Mandatory Reporting Laws in New York: Why Aren’t We Protecting Our Elderly Like We Protect Our Children?

By Jessica Coombs, Albany Government Law Review

       I.            Introduction

            All fifty states and the District of Columbia have Adult Protective Services (APS) agencies in place to investigate reports of elder abuse and provide vulnerable individuals and victims of abuse with protective services and treatment.[1]  APS was created by law to assist in the protection of impaired adults age eighteen and over.[2]  Nearly every county has its own APS unit which is maintained by that county’s Department of Social Services.[3]  In New York, APS units offer numerous services including investigation and assessment of the adult’s needs, advocacy and case management, legal interventions, counseling for the victim and their family, and emergency living arrangements.[4]

            The services provided by APS have the potential to help many victims; however, they are not implicated until APS has been notified of a potential case.[5]  The lack of a mandated reporting system in the state of New York hinders APS’s ability to help victims who may not be able to seek help themselves.  “Mandatory reporting statutes require individuals to report certain injuries or cases of abuse or neglect to law enforcement, social services, and/or a regulatory agency.”[6]  Every jurisdiction has different statutes regarding which types of abuse must be reported, and who is required to report the abuse.[7]  New York has no such mandatory reporting requirement.

            With elder abuse in particular, it is extremely important that suspected abuse be reported to the proper authorities because the elderly are less likely to self-report any abuse they are experiencing, and because elderly individuals have an increased susceptibility to abuse.[8]  Without mandatory reporting laws in New York, there is a decreased chance that cases of elder abuse will be caught at the early stages, when APS is the most effective.

  1. Adult Protective Services vs. Child Protective Services

            When reports of suspected abuse of an older adult are received, APS staff screens the case and makes a determination of APS eligibility.[9]  If eligible, the case is assigned to a caseworker, who then contacts the suspected victim to assess risk, investigate alleged abuse, and determine if the abuse is substantiated.[10]  If substantiated, and the elderly individual wishes to voluntarily accept help, APS can then provide for a variety of services to protect the adult. Additionally, any substantiated case involving criminal activity must be referred to the proper authorities for investigation and potential prosecution.[11]

            Many people link APS with Child Protective Services (CPS) and assume that they are one in the same; however, there are a few major differences between the two.  APS was put in place to benefit all individuals over the age of 18 who are presumed competent and with the right to make their own decisions.[12]  CPS, on the other hand, benefits all children under the age of 18, who are considered legally incompetent.[13]  APS faces a substantial problem when a victim is in need of services but refuses, as they have the right to do.[14]  In contrast, CPS services cannot be refused by the potential victim because individuals below the age of 18 are considered to be incompetent and unable to make that decision for themselves.[15]

            Elderly victims who are experiencing abuse from family members, friends, or neighbors are likely to refuse help out of fear, embarrassment, or the desire to protect their abuser.[16]  Therefore, APS may need to persuade the victim to accept services and, if persuasion is not possible, involuntary services may be forced upon the individual.[17]  For involuntary services to be rendered, an APS agent must show that the affected individual lacks the capacity to understand the consequences of their decision to refuse assistance.[18]

            In Shelton v. Tucker, the Supreme Court held that regardless of whether the government has a legitimate and substantial purpose in providing individuals with protection, the government must use the least restrictive means in doing so.[19]  Consequently, APS should always begin with voluntary interventions and proceed to involuntary interventions only if absolutely necessary to protect the affected individual.  There is a major issue when it comes to protecting individuals who do not want help, or are too scared to accept help, because competent individuals have the right to refuse services and there is little that the State can do to interfere in that right.[20]

            Another factor that distinguishes APS from CPS is the availability of resources allocated to the two agencies.  CPS agencies throughout the state have access to numerous federally funded national resource centers, which provide the agencies with assistance and guidance.[21]  In contrast, APS’s access to federal resources is incredibly limited, making the job of an APS agent even more difficult.[22]  A survey by the Government Accountability Office found that APS programs would benefit exponentially from “more easily accessible and centrally available information on effective interventions, recommended caseload sizes, financial exploitation, and appropriate outcomes for APS cases.”[23]  Without a central resource center for APS, it is unknown how effective the agency actually is.[24]  The majority of APS agencies do not follow identical guidelines, and the lack of research available regarding current interventions makes improving standards very difficult, especially considering the number of cases which go unreported.[25]

  1. Mandatory Reporting

            In New York, Child Protective Services differs substantially from Adult Protective Services with regard to reporting requirements.   It is required by law that numerous officials report suspected child abuse, ranging from medical and hospital personnel to school officials.[26]  Reports of abuse are made to the Statewide Center Register of Child Abuse and Maltreatment which is maintained by the New York State Office of Children and Family Services (NYSOCFS).[27]  NYSOCFS also encourages neighbors, relatives, or concerned citizens to voluntarily report any suspected abuse.[28]

            While there are fourteen states which require every person who suspects adult abuse to report it to APS, New York is one of four states that does not require individual reporting.[29]  However, there are laws in place requiring limited reporting by practitioners who are mandated to report in cases where the elderly individual resides in an institutional setting.[30]  Several Bills have been presented regarding mandatory reporting laws in New York State, nevertheless there has yet to be any real obligation placed upon individuals to protect the vulnerable elderly in the same manner as vulnerable children are protected.[31]

            There are a number of reasons why New York might not want to implement mandatory reporting laws for the sake of an elderly victim.  For example, it might undermine a victim’s autonomy, lead some victims not to seek help, or breach confidentiality.[32]  There are also other reasons, such as the expense of another Statewide Central Register for adult abuse as well as fear of liability issues.[33]  Still, the positive aspects of mandatory reporting of elder abuse far outweigh the negatives.

