Showing posts with label Hospital. Death. Show all posts
Showing posts with label Hospital. Death. Show all posts

November 5, 2019

{Final CHAPTERs 6,7) "UNPLUG" at Barnabas

 By Joe Sexton and Nate Schweber





CHAPTER 6
“News to Me”

OFFICIALS WITH the New York State Department of Health said that, prior to the summer of 2018, the department had never investigated a case where the wrong person had been taken off life support. Close to a year later, it closed the investigation, finding no fault with St. Barnabas.

The department, by law, is not obligated to make much about its investigation public, but it shared some facts and a redacted version of some of the investigative records.
Jonah Bruno, a department spokesman, said the investigation began “immediately following the patient’s death.”

What exactly that initial inquiry involved is unclear. But it apparently wasn’t enough. The article in the New York Post in January 2019, which noted the lawsuit against St. Barnabas brought by Powell and Dudelson, appears to have provoked another examination by the state.

“A broader investigation was triggered by media reports in January that indicated the circumstances surrounding the patient’s death and identification may have been inconsistent with the information obtained by the Department during its initial review,” Bruno said.

The state would not say what the inconsistencies in information were or how the second inquiry was broader. But it said the information given to it by St. Barnabas had been accurate.
Bruno issued a statement in August summarizing the state’s findings.

“The New York State Department of Health conducted an investigation of St. Barnabas Hospital to review the actions taken by the hospital upon the admission in July 2018, of an individual who was unconscious and ultimately misidentified as another person,” he said. “The investigation determined that the hospital had a policy in place regarding the process for determining the identity of a patient in situations like these. Evidence indicated that the hospital followed its policy. As a result, there is no regulatory standard under which the hospital will be cited.”

St. Barnabas, having learned of the state’s findings, seemed grateful, if a bit surprised. The state had credited the hospital with having followed its policies for identifying an unconscious patient, and yet, when asked what those policies were, St. Barnabas said there actually weren’t any. If someone is admitted bearing identification and visiting family members don’t alert the hospital to the mistake, there’s not much more the hospital is required to do, St. Barnabas said.

“If the state Department of Health says we do have specific policies, that’s news to me,” a St. Barnabas spokesman said.

David Hoffman, a lawyer, clinical ethicist and lecturer at Columbia University, said St. Barnabas was obligated to do its own “root-cause analysis” — an internal review meant to examine every aspect of the episode to determine if there was anything that could have been done differently then or going forward.

“It’s the ethical obligation born of humility,” Hoffman said. “Any mistake that happened once is going to happen again. You must have an adequate response even to a freak occurrence.”

St. Barnabas would not say if it had done such an analysis, and, when asked, it would not say if it had altered any of its practices or procedures as a result of the mistake. Bruno said the state Health Department’s investigation had not produced any recommendations for possible improvements.

The state’s own records and interviews make clear the inquiry was ultimately quite limited. State investigators did not speak to the Williams or Perry families. The state, while saying Perry had been appropriately treated for his condition, did not explore whether the hospital had properly counseled the Williams family about the patient’s condition or met its obligations for handling the termination of life support.

There is a federal agency that could have launched its own inquiry — CMS, or the Centers for Medicare and Medicaid Services. Asked if it had, CMS said it had accepted the state’s investigation as adequate.

Arthur Caplan, founding head of the Division of Medical Ethics at NYU School of Medicine, said the New York State Health Department should have looked harder at whether St. Barnabas followed the state’s laws governing a hospital’s obligations to families facing end-of-life decisions.

Health care providers treating the terminally ill are required to inform patients and their families of the full range of options for navigating their final days. There are strict protocols for doctors to follow if they have decided ending life support is the appropriate option.

LaTanya Perry, whose husband’s life was ended, wants to know if those laws were followed. Was the Williams family properly advised? If Perry was admitted as an overdose and died of blunt force trauma, had he been properly treated? Had there been any disagreement about the assessment of her husband’s chances? Had staff at the hospice really told the Williams family it would be liable for the costs of continued life support.

