Brain Dead & Comatose = synonyms per news w/s. Preg. Lisa Avila, 37, Orange Co, CA

[jjenny]

Apparently it's not that unusual for ER to miss an ectopic pregnancy, as it's the leading cause of emergency malpractice claims.

"Clinicians should consider the diagnosis of ectopic pregnancy in any woman in the first trimester of pregnancy who has abdominal or pelvic pain, vaginal bleeding, or both.[1] Ectopic pregnancy is the most common cause of pregnancy-related death in the first trimester and accounts for about 10% of all pregnancy-related deaths. Missed ectopic pregnancy is a leading cause of emergency medicine malpractice claims."

http://emedicine.medscape.com/article/104382-overview

 

[Hiandmighty]

I agree its possible the pregnancy was neither in the uterus nor the fallopian tubes. ETA: but, yeah, sending a 12 week pregnant woman home with Percocet needs to be justified. (The script shown on a news story shows Percocet).

The latest update is the family is removing the vent tomorrow. Their outside doc did the tests and the tests show Lisa is brain dead. The family accepts this and seem to indicate that since their doc (chosen by their atty) was not affiliated with this hospital, they trust the results.

This is in their fundraising site, the other one not the one mentioned above. "Mother in a coma".

 

[gitana1]

I haven't been following this closely-- travelling a lot lately. However, I see 2 separate issues here-- the misdiagnosis of the ectopic pregnancy, and the occurrence of brain death.

I read in one article that she was 12 weeks pregnant, and this was her 8th pregnancy (at least). I'm really, really confused as to how an emergency dept could "miss" a 12 week ectopic-- from my experience, I don't think a 12 week pregnancy can "fit" inside a fallopian tube-- they usually rupture a lot earlier than that, so I have to wonder if it was implanted outside the tube in the abdomen? I just don't understand the circumstances whereby a gravida 8, 12 week pregnant woman, with acute abdominal pain would be sent home from ER with a MSO4 script?? Granted, we have no idea what was done or not done at the hospital, and only have the family's version. But something is very, very wrong with that story, as they have told it. I'd expect a malpractice suit will be filed to find out what happened, and they have every right to that.

And the second issue-- this very unfortunate woman is now brain dead, for several weeks, if I have that right? Tremendously sad-- a real tragedy, as she was quite young at 36. The one article says 5 separate docs have verified the brain death critieria (including the not-required, but definitive intracranial flow studies), so I have no doubt that they are correct, and she is irreversibly brain dead. I wonder if the courts will do what they did in Jahi McMath's case-- allow the family to take her, after initiating a death certificate? It's a good compromise for families who refuse to accept brain death, but it does contribute to setting a disturbing precedent.

Somehow, the states all need to come together to have a consensus conference on what to do in these circumstances of brain death with family refusal of diagnosis, because while rare, there have been so many in the news lately that we need a large scale discussion on this, IMO. Just as we did back in the 70's and 80's on the Uniform Determination of Death Act. I don't think it's good to leave the mechanism for resolving these kinds of decisions in the hands of individual judges and individually filed lawsuits, for the long term, for many reasons.

Dead is dead-- families cannot mandate that CPR/ ACLS be continued indefinitely-- why are dead patients on ventilators different? It's hard for me to understand why some people have trouble accepting brain death, although I certainly understand the shock of the diagnosis in the first hours and days. I would want to see the results myself, to be sure-- I do understand that. Is it just because the patient is warm and pink? Why don't people "believe" in brain death, as actual death?

Is there any indication that this case has anything to do with the malpractice caps on payouts for death, versus disability, in California?

Thanks for the excellent info. As to not accepting brain death, it's quite easy for me to understand. I've been through death and fatal diagnoses with loved ones. It's very hard to give up hope. Holding on to hope kept me from losing my mind. It can take a while to go through the stages that allow a person to cope with such a tragedy.

But aside from that, these are sudden deaths involving what appears to be malpractice, at least in the eyes of the family. How on earth are they supposed to except anything stated by the very people they feel caused the catastrophe to begin with? To me, it is very easy to understand how they can be in denial.