            Many elderly victims may not even realize they are being victimized because the majority of abusers are family members or people the abused are close to.[34]  Mandatory reporting may improve the victim’s safety by connecting them with APS and the services the agency offers.[35]  Additionally, mandatory reporting may lead to a greater understanding of elder abuse as more and more cases are reported.[36]

  1. Conclusion

            Implementation of mandatory reporting laws in the state of New York with regard to abuse of the elderly population would be beneficial, not only for Adult Protective Services, but for our elder generation as well.  Many elderly individuals are highly susceptible to abuse in the form of financial deprivation, neglect, or physical abuse, and most do not report the abuse for many reasons.  If it were required that those who witness any type of abuse toward the elderly had to report it, APS would have more information regarding this increasing phenomenon and would possibly have the ability to intervene in the early stages, preventing the furtherance of abuse.


[1] Alice Y. Flanagan, Elder Abuse: Cultural Contexts and Implications  27 (2011).

[2]Adult Protective Services, NYS Office of Children and Family Services  http://www.ocfs.ny.gov/main/psa (last visited Feb. 2, 2014).

[3] Flanagan, supra note 1, at 23.

[4]Adult Protective Services, NYS Office of Children and Family Services  http://www.ocfs.ny.gov/main/psa/services.asp (last visited Feb. 2, 2014).

[5] NYS Office of Children and Family Services, supra note 2.

[6] Jessica Mindlin & Bonnie Brandl, Mandatory Reporting of Elder Abuse for Victim Service Providers: 6-Part Series of Information Sheets, Part 1 1 (2011).

[7] U.S. Gov’t Accountability Office, GAO-11-208, Elder Justice: Stronger Federal Leadership Could Enhance National Response to Elder Abuse 14, 41–42 (2011) [hereinafter GAO].

[8] Bonnie Brandl & Tess Meuer, Domestic Abuse in Later Life, 8 Elder L. J. 297, 298 (2000); see also Elder Abuse Prevalence and Incidence Fact Sheet, National Center on Elder Abuse,   http://www.ncea.aoa.gov/Resources/Publication/docs/FinalStatistics050331.pdf (last visited Feb. 2, 2014) [hereinafter NCEA Fact Sheet].

[9] GAO, supra note 7, at 15.

[10] Id.

[11] Id.

[12] NYS Office of Children and Family Services, Adult Protective Services: Scope of Protective Services for Adults,  http://www.ocfs.state.ny.us/main/psa/protectiveservices.asp (last visited Feb. 2, 2014).

[13] NYS Office of Children and Family Services, Child Protective Services, http://www.ocfs.state.ny.us/main/cps/ (last visited Feb. 2, 2014).

[14] NYS Office of Children and Family Services, supra note 12.

[15] See A Parents Guide to Child Protective Services, Preventing Child Abuse New York, (last visited Feb. 2, 2014), http://www.preventchildabuseny.org/resources/for-parents/a-guide-to-child-protective-services/.

[16] Shelly L. Jackson & Thomas L. Hafemeister, Financial Abuse of Elderly People vs. Other Forms of Elder Abuse: Assessing Their Dynamics, Risk Factors, and Society’s Response 31 (2010), available at https://www.ncjrs.gov/pdffiles1/nij/grants/233613.pdf.

[17] Id. at 171.

[18] Id.

[19] See Shelton v. Tucker, 364 U.S. 479, 487 (1960).

[20] Hearing on Justice for All: Elder Abuse, Neglect and Financial Exploitation Before the Senate Special Committee on Aging, 112th Cong. 11–12 (2011) (statement of Marie-Therese Connolly, Senior Scholar, Woodrow Wilson International Center for Scholars) [hereinafter Justice for All].

[21] GAO, supra note 7, at 20.

[22] Id.

[23] Id.

[24] See Justice for All, supra note 20, at 9.

[25] See NCEA Fact Sheet, supra note 8.

[26] NYS Office of Children and Family Services, supra note 13.

27 Id.

28 Id.

29 GAO, supra note 7, at 15–16, 41.

30 Adult Protective Services, NYS Office of Children and Family Services, http://www.ocfs.state.ny.us/main/psa/professionals.asp (last visited Feb. 2, 2014).

31 See Financial Crimes Against the Elderly 2012 Legislation, National Conference of State Legislatures, http://www.ncsl.org/issues-research/banking/financial-crimes-against-the-elderly-2012-legis.aspx#NY (last visited Feb. 2, 2014).

[32] Jessica Mindlin & Bonnie Brandl, Mandatory Reporting of Elder Abuse for Victim Service Providers: 6-Part Series of Information Sheets, Part 2 2 (2011).

[33]  See GAO, supra note 7, at 27, 34–35.

[34] See id. at 1; MetLife Mature Market Institute, the National Committee for the Prevention of Elder Abuse, & the Center for Gerontology at Virginia Polytechnic Institute and State University, Broken Trust: Elders, Family, and Finances 4, 13 (2009),  available at http://www.metlife.com/assets/cao/mmi/publications/studies/mmi-study-broken-trust-elders-family-finances.pdf.

[35] Mindlin & Brandl, supra note 32, at 1.

[36] Id.

6 Comments

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6 responses to “Mandatory Reporting Laws in New York: Why Aren’t We Protecting Our Elderly Like We Protect Our Children?

  1. Pingback: President Obama and Governor Cuomo Step Forward to Combat Elder Abuse | Aging and Longevity Law Institute

  2. Hello there! Do you use Twitter? I’d like to follow
    you if that would be okay. I’m definitely enjoying
    your blog and look forward to new posts.

  3. Frank

    John T Mather Mem Hospital

    Doctor: Kanakoudas,dimos

    Mather Hospital, Failure to Report, Failure to Intervene, Fails 90 Year Old Patient

    Hospital Complaint About: John T Mather Mem Hospital – Kanakoudas,dimos

    New York, Port Jefferson
    Author: Undisclosed
    Hospital Service: No Comment

    Occur date: Jan 30 2013
    Post date: Jun 16 2014, 01:11:33 PM
    Doctor Complaint: Kanakoudas,dimos – John T Mather Mem Hospital

    Mather Hospital, Failure to Report, Failure to Intervene, Fails a 90 Year Old Patient.

    Confirming the Diagnosis of Elder Abuse can be made Exclusively by Documenting “Abruptly Discontinued Pain Medications” without Medical Supervision.