Right now, she has only the hospital’s word — the same hospital that saw the wrong person have his life ended.

David Leven, executive director emeritus for End of Life Choices New York, an advocacy organization, said too many health care providers remain uninformed about their obligations under the law.

“The vast majority of doctors have never been trained in end-of-life care, or palliative care, or hospice care,” Leven said. “The vast majority of doctors have not been trained on how to have difficult discussions with their patients, and family members of patients.”

Bruno said the state Health Department makes considerable effort to educate providers with information about their obligations for end-of-life care. He said its surveyors conduct regular checks on whether health care providers — including hospitals and nursing homes — are abiding by the laws on end-of-life care. He said the department provides surveyors with guides for conducting those checks — sample interview questions, lists of documents to review and observations they should make to determine whether the hospital is complying with regulations. The department, he said, had posted ample information about the relevant legislation online.

Bruno said the department over the years had cited providers for violations of federal and state regulations governing end-of-life care. But he conceded the department had never cited a health care provider for violating the laws relating to end-of-life decisions for an incapacitated patient without a health care proxy.

“Why have a law if no one is going to enforce it?” Leven asked.
St. Barnabas said responsibility for Perry’s final days rested with the Hospice of New York.
Hoffman, the bioethics professor, said when a hospital works hard to explore ways of determining whether an incapacitated patient had ever expressed his or her wishes for end-of-life decisions, they often seek out doctors who had treated them before. Talking to those prior doctors, Hoffman said, might have led to a discovery.

“It’s possible,” he said, “they might have figured out they were talking about two different people.”

CHAPTER 7
“Could Have Been Me”


Frederick Williams And Shirell Powell
Frederick Williams, left, and Raheme Malik Perry. (Williams family and Perry family)
   

FREDERICK WILLIAMS sat on a plastic chair inside the chapel at the Anna M. Kross Center, one of the jails on Rikers Island. “Every Moment, Thank God,” reads an inscription on a nearby wall.
Williams was not happy to be back at Rikers, and he later pleaded guilty and accepted a five-year prison term for assault. Still, given everything that happened a year ago, he is grateful to be alive.
“Could have been me,” Williams said of what happened in the Bronx in July 2018.

After his family learned he was not the man who had died at St. Barnabas, they set out to track him down. They eventually learned he’d been arrested that August and had a court date pending.
Williams thus first learned of his role in an improbable saga when he was in what’s known as a “bullpen” — essentially a cage in a courthouse anteroom where inmates are placed to await a hearing before a judge. The public defender representing Williams in State Supreme Court in Manhattan passed him a taped-together single-page letter through the bullpen’s bars. It had been given to the lawyer by two relatives of Williams outside in the public courtroom.

“They want you to read this,” the lawyer told Williams, not having looked at the letter himself.
It was a doozy. Life support. Funeral plans. Mistaken identity. And the joy that he hadn’t died.
“I’m like, what the fuck is going on?” Williams said. “Is this a joke or something?”
Williams said he finished only half of the letter before being called before the judge. He saw two of his siblings in the courtroom, smiling.

When he got back to the bullpen, Williams finished the letter.
“I kept reading it and reading it and reading it,” he said. “Thinking the words would change.”
Williams, in an interview, did his best to reconstruct the events of the summer of 2018.

At the time, he said, he had been renting an apartment in Lower Manhattan, but because of issues with his landlord, he and his girlfriend often found themselves sleeping on the street. He said he remembers losing his state ID while roaming the streets of Manhattan. He said he often stuck flyers and other papers in his pocket and believes the ID tumbled out with some flyers.

“It’s got your picture on it, it says your name, date of birth,” Williams said of the ID. “You could use it just about anywhere.”

He said he didn’t apply for a replacement because he still had what he called his “welfare” ID card. It substituted just fine, he said.

On July 1, Williams was arrested for assaulting his landlord and was held for several days. Police records show he used an electronic benefits card as his ID.

On Aug. 21, Williams was again arrested, this time for assaulting his girlfriend, and it was at a court hearing for that arrest that he learned of his strange connection to Perry’s death.
Williams, in multiple interviews, said he’d never met Perry.