 

[gitana1]

You would not think of doing that? FWIW, me neither. Personally, I cannot imagine doing that - opening a funding site for myself - at all ever.

What's the point of naming doctors (in funding site, allegedly now saying she's alive)? Rethinking it, prolly none.

Trying to get financial support and prayers? IIUC, funding sites' goals are $. Many websites & other methods for asking for prayers. Guess nothing wrong w combining requests.

That said, I cannot imagine being in the shoes of her family members facing this sudden, out of left-field medical catastrophe. Sad, sad, sad.
Hoping they eventually find answers & healing they seek.

As always, gitana1, thank you for the benefit of your legal knowledge and experience you bring to W/S.

I think it's typically extended family or friends who open such sites. I can't imagine opening such a site either in the middle of something like this. There is no way I would be thinking about financial matters at such a time.

 

[K_Z]

I agree its possible the pregnancy was neither in the uterus nor the fallopian tubes. ETA: but, yeah, sending a 12 week pregnant woman home with Percocet needs to be justified. (The script shown on a news story shows Percocet).

The latest update is the family is removing the vent tomorrow. Their outside doc did the tests and the tests show Lisa is brain dead. The family accepts this and seem to indicate that since their doc (chosen by their atty) was not affiliated with this hospital, they trust the results.

This is in their fundraising site, the other one not the one mentioned above. "Mother in a coma".

So, I'm still trying to understand and piece together what happened before the diagnosis of brain death, because the stories from family just do not add up for me. I realize that this family is not highly educated, and some of the info is probably second or third hand, so may not be accurate.

I found a family support site page (weebly), which I'm not sure is allowed here, so I won't link it. The writer says 2 days prior to Valentine's day, LA had a doc visit and ultrasound. So the pregnancy was apparently medically verified BEFORE the events Feb. 14. The writer says "all was well" at that visit-- so understanding that, an intra-uterine pregnancy with a heartbeat must have been visualized. (10 weeks is definitely easy to see on U/S, and she appears relatively thin in pictures.) The original articles say she was 12 weeks pregnant, this source says 10 weeks.

Then the writer says LA and husband were at a restaurant when the abdominal pain began, and they went to the ER. The writer describes it as extreme pain. A woman who has had 8 pregnancies definitely knows what early pregnancy feels like (and her youngest was only 6 months old, according to this, so this pregnancy came VERY soon after the last baby-- she would have become pregnant only about 3-4 months after giving birth to the last baby.)

The writer says the ER did an U/S, "due to the fact that she was 10 weeks pregnant." Then the writer has some discussion that the hospital told them the pain would pass, they wouldn't take their word for it, and they had to give LA pain medicine to "quiet her down".

When that did not stop the pain, they told Robert to take her home and they will prescribe more pain medication.

After 3 attempts to stay there at the hospital they were finally forced to leave. The medical staff had to wheel chair Lisa out to the car. From there Robert attempted to get to the pharmacy to fill the prescription given to him. The pharmacy was just down the street and he went to drop it off as quickly as possible when he returned to the car a few minutes later, he found Lisa unconscious and not breathing.

So my questions based on this story are, did OB see her? Why was a paper prescription for a controlled substance given to the patient/ family? Unless Anaheim is very far behind the times, that just never happens at an ER anymore. There are a lot of issues with addicted patients ER-shopping for controlled substances (not saying at all this is the case here), so most hospitals have put in place measures to prevent diversion.

Most modern ER's have either automated "vending machine" type prescription filling machines (the ER doc electronically sends the script to the machine, and family use a unique patient-specific code, with cash or credit card, to fill a small amount of meds until an office visit can be made.) Or, they order 24-48 hours of meds in a pre-filled pharmacy bottle (stored in the ER) and give to patient. OR-- a prescription is called in, or electronically sent, to the pharmacy of choice for the family. Especially with controlled substances, I haven't seen an ER write a paper script for controlled substances, and send people on their way, for many years now. The potential for tampering with paper prescriptions, and drug diversion, has forced a lot of changes within the medical industry in recent years. So the story of being given a paper prescription for a controlled substance, that they had to "race to the pharmacy" from the ER to fill before they closed, just clangs my hinky meter. That part of the story sounds very wrong to me.