    “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.
    Mather Hospital 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, 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

    Mather Hospital “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”, D
    Mandatory 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 WHILE MEDICALLY UNSUPERVISED, IS ABUSE!

    Patient’s Pain, Suspected Multiple Myeloma Mather Hospital Not Addressing Pain, Withdrawal and Rebound Effects.
    “Complaint: Your Mother’s medications were not appropriately adjusted, causing her condition to be effected”.
    “Response: Your mother’s medications were in fact appropriately adjusted in accordance with laboratory results.” (Letter, Maryanne B. Gordon, MA, RHIA, CHCQM, Administrative Director, Mather Hospital.)
    Which of the following “Laboratory Test Results” done at Mather Hospital, (CMP, APTT, BNP, CBC W/DIFF, Magnesium, Prothrombin Time, Troponin, TSH, Urine Admission, Troponin, Basic Metabolic Panel, CBC, Phosphorus, John T. Mather Encounter Summary, 1/30/13, page 1, Orders:) based upon Medical Science, justifies the “Abrupt Discontinuance” of Vicodin and Prednisone for Cancer Pain, without a substitute, while not being Medically Supervised?
    Looking specifically at pain medications for cancer, due to it’s debilitating effects.
    Mather Hospital Establishes Timeline of Discontinued Pain Medication.

    “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.)

    Withdrawal Symptoms Appear Exactly 2 Days As Would Be Expected.
    “Withdrawal symptoms usually start within a day or two of stopping the medication”.
    © 2014 Addiction Vicodin. All Rights Reserved. Home | XML Site Map | RSS
    “Withdrawal symptoms typically begin within a day or two of stopping the medicine” “I urge anyone in this situation to stop their narcotic medication under their doctor’s supervision”. (Living Well Expert, Dr. Jennifer Shu)
    “15:35 The patient reports chest pain that is located primarily in the substernal area. Onset Yesterday”, John T. Mather Hospital Physician Documentation, 1/30/13, page 1,)
    Abruptly Discontinued 1/27/13, Symptoms 2 Days Later, 1/29/13.
    Mather Hospital’s Knowledge of Vicodin Usage Confirmed.
    “Apparently was on high dose of Vicodin” (Mather Hospital, Consultation Report”, dated 1/30/13, page 1, heading Medications.)

    Prescription given at discharge of Mather Hospital ER, Discharge Instructions, 1/13/13, Vicodin 5-500 mg. Oral Tablet, take 1 tablet(s) by ORAL route every 6 hours as needed; Quantity: 20 tablet(s).
    Vicodin 5 mg. 1q6h prn since 6/30/11, Prednisone 5 mg., 1 in AM and 2 at PM, since 5/31/11, (Primary Care Physician Face Sheet for patient, printed April 16, 2013.)
    “Vicodin daily for 3 years”, (John T. Mather Memorial Hospital Admission Profile, 1/30/13, page 4, Street Drug/Medication/Inhalent Use, Frequency of Street Drug/Medication/Inhalent.)

    Cancer Pain Established, “Symptoms and Laboratory Results” indicative of Multiple Myeloma.

    “Generalized Bone Pain”, (John T. Mather Memorial Hospital Admission Profile, 1/30/13, page 2, Medical Surgical History.)

    Mather Hospital Reference Lab Testing, 2/2/2013, 07:00, “Serum IFE reveals the presence of monoclonal free lamba light chains”.
    Mather Hospital Affiliated Physician. “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.)

    Mather Hospital Physician. “Immunofixation, urine. Bence Jones Protein Positive Lamba Type.” (Joseph P. Boglia, M.D., P.C.)

    Patient’s Pain was from 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.”
    Universally Accepted 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.”

    Medically Supervised Tapering; Universally Recognized Protocol for Discontinuing Vicodin not Established at Mather Hospital.

    “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 Unsupervised 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 Sudden Onset of Cardiac Event Associated with Vicodin, Metroprolol and Prednisone Withdrawal and Rebound Effects and Characteristics of “Broken Heart Syndrome”.

    “The patient was admitted for possible” acute coronary syndrome.”(John T. Mather Hospital Discharge Summary, 1/30/13, page 1, Hospital Course.)

    “SAO2 41% @15%” (Terryville Fire Department, Hospital Patient Record Copy, 1/30/13)

    “Chest Pain” …” (John T. Mather Hospital Discharge Summary, 1/30/13, page 1, Chief Complaint.)

    “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…” (John T. Mather Hospital Physician Documentation, 1/30/13, HPI, 15:35)

    “S1 and S2 Positive”. …” (John T. Mather Hospital Discharge Summary, 1/30/13, page 1, Heart.)

    “Abnormal ECG” (John T. Mather Hospital Nurse’s Notes, 1/30/13, page 1, Diagnosis:)

    ”Rythym is atrial fibrillation With PVC’s” (John T. Mather Hospital Nurse’s Notes Cont, 1/30/13, page 2, Assessment:, Cardiovascular:)

    “17:18 Notified ED physician of critical lab value positive troponin reported to dr. morgan 0.07. (John T. Mather Hospital Nurse’s Notes, 1/30/13, page 2, ED Course:)

    “CARDIAC MARKERS, Troponin 1, 0.06 H, 1/31/13 11:27, BNP 260 H, 1/31/13 09:01”.
    (John T. Mather Hospital Chemistry, Cardiac Markers, 1/31/13, page 2.)

    15:39 “abnormal EKG, acute myocardial infarction, acute pericarditis, anxiety, atypical chest pain, coronary artery disease chest wall pain. (John T. Mather Hospital Physician Documentation Con’t., 1/30/13, page 2, Differential diagnosis:)

    Mather Hospital Confirming “Acute Coronary Syndrome” Associated with Withdrawal and Rebound Symptoms.

    “1/30/13 17:38 Admit ordered for Kanakoudas, Dimos. Preliminary diagnosis are Chest Pain, Abnormal ECG. Problem is new.” (John T. Mather Hospital Physician Documentation Con’t., 1/30/13, page 4, Disposition:).

