Hello,
I wondered if you could kindly help me as to whether my mother would have a medical malpractice case.
My mother is 88 years old and has esophageal cancer.
When she was diagnosed over 2 years ago, she was told that the cancer had spread to multiple lymph nodes outside of the esophagus and that it was not curable.
She had been receiving chemotherapy for over 2 years now at a very large hospital and medical center.
Her heart was fine up to the last three chemo sessions. However, the last three chemotherapy sessions caused her to suffer heart problems.
More specifically, two of the last chemotherapy sessions caused atrial fibrillation (her heart started beating at a very fast pace of about 120 to 130 beats per minute).
She went to the emergency room and hospital – the same hospital where she has been receiving chemotherapy - twice and stayed overnight each time until her heart rate was brought under control.
After the latest chemotherapy session, I rushed her to the same hospital for the third time.
This time, the hospital found that she had very low white blood cells and that she had a colon infection and fever (as well as atrial fibrillation) all as a result of the chemotherapy. They gave her various antibiotics for the colon infection and shots to boost her white blood cells. She was scheduled to leave the hospital in about 9 days.
During her hospital stay, however, her heart developed a new problem. Her heart rate would suddenly drop to 30…20…10…5…0 beats per minute…In other words, her heart would pause for about 4 seconds or so. Despite these pauses which happened a number of times each day, my mother was not experiencing any symptoms.
To manage this problem, the hospital staff kept her heart rate high – in the 120s or so – which means they made sure my mother was experiencing atrial fibrillation which itself is not good.
However, the hospital staff said it was much less dangerous to have the high heart rate rather than the low heart rate which causes pauses since the pauses could actually cause her to pass away.
They kept my mother’s heart beating at a very high rate by continuously giving her a number of drugs intravenously.
The hospital staff said that they would eventually discharge my mother – once the colon infection and low white blood cells were okay - and send her to a Skilled Nursing Facility since the heart pauses were not causing her any symptoms.
They said that if the pauses caused any symptoms, then a pacemaker would eventually be required.
On the 9th day, which happened to be a Friday, just as my mother was about to be discharged to go to the Skilled Nursing Facility, her heart paused for over 7 seconds (instead of 4 seconds). This time, she experienced dizziness, lightheadedness, and lost consciousness.
Her body reacted the way I would imagine someone would react if they are having a seizure. Her whole body was shaking, her eyes closed, she would cry out “oh…oh…oh…,” her head would shake up and down for over 7 seconds and she would lose consciousness and feel disoriented for a while when she regained consciousness. It was scary to see.
Despite this, the hospital staff were eagerly trying to discharge her since the low white blood cell problem and colon infection – the problems for which she had initially been hospitalized - had been cured.
Although they told me that only a pacemaker could cure her problem, they did not want to put in a pacemaker.
They claimed that they had spoken to my mother’s oncologist over the phone the previous day and the oncologist had mentioned that my mother only had six more months to live. Apparently, the oncologist had told the cardiologists that my mother cancer had spread to her lungs.
However, the oncologist never told us this.
The over 7 second pauses occurred on a Friday at around 12 p.m. Between 12 p.m. and 3 p.m., while my mother was going though these over 7 second pauses and experiencing these terrible seizure-like symptoms, all the cardiologists gathered around me. They did not seem the least bit concerned about what she was going through and were very nonchalant and indeed a few of them were laughing about the situation.
The cardiologists mentioned that implanting a pacemaker would only prolong my mother’s suffering since she had terminal cancer, that pacemakers often do not work well and that my mother would experience severe heart pain even if a pacemaker was implanted. They described the pain that the pacemaker would cause to her heart to be similar to the pain one would experience if a horse were to kick your heart. They claimed that they had implanted a pacemaker in one patient who was in his 30s and that he was suffering great pain due to the pacemaker.
In any event, since I insisted that I would not allow my mother to leave the hospital until she stopped having these terrible symptoms and since it appeared from the numerous pauses that she was experiencing during the time the cardiologists were having these discussions with me that she might pass away, the cardiologists transferred my mother to the cardiology section, which is located in a different section on the same floor of the same hospital.
From around 12 p.m. and 1 p.m. on Friday, the Cardiology team gave my mother a number of electric shocks and other treatment to revive her and to prevent her from continuing to experience these terrible pauses. They mentioned that she needed a pacemaker but they added that since she had only 6 months to live, it was not worthwhile to implant a pacemaker.
After my mother received the electric shocks and stopped having pauses, the cardiologists mentioned that the electrophysiology team (the doctors responsible for implanting pacemakers) would come by later to talk to me about the pacemaker issue.
The electrophysiology team came by at around 3 p.m. on the same day, Friday, and said that they can’t put in a pacemaker since her oncologist had said she only has 6 months to live.
They mentioned that Medicare would not pay for a pacemaker unless the patient was expected to live at least a year.
They said they would keep my mother at the hospital over the weekend, and give her medications to increase her heart rate, control the rhythms, and restart the heart every time she had long pauses. Once her heart rate was back to “normal” – whatever that means – they would discharge her.
