fentanyl....

    WHY did they give Fentanyl? That is an opioid with one hundred times the potency of morphine! You're not even supposed to take it unless your system has an established tolerance to opioids.

    Using dilaudid (also nicknamed hospital heroin) and Fentanyl are extreme (I've taken both) narcotics that you work your way up to for pain - not to be given loosely for sedation!

    MAOs... who doesn't know that you have to tread with caution with these?!

    I also wonder: is your son bipolar? I am also bipolar, and as a result, I notice people seem to enjoy treating bipolar patients like total nut jobs with zero credibility. They may have deduced from his medication (I'm not assuming, as everything can be used for something else) that he was bipolar or had another mental illness and ignored symptoms that they thought were just stereotypical of someone with a mental illness.

    The antibiotics... this is the stupidest thing I've read in a long time. I am reading on to hope there is some resolution to a blatantly abusive case of medical malpractice. They should NOT be practicing medicine.

    My warmest wishes to you, this must have been unbearable.

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    Replies
    1. Thank you so much for your commments - you bring up VERY good points. At first they gave Mark the Dilaudid for supposed pain (Mark had gallstones / which caused pancreatitis [of course Valley had no idea about the gallstones because they didn't read]). When Mark started going through the medication withdrawal they gave him Fentanyl and Versed to sedate him (they said Mark was septic and in pain - he was not). Isn't it interesting that patients/the public know more about MAOs than a Valley ICU or pharmacy? Mark was taking the MAOs because he was depressed (accidental deaths of his father and brother; then his labrador had a heart attack). You would think you can trust a hospital and their doctors to make the right decisions for their patients - I learned you cannot. I can only imagine the number of people that have and will go through the same things Mark did at Valley. I just hope something has changed. BTW, this happened 2 years ago and I'm sure this has been going on since around 1949 when they opened their doors. The best to you too and thank you for the comments.

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  3. Anonymous8:14 PM

    Also, what year was this? It sounds medieval.

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