    Mather Hospital Confirming “Acute Coronary Syndrome” as Withdrawal and Rebound Symptoms by Restoring Opiates and Relieving Symptoms.

    “16:49, Morphine 2 mg., Sub-Q, upper left arm” (John T. Mather Hospital Nurse’s Notes Cont., 1/30/13, page 2, Administered Medications:)

    “17:35, The Patients symptoms have improved, morphine markedly releived the patient’s pain. Symptoms have improved. Pain Meds Pain medication ordered, see orders”
    (John T. Mather Hospital Physician Documentation Con’t., 1/30/13, page 2, Medication Response.)

    “17:35 Moderately improved”, John T. Mather Hospital Physician Documentation Con’t., 1/30/13, page 2, Response to treatment:)

    Mather Hospital Not Addressing the “Abrupt Discontinuation” of Pain Medications for Cancer and the need for Immediate Medical Supervision for the Continuation of Pain and Withdrawal.

    “16:49, Morphine 2 mg., Sub-Q, upper left arm” (John T. Mather Hospital Nurse’s Notes Cont., 1/30/13, page 2, Administered Medications:)

    “16:49, Morphine 2 mg., Sub-Q, ONCE” (John T. Mather Hospital Nurse’s Notes Cont., 1/30/13, page 2, Order Name.)

    “The Patient was Discharged”, 2/2/13. (John T. Mather Hospital Discharge Summary, 1/30/13, page 2, DISPOSITION:)

    FOLLOWUP: “Followup in one or two weeks with primary care physician”. (John T. Mather Hospital Discharge Summary, 1/30/13, page 2,)

    MEDICATION: “As per medical reconciliation list.” (John T. Mather Hospital Discharge Summary, 1/30/13, page 2,)

    Only 3 Medications on Reconciliation List Given In Hospital, Pain Medications Neglected for Cancer Pain at Home.

    “Verified Keppra 500mg. orally 2 times a day, 1/30/13, continued as the inpatient order levetiracetam.” (John T. Mather Memorial Hospital Admission Reconcilliation, 1/30/13, Admit Date: 1/30/2013, Discharge Date: 2/2/2013, Att: Kanakoudas, Dimos).

    “Verified Remeron 15mg. orally 2 times a day, 1/30/13, Remeron continued as the inpatient order mirtazapine.” (John T. Mather Memorial Hospital Admission Reconcilliation, 1/30/13, Admit Date: 1/30/2013, Discharge Date: 2/2/2013, Att: Kanakoudas, Dimos).

    “Verified Valium 2.5 mg. tablet bid prn anxiety, 1/30/13, Valium continued as the inpatient order diazepam. (John T. Mather Memorial Hospital Admission Reconcilliation, 1/30/13, Admit Date: 1/30/2013, Discharge Date: 2/2/2013, Att: Kanakoudas, Dimos).

    “diazepam (dispense as Valium) Give 5 milliGRAM(S) Oral 2 times per day for Moderate Pain PRN Special Instructions: HOLD FOR SEDATION Date Due to Review:01-Feb-2013 00:00 **Discontinued**(John T. Mather Memorial Hospital Admission Reconciliation, 1/30/13, Admit Date: 1/30/2013, Discharge Date: 2/2/2013, Additional Current Orders, Att: Kanakoudas, Dimos).

    “levetiracetam (Dispense as Keppra) Give 500mgs. Oral 2 times per day Priority- Time:Routine Rx Date Due to review:01-Mar-2013 00:00 (John T. Mather Memorial Hospital Admission Reconciliation, 1/30/13, Admit Date: 1/30/2013, Discharge Date: 2/2/2013, Additional Current Orders, Att: Kanakoudas, Dimos).

    Mirtazapine (Dispense as Remoron) Give 15 mgs. Oral 2 times per day Priority- Time:Routine Rx Date Due to review:01-Mar-2013 00:00 (John T. Mather Memorial Hospital Admission Reconciliation, 1/30/13, Admit Date: 1/30/2013, Discharge Date: 2/2/2013, Additional Current Orders, Att: Kanakoudas, Dimos).

    Mather Hospital Documents the Knowledge of Discontinued Medications on Admission Dates 1/30/13 and 2/9/13.

    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”, again confirmed reduction to Keppra, Remeron and Valium.

    Hospital “Admission Reconciliation”, 2/9/13, 5:15:46 AM hospital staff document just Valium.

    “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.)

    Hospital “Admission Reconciliation”, 2/9/13, 5:15:46 AM hospital staff document just Valium.

    “Patient was not given aspirin… states patient no longer takes medications”. (Mather Hospital, Physician Documentation, 2/9/13, 21:08, page 2).

    No Longer Taking, Home Medications:
    acetaminophen HYDROcodone 325 mg. 5 mg. oral tablet 1 tab orally every 4 hours, as needed. (John T. Mather Memorial Hospital Admission Reconciliation, 2/9/13, Admit Date: 2/9/2013, Discharge Date: 2/12/2013, Additional Current Orders, Att: Kanakoudas, Dimos).

    No Longer Taking, Home Medications:
    prednisone 5 mg. oral tablet 1 tab orally once a day.
    (John T. Mather Memorial Hospital Admission Reconciliation, 2/9/13, Admit Date: 2/9/2013, Discharge Date: 2/12/2013, Additional Current Orders, Att: Kanakoudas, Dimos).

    No Longer Taking, Home Medications:
    metoprolol succinate 25 mg. oral tablet, extended release 1 tab orally once a day.
    (John T. Mather Memorial Hospital Admission Reconciliation, 2/9/13, Admit Date: 2/9/2013, Discharge Date: 2/12/2013, Additional Current Orders, Att: Kanakoudas, Dimos).

    No Longer Taking, Home Medications:
    levothyroxine 25 mcg (0.025 mg.) oral tablet 1 tablet orally once a day.
    (John T. Mather Memorial Hospital Admission Reconciliation, 2/9/13, Admit Date: 2/9/2013, Discharge Date: 2/12/2013, Additional Current Orders, Att: Kanakoudas, Dimos).