“Until this day, right now, I didn’t know his name,” Williams said in the interview this summer.
Later shown a picture of Perry, Williams insisted he didn’t recognize him.
“I just send my condolences,” Williams said.

Williams acknowledges the remarkable series of events and coincidences that had to happen to produce the error at St. Barnabas. He had to lose an ID he’d had for years. It had to wind up in the pocket of a man close to him in age and appearance. That man had to have fallen in the street close to a hospital that had once treated Williams and had his information on file. The discovery of the misidentification happened only because both men had criminal records and fingerprints in a database.

“This,” he said by way of summary, “is crazy.”
What feels almost as crazy is that Williams has the rare opportunity to pass judgment on his family’s decision to end his life.

Thaddeus Pope, a law professor and the director of the Health Law Institute, said no one really knows if the decision to end an incapacitated patient’s life is, in truth, what they would have wanted. The scholarship that does exist, he said, has consistently shown that the decisions surrogates make for loved ones are often mistaken.

Williams, for his part, said he was touched that his family seemed to rally to his situation. His siblings showed up; his child came to see him; the decision to let him die was not made hastily; he liked their idea to bury him next to his adoptive mother.

But he admits he was at first angry and hurt that his family was willing to give up hope.
“If it was me,” he said, “why would you pull the plug?”

November 4, 2019

{Chapters 4,5} HowDoes This S*Happens? UNPLUG at Barnabas



 Picture by adamfoxie

 
 By Joe Sexton and Nate Schweber



CHAPTER 4
“How Does This Shit Happen?

ALEXANDER M. DUDELSON’S 23rd-floor law office on Court Street in Brooklyn has a spectacular view of New York Harbor. The Statue of Liberty is off to the left; One World Trade Center is off to the right.

The case files stacked inside that Brooklyn office, however, offer a window into less glorious sides of New York — angry divorces, fights over estates, stolen property, a disputed murder conviction. A plaque, given as a gift, sits on Dudelson’s desk: “The Wolf of Court Street.”

“I’m not smarter than anybody,” Dudelson said. “I just put in the time other people may not. I like to learn, that’s the thing. If I have to read 20 books on my own time to figure it out, I’ll do it.”
No book prepared Dudelson for the case that walked into his office last fall. Shirell Powell, one of Frederick Williams’ sisters, told Dudelson the story of what had happened at St. Barnabas. Her family had been told there was no hope for her brother, and they took him off life support only to be told the patient on the respirator had been someone else. She was distraught. She wanted someone to do something.

Dudelson said he found the tale hard to believe.

“Well, I believed her, I mean, I just couldn’t believe, you know, how does this shit happen?” he said.
On Jan. 23, 2019, Dudelson filed suit against St. Barnabas in State Supreme Court in the Bronx.

“The defendants negligently misinformed the plaintiff that her brother Frederick Williams was admitted to the hospital in an unconscious state. The defendants negligently misinformed the plaintiff that her brother had died on July 29, 2018. As a result of the defendant’s misinformation and negligent conduct the plaintiff has suffered severe emotional harm and injuries.”

St. Barnabas, in response, did not deny the mix-up, but argued it was not liable for any damages because no member of the Williams family — not Frederick, not Shirell — had actually been a patient at the hospital. The hospital asked a judge to dismiss the case.
Powell’s lawsuit was reported in a daily story inside the New York Post on Jan. 27, 2019. It did not report the identity of the person taken off life support, but the story was reproduced on a slew of news websites.

LaTanya Perry found the article on her Facebook feed. It had been aggregated on a website called Dearly.com. She eventually realized the story involved Raheme’s death, that he was the unidentified dead man in the article. Months into her efforts to figure out the details of her husband’s death, she saw in Dudelson, who’d been quoted in the article, someone who might help. Maybe Dudelson would represent her, too.

She met Dudelson in his Brooklyn office. He was quite certain she had a case. He was less certain he could represent both families. He arranged for her to call Powell to see if everyone was comfortable with the idea. He got Powell on speaker phone and left the room.

