LACK OF DOCTOR FOLLOW-THROUGH

It’s a wonder VMC is still contracting doctors from South Lake Clinic in Renton – each “team” of doctors operate in silos – with no thought process on how something they do or prescribe might impact another system (within the patient) or “team of doctors.”

“Practicing” medicine takes on new meaning at VMC…

This is by no means a complete list of what I documented.

Because of the poor decision making abilities and arrogance of the Valley Medical Center (VMC) Intensive Care Unit (ICU) doctors and staff the following occurred:

VMC doctors did not contact Mark’s Swedish doctors to document the correct drugs and doses Mark was taking prior to hospitalization at VMC – even though I asked them to. If VMC had completed this basic NECESSARY STEP medication withdrawal would not have occurred, Mark would have not been given medications known to cause toxic interactions with MAO inhibitors, Mark would not have been intubated, Mark would have never received the Hospital Acquired Infections (HAI’s), and Mark would be alive today.

VMC doctors were given the facts and data to prescribe the correct antibiotics needed to fight the HAI’s VMC gave to Mark but the VMC doctors continually ignore recommendations presented to them (from the University of Washington [UW], from their own lab, one doctor (Dr. Michael Hori) is said to be “in charge of prescribing all antibiotics for Mark,” Dr. Michael Hori’s “shotgun” approach to prescribing drugs is appalling.

VMC doctors were given the facts and data of Mark’s 2C9 inhibitor study precautions but continually ignore this critical information which caused Mark’s liver to fail. VMC pharmacy and Gastrointestinal (GI) staff did not perform their job in questioning these medication decisions made by VMC’s contracted doctors.

VMC’s ICU Medical Director, Dr. Richard Wall, had no idea what a 2C9 inhibitor was – actually none of the other contracted doctors did either. Very scary.

5 VMC GI doctors were monitoring Mark. Mark had documented gallstones on November 26, Mark was given medications contraindicated with pancreatitis/gallstones and none of these doctors followed through or verified the records as these are not listed in their Focus Notes. Mark’s condition deteriorated because of their negligence.

5 VMC GI doctors never treated the most likely cause of the pancreatitis - duct obstruction; minimal pancreatic tissue was noted at autopsy.

Mark received drugs contraindicated with infection; Dexamethasone (December 26 to January 7). Dr. William Park was in command when this drug was started.

To date, VMC has no idea which medications were administered to Mark. I note in my audit of only 3 drugs that: The “Medication Administration Records (MAR)” differs from the “Detailed Hospital Bill” which differs from “Physician Orders” which I send to VMC. Per VMC, “it may be the nurse did not give it for some reason or that the nurse did not remember to record it on the MAR.”

The top “lack of doctor follow through” notes I made

Liver failure and Dexamethasone (December 26 to January 7):

Warnings: If Dexamethasone is given orally or by injection over a period of more than a few days, side-effects common to systemic glucocorticoids may occur. These may include:

·         Stomach upset, increased sensitivity to stomach acid to the point of ulceration of esophagus, stomach, and duodenum

·         Immunsuppressant action: Bacterial, viral, and fungal disease may progress more easily and can become life-threatening. Fever as a warning symptom is often suppressed.

·         Elevated liver enzymes, fatty liver degeneration (usually reversible)

December 25: Dr. William Park comes in and mentions that the pancreatitis seems to be in control right now and that the pseudomonas in Mark’s lungs is a real problem. Pseudomonas can actually liquefy his lungs. I tell Dr. William Park that Mark will fight these bacteria.

December 26: Under Dr. William Park’s command Dexamethasone is started today.

December 31: Dr. Vilma Quijada (nephrologist) tells me “I need to get all the doctors together to discuss a plan because Mark’s labs are all over the place with the new antibiotics and changes.” Dr. Vilma Quijada says that Mark’s liver isn’t good. Dr. Vilma Quijada also mentions the only way to fix something like this is for a liver transplant. I am still trying to locate any medical record (that exists) to see the dictation from this meeting and what plan they came up with. Obviously, this meeting never occurred.

January 2: Dr. Frank Thomas stops by and says Mark’s liver tests/enzymes are getting worse. TPN has been stopped which when started seems to have impacted the increase in the liver enzymes.

January 4: Dr. Michael Hori  mentions that Mark’s liver issues are not drug related.

January 6: Dr. Daniel O’Neill mentions that when someone has liver failure 2 enzymes are elevated; Mark only has one of those elevated. So why are all the other doctor’s telling me Mark’s liver has failed and he needs a transplant?

January 7: Dr. Daniel O’Neill says the liver biopsy shows blockage of the ducts which is most likely caused by medications. Dexamethasone is stopped today.