    No Longer Taking, Home Medications:
    citalopram 20 mg. oral tablet 1 tab orally once a day.
    (John T. Mather Memorial Hospital Admission Reconciliation, 2/9/13, Admit Date: 2/9/2013, Discharge Date: 2/12/2013, Additional Current Orders, Att: Kanakoudas, Dimos).

    Verified, Valium 2.5 mg tablet bid prn anxiety (John T. Mather Memorial Hospital Admission Reconciliation, 2/9/13, Admit Date: 2/9/2013, Discharge Date: 2/12/2013, Additional Current Orders, Att: Kanakoudas, Dimos).

    The Results.

    1/14/13: While Patient was taking All Prescribed Medications: Vicodin, Prednisone, Levothyroxine, Lopressor, Keppra, Remeron and Valium Under my Care.

    “Negative for Body Aches”, “Negative for Pain”,

    “Negative for Pain with Movement”, “Negative for Chest Pain”,

    “Negative for Shortness of Breath”, “Negative for Headache”,

    “Negative for Anxiety, Depression” ( John T. Mather Hospital Physician
    Documentation, 1/13/13, page 1, ROS:, 32:31, Constitutional:)

    “The patient appears in no acute distress, alert, awake, (John T. Mather Hospital Physician Documentation, Constitutional Con’t., page 2)

    “The patient does not display signs of respiratory distress, Respirations: normal, Breath sounds: are normal, clear throughout, no rales, rhonchi, no wheezing.” (John T. Mather Hospital Physician Documentation, Constitutional Con’t., 1/13/13, page 2, Respiratory:)

    “Rate: normal, Rythym: regular, Heart Sounds: normal, normal S1 and S2.” John T. Mather Hospital Physician Documentation Physician Documentation, Constitutional Con’t., 1/13/13, page 2, Cardiovascular:)

    ”Pain, that is mild of the thoracic area, ROM normal”(John T. Mather Hospital Physician Documentation Con’t., 1/13/13, page 2, Back:)

    “Orientation is normal, Cerebellar function: normal finger to nose testing, able to perform alternating rapid hand movements, Motor: is normal, moves all fours, strength is normal, Sensation is normal, Deep tendon reflexes are normal”(John T. Mather Hospital Physician Documentation, Constitution Con’t., 1/13/13, page 2, Neuro:)

    “ROM : Intact in all extremities, Circulation: Circulation is intact in all extremities, Joints: All joints appear normal with full range of motion, neurovascular is intact distal to injury” (John T. Mather Hospital Physician Documentation, Constitution Con’t., 1/13/13, page 2, Musculoskeletal/extremity:)
    “Behavior: appropriate for age, cooperative” (John T. Mather Hospital Physician Documentation, Constitution Con’t., 1/13/13, page 2, Psych:)

    “Negative for Chest Pain, Palpatations”, (John T. Mather Hospital Physician Documentation, Constitution Con’t., 1/14/13, page 1, Cardiovascular)

    “This is a well developed, well nourished patient who is awake, alert, and in no acute distress”, ” (John T. Mather Hospital Physician Documentation, Constitution Con’t., 1/14/13, page 2, Constitutional:)

    While Patient was Known to be off Prescribed Medications: Vicodin, Prednisone, Levothyroxine and Lopressor, Not Under my Care.

    “SAO2 41% @15%” (Terryville Fire Department, Hospital Patient Record Copy, 1/30/13)

    “Chest Pain” …” (John T. Mather Hospital Discharge Summary, 1/30/13, page 1, Chief Complaint.)

    “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…” (John T. Mather Hospital Physician Documentation, 1/30/13, HPI, 15:35)

    “S1 and S2 Positive”. …” (John T. Mather Hospital Discharge Summary, 1/30/13, page 1, Heart.)

    “Abnormal ECG” (John T. Mather Hospital Nurse’s Notes, 1/30/13, page 1, Diagnosis:)

    ”Rythym is atrial fibrillation With PVC’s” (John T. Mather Hospital Nurse’s Notes Cont, 1/30/13, page 2, Assessment:, Cardiovascular:)

    “17:18 Notified ED physician of critical lab value positive troponin reported to dr. morgan 0.07. (John T. Mather Hospital Nurse’s Notes, 1/30/13, page 2, ED Course:)

    “CARDIAC MARKERS, Troponin 1, 0.06 H, 1/31/13 11:27, BNP 260 H, 1/31/13 09:01”.
    (John T. Mather Hospital Chemistry, Cardiac Markers, 1/31/13, page 2.)

    15:39 “abnormal EKG, acute myocardial infarction, acute pericarditis, anxiety, atypical chest pain, coronary artery disease chest wall pain. (John T. Mather Hospital Physician Documentation Con’t., 1/30/13, page 2, Differential diagnosis:)

    “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).

    “Deceased” within a month, ( Death Certificate 2/12/13).

    “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)
    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”.
    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

  4. Frank

    Interesting article. Clearly the laws in New York State can enable a homicide to occur within the Hospital.

    An elderly person accidentally consumes a poison, the Health Care Proxy Agent not being aware, thinks that the elderly patient is merely dying of old age. Upon entering the hospital ER the HCP Agent informs staff that the patient is actively dying and request not to have any diagnostic exams, blood work, etc. that would disturb the patient.

    The hospital confers with the diagnosis of dying without performing any diagnostic testing, honoring the agent’s wishes.

    The patient soon passes at the hospital as a result from the reversible, undiagnosed and untreated poisoning.

    In the absence of following the mandate to Diagnose and Prognose, the inherent vulnerability for the unintentional consequences or abuse is inevitable.

    And if this vulnerability is not rectified, what protection is there for elderly patients found in the more common circumstance, that of a Healthcare Proxy Agent who intentionally harms the patient?

    Under these circumstances, by the hospital avoiding this mandate they are in fact contributors in the patients accidental death or homicide.