When the conversation was over, Dudelson was representing both families.
“It’s not normal,” Dudelson said. “You don’t see this case in the law journal.”


Image result for bethany baptist church, brooklyn
 Bethany Baptist Church (2015) Brooklyn
                     


CHAPTER 5
“Mommy, We Did That to Somebody Else”

WHEN BROOKLYN LEWIS heard her father, Frederick Williams, was desperately ill and in the hospital, she decided she had to see him.

Brooklyn was 16, and had only seen Frederick twice before, fleeting moments in two different jails, the last more than a decade earlier. Now, in July of 2018, Brooklyn packed her bags in Richmond, Virginia, and tried to prepare herself for her third meeting, knowing it might also be the last.
Starr Lewis-Jones, Brooklyn’s mother, was worried but said Brooklyn had always wanted a relationship with her troubled and distant dad.

“She has a strong desire to know him,” Starr said.

Starr had met Frederick as a teenager in Queens. He flirted with her on the street, and while she noticed and was intrigued, it was years before she spoke to him. Her parents worked for the New York Police Department, and she was a member of the choir at Bethany Baptist Church. She was, she said, “a good kid,” and Frederick, she said, had the makings of a bad one.

But the two eventually dated, and had back-to-back girls together in 2000 and 2001. Starr, named for her, was the first, Brooklyn the second. Frederick, though, was not cut out for parenthood. He could not control his cocaine habit or his violence, Starr said, and she wound up taking the girls with her to Richmond, where she had family. She left in the middle of the night.

“I remember it was wintertime, and I didn’t even have a coat,” she said. “I bundled them up. I got in the car, and I was just gone.”

In July 2018, Brooklyn ultimately made two trips to see the man she thought was her father. She called her mother after the first visit.

“Oh, God, she called me on video chat,” Starr said. “She was just hysterically crying. I could barely understand her.”

“She was wrecked,” Starr said of Brooklyn. “You anticipate so long seeing somebody, talking to them, knowing them. And then when you find them, that’s the state they are in.”

It’s not clear how recently any of the family members who visited the hospital had seen Frederick. For any number, it had been a while. Brooklyn hadn’t seen him in more than a decade. For Ralph, his adopted brother, it was at least two years.

Pictures taken of the patient at St. Barnabas show that the lower half of his face was largely covered with the plastic apparatus holding the breathing tube. His neck was in a large brace. Another tube traced along his cheek and was taped to his forehead. Any scrapes or cuts were not disfiguring, but it’s hard to know if the face was swollen to some degree. In one picture, pillows obscured the sides of his head. Starr, the woman who had borne Frederick’s children, refused to go into the hospital room given their acrimonious past. But family members showed her pictures of the patient.

“All you really saw was the nose and the eyes,” Starr said. “And it looked like Freddy from the nose and the eyes. It really wasn’t no face we were actually looking at.”

Keshona Williams, one of Frederick’s two blood sisters, had driven through the night with her husband from Sanford, North Carolina, to see Frederick when she’d been told. She had been adopted into the Williams family along with Frederick as a tiny child and was likely the closest to him throughout his life. She said Frederick’s life went off track with his adoptive mother’s death. He was, she said, the youngest of the brood — “her baby.”

She said she’d first been sent a picture of the man in the hospital bed and it looked like her brother. At the hospital, she sat next to him and massaged his legs. She said she thought she saw him try and blink his eyes.

“I was trying to wake him up,” she said.

Keshona said she had a single flash of uncertainty about whether it really was Frederick. Something, she said, didn’t feel right. But the doctors, she said, were certain. Her other family members were, too. She convinced herself, then, that maybe his face looked odd because it was swollen from the incident and the medication.

St. Barnabas did have medical files from his prior treatment at the hospital. Hospital officials would not say what he’d been treated for or what array of information his records contained.