January 8: Mark’s Liver function tests start to fall drastically (getting in a better range). By January 12 Mark’s AST/GOT had gone from 4273 (on January 8) to 218.

Gallstones – Dr. Frank Thomas and the gastrointestinal staff:

November 26: This is the first time I see Dr. Duane Carlson and he says to me "how long has your son had liver disease” I respond "since he has been in your hospital." Dr. Duane Carlson says he will go and review Mark’s records and get back to me - he does not. Dr. Duane Carlson orders a gallbladder ultrasound right after this conversation and 2 gallstones are located. Of course, the doctors rotated and Dr. Frank Thomas doesn't read the ultrasound report the very next day nor did any VMC doctors after that. I have to show them the records (after VMC told me to get a lawyer before they would release them).

January 10: I ask Mary to page Dr. Christopher DiRe. Dr. Christopher DiRe shows up at ~12:30 and tell him about the foaming at the mouth, massive gas, belching, rectal tube bag being full of gas, the gurgling feces and about the G-tube incision discharge gurgling (you can hear air in there). DiRe says this all has to do with the complex nature of fluid collection and that it is possible that the stomach fluid got into his abdomen. I told him this all started right after the Bronchoscopy. I ask about the stomach fluid sample that Jed took the day before and Dr. Christopher DiRe says it has amylase in it. I also mention gallstones from the ultrasound report (Dr. Christopher DiRe has no idea that the gallstones showed up back in November; he also has no idea about the Pseudomonas in the stool from December 14). I have to show Dr. Christopher DiRe the lab report for the gallstones (and he looks up on the computer in Mark’s room); I have no idea about the Pseudomonas in Mark’s stool until after his death. Dr. Christopher DiRe does not mention either of these in his focus notes.

The bacteria are rampant in Mark’s body:

December 14: Pseudomonas is now detected in Mark’s stool sample. This is on the lab work however, not mentioned in any of the focus notes or discussed with me.

December 19: Cheryl tells Dr. Amy Morris that the same fluid that is coming out of Mark’s lungs appears to be coming out of his stomach Peg tube. I ask Dr. Amy Morris about this and she isn’t concerned. I ask Cheryl if she could interpret Dr. Amy Morris’s explanation; Cheryl says Dr. Amy Morris really didn’t explain it well but isn’t concerned.

December 24: I notice foam coming out of Mark’s Peg tube today.

December 25: Mabel and I talk about the thick white mucous coming out of Mark’s Peg tube and I ask if she has mentioned it (she has). I ask why this isn’t being considered as a place for infection. She said that she mentioned it to Dr. William Park and he isn’t concerned (Cheryl told Dr. Amy Morris). Mark vomits up a whitish color and a lot of it. Mabel is standing next to him when it happens. I can’t tell if it is foamy or not (to match what is coming out of the Peg tube).

Vascular Surgery:

December 28: New Picc line put on the right side today (Mark’s arm). An iv nurse comes in to do it; I voice my concern with the trouble the doctor had putting in the dialysis catheter. I ask for a doctor to do it. Dr. Kenneth Reger comes in to place it. This line is placed into Mark’s heart too far (and the 2 x-rays they did on Mark didn’t show the tip of it) causing the V-tec and heart rate indicators to go off every second (I told the nurse something was wrong). Instead of Dr. Kenneth Reger coming back to reposition it; he tells the nurse (Cindy) to pull it out a bit and she won’t. Cheryl comes in and pulls it out a bit. VMC now orders a third x-ray to confirm the placement.

The other lack of doctor follow through notes I made:

November 20: Dr. Stefanie Nunez wants to know if I have talked to Dr. Robert Winrow of Swedish. Dr. Stefanie Nunez mentions that Dr. Suzanne Krell talked to him on November 17 (and remember that Mark went to the ER on November 9 and was hospitalized on November 10 at 2:30 am) and Dr. Robert Winrow (of Swedish) had no idea how severe Mark’s status is. Why have the VMC doctors not contacted him?? They said they would be in continuous contact.

December 17: I ask Dr. Michael Hori if the State of Washington and/or CDC have a website/phone for him to call to see what viruses or bacteria are coming up in this local area during a certain time – like now. Dr. Michael Hori says none that he is aware of. We ask if Dr. Michael Hori has contacted any other doctors in his field (like Dr. Seigel who is listed as an exceptional doctor – but is at the Poly Clinic in Seattle). Dr. Michael Hori states that because he cannot pin point what Mark has (for the fevers) and doesn’t have a particular question to ask them he has contacted no one. What we didn’t realize is that Mark has Pseudomonas now growing in his gastrointestinal track from the procedures Dr. C. Gabriel Alperovich performed.