    If however the hospital intervenes in the patients behalf and report reasonably suspicious activity to APS, the patients right to life may be honored by an investigation.

  5. Frank

    The Fundamentals: Mather Hospital’s Reason to suspect Carbon Monoxide Exposure.

    Sudden Change in Behavioral and Physical Condition. Patients Condition as recent as 1 week prior to Carbon Monoxide Exposure.

    1/30/13 Admission at Mather Hospital

“Awake, Alert and Oriented X 3, (Discharge Summary, 2/1/13 under Neurological)



    “Awake and alert, GCS 15, oriented to person, place, time and situation. (Physician Documentation Cont’. 1/30/13, page 2, Neuro:) 


    “Awake, Alert and oriented x 3”, (John T. Mather Hospital Discharge Summary Dis Date: 2/2/13, Physical Examination:)



    “No deficits noted, patient oriented X3, eyes open spontaneously and obeys commands. Level of consciousness is awake, alert”. ( Mather Hospital Nurse’s Notes Con’t, 1/30/13, page 2, 17:06, Neuro:)



    “Mild Dementia”. (John T. Mather Hospital Admission Profile, 1/30/13, page 4, Neurological Comment.) 



    Patients Symptoms Presented Immediately after Carbon Monoxide Exposure.

    “Weakness, No Meds/ Blood Drawn, wants comfort care, Palliative Care” John T. Mather Memorial Hospital ER Enc, 2/9/13, page 3 of 3).

    “90 YO presents w Fatigue/ weakness-Pt/family would like end of life care”: 1 Admit to Med/Surg
    -comfort Care-0 Labs-Meds PRN-Palliative Consult(Problem List and Plan/Recommendation: John T. Mather Memorial Hospital ER Enc, 2/9/13, page 3 of 3).

    “Weakness/ Fatigue” (John T. Mather Hospital ER, 2/9/13, page 1, Chief Complaint.)

    “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 2/12/13)

    “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).

    Carbon Monoxide Poisoning Symptoms
    Symptoms
    By Mayo Clinic Staff

    Signs and symptoms of carbon monoxide poisoning may include:
    • Dull headache
    • Weakness
    • Dizziness
    • Nausea
    • Vomiting
    • Shortness of breath
    • Confusion
    • Blurred vision
    Loss of consciousness

    Red Flags: No fever associated with symptoms, history of exposure, multiple patients with similar complaints.

    CARBON MONOXIDE EXPOSURE WARNING SIGNS
    Even doctors can have trouble making a carbon monoxide poisoning diagnosis. Experts say two sure signs that carbon monoxide may be at play is when multiple people in the same building begin to experience similar symptoms at the same time. Another sign is that the symptoms seem to disappear or lessen when the person leaves a certain area and gets fresh air.
    John T Mather Mem Hospital
    Doctor: Kanakoudas,dimos
    Mather Hospital Neglects Diagnosing Carbon Monoxide Exposure.

    New York, Port Jefferson

    Hospital Service: No Comment

    Occur date: Feb 09 2013
    Post date: Jun 27 2014, 03:31:46 PM

    “On or about 2/7/13, my Mother was exposed to Toxic Levels of Carbon Monoxide. On or about 2/7/13, 4+ Patients Admitted to Mather Hospital, Diagnosed and Treated for Carbon Monoxide Poisoning. Poisoned were 3 individuals from within my mother’s apartment and a family in an apartment directly above my mother, necessitated they’re hospitalization.”

    “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”. Also 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.”

    The “Standard” Diagnostic Exam for Carbon Monoxide Exposure Carboxyhemoglobin (COHb) Test” was not performed.

    Respir Care. 2013 Oct;58(10):1614-20. doi: 10.4187/respcare.02313. Epub 2013 Mar 19.
    Emergency department management of suspected carbon monoxide poisoning: role of pulse CO-oximetry.
    Sebbane M1, Claret PG, Mercier G, Lefebvre S, Théry R, Dumont R, Maillé M, Richard JP, Eledjam JJ, de La Coussaye JE.
    Author information
    Abstract
    BACKGROUND:
    The RAD-57 pulse CO-oximeter is a lightweight device allowing noninvasive measurement of blood carboxyhemoglobin (S(pCO)). We assessed the diagnostic value of pulse CO-oximetry, comparing S(pCO) values from the RAD-57 to standard laboratory blood carboxyhemoglobin (COHb) measurement in emergency department patients with suspected carbon monoxide (CO) poisoning.
    METHODS:
    This was a prospective, diagnostic accuracy study according to the Standards for the Reporting of Diagnostic Accuracy Studies criteria in consecutive adult emergency department patients with suspected CO poisoning. S(pCO) was measured with the RAD-57 simultaneously with blood sampling for laboratory blood gas analysis. We made no changes to our standard management of CO poisoning. Blood COHb > 5% for non-smokers, and > 10% for smokers were applied as the reference standard.
    RESULTS:
    We included 93 subjects: 37 smokers and 56 non-smokers. CO poisoning was diagnosed in 26 subjects (28%). The S(pCO) values ranged from 1% to 30%, with a median of 4% (IQR 2.7-7.3%). The COHb values ranged from 0% to 34%, with a median of 5% (IQR 2-9%). The mean differences between the COHb and S(pCO) values were -0.2% ± 3.3% (95% limits of agreement of -6.7% and 6.3%) for the whole cohort, -0.7% (limits of agreement -7.7% and 6.2%) for the non-smokers, and 0.6% (limits of agreement -5.0% and 6.2%) for the smokers. The optimal thresholds for detecting CO poisoning were S(pCO) of 9% and 6% for smokers and non-smokers, respectively.
    CONCLUSIONS:
    S(pCO) measured with the RAD-57 was not a substitute for standard blood COHb measurement. However, noninvasive pulse CO-oximetry could be useful as a first-line screening test, enabling rapid detection and management of CO-poisoned patients in the emergency department.
    KEYWORDS:
    CO poisoning; CO-oximetry; carbon monoxide; emergency department; pulse oximetry; sensitivity; specificity
    PMID: 23513247 [PubMed – indexed for MEDLINE] Free full text

    Mather Hospital’s Failure to perform other tests to determining the degree of potential damage of Carbon Monoxide Exposure.