Later that day (Friday) at around 5 p.m., I was able to speak to my mother’s oncologist over the telephone. (The oncologist works for the same hospital and medical center).
The oncologist told me over the phone that the cancer had NOT spread to my mother’s lungs.
However, he claimed that the cancer was causing stress to her heart and lungs. The oncologist also said that he didn’t want to do anymore chemo due to the fact that the chemo damages her heart so he thinks she won’t live long if she can’t be given anymore chemo although he did not mention how long he thought she would live.
My mother stayed at the hospital all night Friday and Saturday while they gave her various drugs intravenously most of which was designed to keep her heart at a very high rate (120s or so) in order to prevent pauses.
However, every time the drugs would wear off and my mother’s heart rate returned to a normal rate (70s or so), her heart would eventually drop to a lower rate and pause for over 7 seconds. I witnessed her having many pauses Friday night and Saturday, and the pauses were are all long ones that caused her head and body to shake and respond in the way I imagine someone would respond when they are being electrocuted.
The hospital staff told me that there was nothing that they could do and that she would continue to experience pauses while she continued to receive the drugs that would eventually help her heart return to “normal.”
A major part of the hospital’s strategy was to keep my mother’s heart beating at an atrial fibrillation rate (120s or so) which is safer than pauses.
However, the hospital staff admitted that if my mother’s heart continued to beat at a very fast pace over a month or so, the high heart rate would damage her heart muscles.
My mother remained in the hospital on Friday afternoon – when the heart problem started - and received various drugs intravenously all day Saturday and Sunday to “improve” her heart.
On Sunday I decided to contact Medicare – they are open 7 days a week - and they told me that Medicare will pay for the pacemaker as long as the hospital enters the right diagnostic code.
Apparently, Medicare doesn’t care if the oncologist says that the patient has 6 months to live since the oncologist could be wrong. According to the Medicare staff member I spoke to, as long as the doctor states that the pacemaker is a medical necessity, Medicare would pay for the surgery.
Therefore, the hospital’s cardiology team’s claim that Medicare would not pay for a pacemaker unless the patient had a life expectancy of over a year was not true.
After hearing this I went to the hospital on Sunday at around 11 a.m. It so happened that between 7 a.m. and 11 a.m., my mother’s heart rate had been “stable” – meaning no pauses - so one of the doctors walked into her room and said that they were discharging her because she was feeling okay.
I told him that Medicare does pay for pacemakers and that she needed a pacemaker since she was experiencing so many scary pauses on Friday and Saturday and she would probably continue to have pauses. We argued about the issues for quite a while but I did let him know that my mother wanted and needed to get a pacemaker.
About 10 minutes after the doctor left the room, my mother once again experienced one of those long pauses where her body shook violently and she lost consciousness. So much for the “stability” of her heart.
A few hours later, on Sunday, the Head of the Cardiology department and another doctor came by and spoke to us and verified whether we really want a pacemaker. We said yes. He said that they would perform surgery to put a temporary pacemaker tomorrow, Monday, and they would implant a permanent pacemaker a few days later when they got one.
On Monday morning, we were told that my mother would get a permanent pacemaker the next day, i.e., on Tuesday.
However, now they said that they had paged her oncologist, that her oncologist was coming to the hospital in person to talk to my mother to tell her that she only had about 6 months to live and to verify whether my mother really wanted a pacemaker in light of her short life expectancy. After some argument, I told them that we didn’t need to talk to the oncologist.
About an hour later, they told us that she was going to have surgery to get a permanent pacemaker at 2:30 p.m. on that same day, Monday.
The surgery was done on Monday at 2:30 p.m. It went very well and was over by 4 p.m. My mother was awake and alert and said that during the surgery, she was conscious and felt no pain.
My mother was discharged the next day, Tuesday, and was discharged to a Skilled Nursing Facility. She stayed at the Nursing facility for 3 weeks and she is now at home.
Very recently, about a month after my mother received a pacemaker, she experienced shortness of breath and swelling around her leg and ankle.
We visited her cardiologist a few days ago, and he stated that there may have been a fluid buildup in her body. For now, he gave her a water pill (diuretic) and potassium and had her do a blood test. We will get the results of the blood test in a few days. However, the shortness of breath and leg/ankle swelling can be an indication of congestive heart failure.
The oncologist – who works in the same hospital and medical center - who gave my mother chemotherapy over the past 2 years damaged her heart and caused her to experience atrial fibrillation and to stay in the hospital due to heart problems on 3 occasions.
The hospital would not put in a pacemaker for 3 days causing my mother to experience much pain and suffering.
And it appears that the atrial fibrillation and the fact that the hospital kept her heart beating at a fast pace for over a week – in order to avoid pauses – may have caused congestive heart failure.
In light of the above details, I was wondering if my mother has a case against the hospital and medical center.
I would greatly appreciate any help and advice. Thank you very much for your time and kind assistance!
Tom