Medical experts said those files, depending on how much information they held and how extensively the hospital staff referred to them, could have raised red flags about who was really in the hospital bed. Were there scars or tattoos that didn’t match? Was there evidence of prior surgery not reflected in either the medical files or on the body of the patient? Perry had himself undergone surgery for the knife wounds he’d suffered weeks earlier and bore the scars.

St. Barnabas would not say what, if any, comparisons were made between the patient and its files.
Williams’ circumstances were certainly complicated when it came to figuring out who should decide what was in his best interests. His natural and adopted parents were dead; his children were minors. He had two natural siblings and a handful of adopted ones.

The available hospital records capture some of the painful details as the days passed.
Sedatives were sometimes required, the notes say, for the patient tended to bite the respirator tube that was helping to keep him alive. “Suffers from shivering,” his medical records noted. “Slight movement left hand and feet in response to pain,” another note read.

Experts say just 30% of Americans have taken steps to make sure their wishes about end-of-life care are spelled out, respected and followed — whether that be by signing what are known as advance directives, or by formally designating someone to serve as their health care proxy. The people who have put in place such safeguards, experts say, tend to be better educated, with intact families and substantial financial resources.

For close to a decade, however, laws have existed in New York detailing a hospital’s responsibilities in administering end-of-life care, and laying out who gets to make the often painful decisions for people who can’t speak for themselves and who lack any designated health care proxy.

For incapacitated patients without health care proxies, New York created a kind of hierarchy of authority. A spouse is the first option, adult children the next. Siblings can make the choices in certain circumstances. If necessary, the law says, the decisions can be left to a category of person listed as “good friend.”

When asked, some Williams family members — Shirell, Crystal, Ralph and Keshona — said little or nothing about any deliberations that took place about who should decide their brother’s fate. Keshona was the most willing to share details.

She said it was “a mess” at the start. Everyone wanted to be heard. No one would listen. Crystal, the oldest sibling, had always made key decisions. But Keshona and Shirell were Frederick’s natural siblings, and they felt that gave them special standing. Emotions ran high. Keshona said the only information the family had about the patient’s treatment was that he was suspected of having overdosed.

Keshona said no one ever told them trauma to his head was an issue as well.
Officials with Hospice of New York, responsible for the misidentified patient’s care over the last four days of his life, didn’t respond to repeated phone calls and a list of written questions.

One of those questions involved an assertion made by two of Williams’ sisters. They said hospital or hospice staff had told them that the family, if it decided to keep Williams alive, would be responsible for the costs going forward. No family member had those kinds of resources.

Keshona said no one at the hospital or hospice formally designated a single family member as the final word on what to do. But she said it became clear to all there were no real options. She said the family was told at a certain point the patient had no brain function.

Keshona said doctors made clear removing the patient from life support was the right call.
“It wasn’t like an ask,” she said. “It was like, this is what’s going to have to happen.”
The family didn’t fight it.

“It was no decision; it was like, it is what it is,” Keshona said. “There was nothing they could do, and that’s just how it’s going down.”

Keshona had returned home by July 29. She was on speaker phone when the respirator was removed.
She heard someone say, “He’s still breathing,” and then someone say, “We love you.”

When Keshona first heard that the medical examiner’s office had discovered the mistake, she thought the hospital had sent the wrong body to the morgue. At least two Williams family members went to the medical examiner’s office. Both still thought the corpse was Frederick.

Once the family finally accepted what had happened, they spread the word. Frederick was alive.
“I didn’t know what to say,” said Ralph.
“It wasn’t him, thank the Lord,” said Crystal.

Brooklyn was back in Richmond when word reached the household that her father was not dead. She had been making arrangements to make yet another trip to New York for the funeral. Starr, her mother, thought Brooklyn would be thrilled. Brooklyn, hearing the news, was indeed glad. But she also broke down.

“Mommy, who was in that hospital?” she asked through tears. “Where’s his mom?”
Starr did her best to explain and comfort. But she knew as little as everyone else.
“Mommy, we did that to somebody else,” Brooklyn sobbed.
“Yeah,” Starr said. “Yeah, baby.”


Two more chapters to come and the Epilogue will beTuesday

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