    Stephen R. Thom, M.D., Ph.D.
    Carbon Monoxide Poisoning
    Testing for CO Poisoning
    Doctors typically measure the patient’s levels of carboxyhemoglobin (COHb) to confirm the diagnosis of CO exposure.(61)

    EKGs and plasma screens are also done, both because of the risk of circulatory system damage from CO and in light of the fact that those who suffer an acute cardiac injury from CO poisoning have an increased risk for cardiovascular-related death in the following 10 years. A chest X-ray also should be part of the ER evaluation, especially in cases of smoke inhalation.(62)(63)

    Confirmation of diagnosis
    • The key to confirming the diagnosis is measuring the patient’s carboxyhemoglobin (COHb) level.
    Carbon Monoxide levels can be tested either in whole blood or exhaled air.
    It is important to know how much time has elapsed since the patient has left the toxic environment, because that will impact the COHb level. If the patient has been breathing normal room air for several hours, COHb testing may be less useful.
    • The most common technology available in hospital laboratories for analyzing the blood is the multiple wavelength spectrophotometer, also known as a CO-oximeter. Venous or arterial blood may be used for testing.
    • A fingertip pulse CO-oximeter can be used to measure heart rate and oxygen saturation, and COHb levels. The conventional two-wavelength pulse oximeter is not accurate when COHb is present. An elevated COHb level of 2% for non-smokers and >9% COHb level for smokers strongly supports a diagnosis of CO poisoning.

    COHb levels do not correlate well with severity of illness, outcomes or response to therapy so it is important to assess clinical symptoms and history of exposure when determining type and intensity of treatment.

    Other testing, such as a fingerstick blood sugar, alcohol and toxicology screen, head CT scan or lumbar puncture may be needed to exclude other causes of altered mental status when the diagnosis of carbon monoxide poisoning is inconclusive.

    Guidance for Management of Confirmed or Suspected CO Poisoning
    • Administer 100% oxygen until the patient is symptom-free, usually about 4-5 hours. Serial neurologic exams should be performed to assess progress, and to detect the signs of developing cerebral edema.
    • Consider hyperbaric oxygen therapy (HBO) therapy when the patient has a COHb level of more than 25- 30%, there is evidence of cardiac involvement, severe acidosis, transient or prolonged unconsciousness, neurological impairment, abnormal neuropsychiatric testing, or the patient is ≥36 years in age. HBO is also administered at lower COHb(<25%) levels if suggested by clinical condition and/history of exposure.
    • Hyperbaric oxygenis the treatment of choice for pregnant women, even if they are less severely poisoned. Hyperbaric oxygen is safe to administer and international consensus favors it as part of a more aggressive role in treating pregnant women.
    Other Considerations
    • Cardiac injury during poisoning increases risk of mortality over 10 years following poisoning, so in patients with severe CO poisoning, it may be important to perform an EKG and measurement of troponin and cardiac enzymes.
    • Chest radiography is recommended for seriously poisoned patients, especially those with loss of consciousness or cardiopulmonary signs and symptoms. Brain computed tomography or MRI is also recommended in these cases; these tests may show signs of cerebral infarction secondary to hypoxia or ischemia.
    • All discharged patients should be warned of possible delayed neurological complications and given instructions on what to do if these occur. Follow-up should include a repeat medical and neurological exam in 2 weeks.

    While Medical Records Suggest that Carbon Monoxide Exposure was Not Disclosed and Diagnosed, it also Demonstrates the Rapid Deterioration in Health from 8 Days Prior to Carbon Monoxide Exposure.

    Admission 1/30/13- Not Deemed Incapacitated / Not meeting the Requirements for Hospice Care. Additionally Medicare and AARP United Healthcare Summary’s do not reflect Hospice Care (Medicare Hospice Benefit) or Physician visit from 1/25/13 to ER visit and admission 2/9/13.

    “Cardiovascular: Positive for chest pain, of the mid-sternal area. Respiratory positive for shortness of breath, negative for cough. All other systems were reviewed and are negative”. (Physician Documentation, 1/30/13, page 1 of 4, ROS:)

    “pt is awake alert and comfortable”, (Physician Documentation, 1/30/13, page 1 of 4, Constitutional)

    ”The patient has not recently seen a physician…” (John T. Mather Hospital Physician Documentation, 1/30/13, HPI, 15:35)



    “Pulses equal, no cyanosis. Neurovascular intact. Full, normal range of motion. (Physician Documentation, 1/30/13, page 2 of 4, MS/Extremity)

    “Awake and alert, GCS 15, orientated to person, place, time, and situation. Cranial nerves II-XII grossly intact. Motor strength 5/5 in all extremities. Sensory grossly intact. Cerebellar exam normal. Normal gait. (Physician Documentation, 1/30/13, page 2 of 4, Neuro.)

    “Mild Dementia”. (John T. Mather Hospital Admission Profile, 1/30/13, page 4, Neurological Comment.)

    “Awake, alert, with orientation to person, place and time. Behavior, mood, and effect are within normal limits”. (Physician Documentation, 1/30/13, page 2 of 4, Psych.)

    “17:38 Critical Care not applicable. Condition is improved, problem is new, symptoms have improved.” (Physician Documentation, 1/30/13, page 3 and 4, disposition).

    “The Patient was Discharged”, 2/2/13. (John T. Mather Hospital Discharge Summary, 1/30/13, page 2, DISPOSITION:)


    FOLLOWUP: “Followup in one or two weeks with primary care physician”. (John T. Mather Hospital Discharge Summary, 1/30/13, page 2,)


    10 Days Later, following Carbon Monoxide Exposure and the Continuation of Mather Hospitals lack of Intervention of the Documented “Abrupt Discontinuation” of Medications.