January 3:     Dr. William Park is the intensivist this week. During rounds I ask Dr. William Park if he has received the UW C & S results back, Dr. William Park only says that he hasn’t seen them. Dr. William Park asks me to leave the rounds, then they proceed to discuss Mark’s case further (for Dr. Michael Hori to change the antibiotics it was obvious Dr. William Park saw them). Another new doctor comes in the room a few minutes later to discuss the UW results with me – the ones I just asked Dr. William Park about.

December 10:  I asked Dr. Ajay Kundra if he heard back from Dr. Khalil Shasha’s conversation with UW to get to the bottom of this and get Mark well. Dr. Ajay Kundra was going to check on this; Dr. Khalil Shasha also said he would follow-up. Neither doctor does and both are Hospitalists ~ the driver’s of the bus for the patient.

December 11: I tie in with Dr. Ajay Kundra and I tell him I have concerns with the meds and how the doctor’s orders differ and the information is not communicated. He smiles nervously at me, knowing this is a big issue at VMC with their “teams” of doctors – in the ICU.

December 12: Dr. Daniel O’Neill: comes in today and looks at ~ 7 blue index cards with patient data on them. He says the enzymes are about the same and that they are waiting on the test to come back from the paracentesis fluid, I tell him those results came in days ago and they were negative.

December 14: Dr. Daniel O’Neill tells us that Mark’s protime (how the liver synthesizes proteins) is normal, yet another protime is collected during dialysis. I discover that on December 10 the protime was done and that Dr. Daniel O’Neill is just getting back to us with results.

December 14: Mark has severe looking sores on his ears because of the respirator straps. I asked Joyce to bandage them and she did on December 11. Within 3 days the bandages look terrible and I take them off (the puss on his ears and bandages are green) and I request the wound nurse look at them. Laura Force doesn’t show up for days. The sores look really bad and we are frightened that Pseudomonas has gone there too. On this same day, Pseudomonas shows up in his stool.

December 30:  Dr. Vilma Quijada (nephrologist) is around today, I see her twice, but she never stops by so I can ask her some questions. I am told dialysis will be every other day now (which they end up doing dialysis today anyway and continue with daily dialysis).

January 7:  Dr. Daniel O’Neill’s notes question if Mark’s pancreatic duct is plugged – and if a fine needle aspiration should be done and test for bacteria - nothing is done for Mark to confirm this.

January 8:   Dr. Amy Morris’s notes state that she is in agreement with Dr. Daniel O’Neill’s comments about the pancreatic duct being plugged; nothing is done to verify anything.

January 10:  Today I give Michele Bohl a list of what I would like to discuss with Dr. Christopher DiRe (GI on call). 1) I would like to sit down and review/compare abdominal CT scans/reports from December 27 and January 3 and find out how many pseudocysts are there. 2) I want to discuss the G-tube (placement, massive leakage, gurgling sounds, belching, massive gas, labs and swab test [all starts right after a bronchoscopy], etc. 3) I want to discuss massive fluid retention on the right side where paracentesis was done, thighs have doubled in size, the effects on the heart and lungs. 4) UW 2^nd opinion on liver biopsy. 5) right side paracentesis review report. 6) What happened to the 2 gallstones reports? 7) Rectal tube issues [bag full of gas, feces on bed gurgling like a geyser]. 8) Trends (enzymes, meds, etc.). 9) 3^rd spacing [per Bob, Mark’s stomach bile was 3^rd placing into his abdominal cavity; this does not make sense to us). Dr. Christopher DiRe only discusses the complex nature of fluid retention and will get back with us to answer the other questions; he never does.

Missing in action, again

December 2:  I ask who the GI this week is because we haven’t seen anyone. Dr. Eric Yap is on call and missing in action. I see Dr. Eric Yap on December 11; he makes no eye contact says a couple of things then leaves. That is the last we saw of him.

December 19:  We see Dr. Christopher DiRe (which I tell him is a little late in the plan). I never realized he had billed for November 15 through November 18 – he never stopped by. Dr. Christopher DiRe says he will review Mark’s chart and get back with me, of course he doesn’t. I next see Dr. Christopher DiRe on January 10 and ask him what happened to the 2 gallstones ~ he didn’t have a clue so I had to tell him which ultrasound to go and look at (November 26). The last I see of Dr. Christopher DiRe is on January 11 for a group doctor meeting (which he has other commitments and can’t stay long).

How did Dr. Christopher DiRe and Dr. Eric Yap bill:

Dr. Christopher DiRe

November 15 to November 18                  

December 17 to December 19      

January 10 to January 13 

Dr. Eric Yap

November 29 to November 30      

December 01 to December 2        

December 11           

January 5 (Dr. Eric Yap never shows up)