    “Child states the patient is dying” (Nurses Notes 2/9/13).
    “Patient is actively dying, as per daughter” (Physician Documentation, 2/9/13, 21:04, page 1)
    “Weakness/ Fatigue, pt.is a 90 YO F, brought in by her daughter. Pt. palliative/ end of life care @ home-lives with daughter lost power @ home, pt’s daughter would like her mother to be confortable here- does not want any invasive care. Pt. DNR/DNI. Pt confortable @ this time”. (John T. Mather Memorial Hospital ER Enc, 2/9/13, page 1 of 3).

    “Pt’s Family/ HCPXY- refusing labs”, (Medical Decision Making Information: John T. Mather Memorial Hospital ER Enc, 2/9/13, page 3 of 3)

    “90 YO presents w Fatigue/ weakness-Pt/family would like end of life care”: 1 Admit to Med/Surg
    -comfort Care-0 Labs-Meds PRN-Palliative Consult(Problem List and Plan/Recommendation: John T. Mather Memorial Hospital ER Enc, 2/9/13, page 3 of 3).

    “Weakness, No Meds/ Blood Drawn, wants comfort care, Palliative Care” (John T. Mather Memorial Hospital ER Enc, 2/9/13, page 3 of 3).

    “0 LABS”, (John T. Mather Memorial Hospital, ER Problem List and Plan/Recommendation, page 2, 2/9/13)
    “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).
    “Daughter-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).
    “Pt daughter declined a full body assessment” (Nurses Notes, 2/9/13, page 2).
    “Unable to assess- family does not want pt undressed” (John T. Mather Admission Profile, Skin Symptoms, 2/9/13, page 5).
    Unfortunately : Severe Carbon Monoxide Poisoning can be Reversed.

    “70% of patients treated with SEVERE (C0) poisoning survive,”Carbon Monoxide Poisoning”, The Internet Journal of Emergency and Intensive Care Medicine, 1997. 

Vol.1 N2. at a COHb level of about 40%, Carbon Monoxide starts to cause Coma and Collapse.”

    Am J Emerg Med. 1993 Nov;11(6):616-8.
    Coma reversal with cerebral dysfunction recovery after repetitive hyperbaric oxygen therapy for severe carbon monoxide poisoning.
    Dean BS1, Verdile VP, Krenzelok EP.
    Author information

    Abstract
    The accepted beneficial effects of hyperbaric oxygen (HBO) include a greatly diminished carboxyhemoglobin (COHgb) half-life, enhanced tissue clearance of residual carbon monoxide (CO), reduced cerebral edema, and reversal of cytochrome oxidase inhibition, and prevention of central nervous system lipid peroxidation. Debate regarding the criteria for selection of HBO versus 100% normobaric oxygen therapy continues, and frequently is based solely on the level of COHgb saturation. Patients who manifest signs of serious CO intoxication (unconsciousness, neuropsychiatric symptoms, cardiac or hemodynamic instability) warrant immediate HBO therapy. An unresponsive 33-year-old woman was found in a closed garage, inside her automobile with the ignition on. Her husband admitted to seeing her 6 hours before discovery. 100% normobaric oxygen was administered in the prehospital and emergency department settings. The patient had an initial COHgb saturation of 46.7%, a Glasgow coma score of 3, and was transferred for HBO therapy. Before HBO therapy, the patient remained unresponsive and demonstrated decerebrate posturing and a positive doll's eyes (negative oculocephalic reflex). The electroencephalogram pattern suggested bilateral cerebral dysfunction consistent with a toxic metabolic or hypoxic encephalopathy. The patient underwent HBO therapy at 2.4 ATA for 90 minutes twice a day for 3 consecutive days. On day 7, the patient began to awaken, was weaned from ventilatory support, and was not soon verbalizing appropriately. A Folstein mental status examination showed a score of 26 of 30. Neurological examination demonstrated mild residual left upper extremity weakness and a normal gait. There was no evidence of significant neurological sequelae at 1 month follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)
    Comment in
    • The science (or lack thereof) in the treatment of carbon monoxide poisoning. [Am J Emerg Med. 1994]
    • Randomized clinical trial in carbon monoxide poisoning needed. [Am J Emerg Med. 1994]
    PMID: 8043054 [PubMed – indexed for MEDLINE]

    The facts presented in my mother’s encounters with Mather Hospital exposes a weakness in Healthcare Proxy Law. With regards to “honoring a Healthcare Proxy Agents wishes” to not “examine, obtain vitals’, diagnose, treat, deny hydration and nutrition” must first follow at least a minimal Examination, Blood Panel and Toxicology Tests.

    Not performing toxicology tests and other diagnostics when Carbon Monoxide Poisoning had been identified and treated from her apartment is troubleing. Not examining the patients skin because the HCP Agent does not want the patient to get undressed is especially worrisome.

    If tests are not performed based upon reason, a Healthcare Proxy Agent with the wrong intentions for whatever reason, can easily poison the principal, and as my mother’s Carbon Monoxide event has proven, the Hospital will enable the death and dispose of the body.

    There is evidence that Mather Hospital had not obtained a copy of the Healthcare Proxy Document related to the Agent, who’s activities are in question. Normally documents containing directives on the patient’s healthcare wishes would be available for examination, authentification and guidance.

    Mather Hospital has transformed me from a victim of the consequences of Elder Abuse/ Neglect, Defamation and Humiliation to a committed Elder Advocate. Within the next several years I will be seeking to change the laws for the protection of the Elderly, with the laws deficiencies clearly demonstrated with mine and my mother's experience at Mather Hospital.

  6. Frank

    Below is the response when the Animal Rights Organization, PETA was presented with my mother’s circumstances as a dog.

    A hypothetical example I am using on a paper on the relationship of human and animal
    rights in healthcare.

    REPLY:
    The laws for the type of situation you are suggesting vary in different jurisdictions. I would suggest that you contact the police in the jurisdiction where this hypothetical case takes place to learn the specific laws that concern your questions.

    If a situation such as this should ever arise in reality, please contact PETA immediately and we will do everything we can to help. Thank you for your compassion towards animals.
     
    Lindsay Greenfield, PETA

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