Then the writer says husband Robert came out of the pharmacy to the car to find LA "unconscious and not breathing", called 911, and LA was rushed back to the hospital they had just left 15 min before, and "rushed into surgery" for an ectopic pregnancy.

So now I'm wondering, did she have a SECOND pregnancy that was ectopic that was missed, because everyone saw the intrauterine pregnancy, and stopped looking? Was OB consulted before they left the hospital the first time? Why would they give controlled substances to a woman with a known first trimester pregnancy, acute abdominal pain, and discharge her? What did the original ER docs tell them was the source of the acute pain? Did they do any lab work? Urinalysis? What kind of discharge instructions were given? There are SOO many things to rule out in a pregnant woman with abdominal pain, that it would take several hours to do all the work ups to rule everything out. Sending her out with a Percocet prescription (or MSO4, or whatever controlled substance it was) just doesn't sound at all right. What did they give her for pain in ER? How busy is this ER?

Why does the family say they tried "three times" to have her admitted? What was going on that there appears to be an antagonistic relationship between the husband and the staff? I also have to wonder what her medical history is, and what the course of her previous pregnancies was. Did she have c-sections, or vaginal deliveries? Did the ER staff have access to any of her past records?

There is just so much that doesn't add up for me in the family's story of what happened. Let alone what happened with the second admission via EMS.

ETA: Here is a good article from only 5 days ago about controlled substance prescribing from ER's in the Los Angeles area.

http://www.scpr.org/news/2015/03/20/50478/county-and-private-hospital-er-s-join-forces-to-co/

The guidelines are designed to educate emergency room doctors on proper opioid prescription practices, as well as help them foil those who go "doctor shopping" in search of these drugs, according to the Department of Public Health.

In addition to L.A. County hospitals, those adopting the guidelines include UCLA Health, Providence Health & Services, Dignity Health, Memorial Care, Adventist Health, Daughters of Charity Hospitals and others. A total of 75 emergency departments signed on to the rules, according to the county.

"The goal is that if all ED’s follow the same guidelines and communicate the same message to patients, we can establish a consistent ED practice throughout the County that can help lead to reduce opioid overuse, abuse, diversion and ED and doctor shopping for pain medications," said Maureen McCollough, a doctor at the county's Olive View-UCLA Medical Center.

Example of automated discharge medication machines:

http://instymeds.com/

 

[K_Z]

Anaheim Regional Medical Center is a 223 bed community hospital. That's a pretty good sized community hospital that definitely has access to OB 24/ 7. (So this is not a tiny rural outpost.)

http://www.anaheimregionalmc.com/Clinical-Services/Obstetrics.aspx

http://www.anaheimregionalmc.com/About-Us.aspx

Quick Facts about Anaheim Regional Medical Center
•223 Beds
•1,200 Employees
•600+ Doctors
• 44,000 patients visit the Emergency Department annually
•Physicians, nurses, and support staff all meet the high standards required for a position on Anaheim Regional Medical Center's medical staff.
•Our Heart Center is one of the only two cardiac receiving centers in North Orange County
•We perform the second largest volume of open heart surgeries in Orange County
• We have the only Safe Place in Orange County.

Each year, The Emergency Department at AHMC Anaheim Regional Medical Center serves 43,000 patients.

We are equipped with a 20-bed ER, laboratory and imaging services that are available 24 hours a day, and staff members who are trained and experienced in Emergency Medicine.

Our Specialized Emergency Care Designations

Orange County Paramedic Base

The Emergency Department is a level two, basic services, paramedic-receiving center and is one of seven Paramedic Bases in Orange County, with thirteen Paramedic Units assigned to it.

 

[Hiandmighty]

So my questions based on this story are, did OB see her? Why was a paper prescription for a controlled substance given to the patient/ family? Unless Anaheim is very far behind the times, that just never happens at an ER anymore. There are a lot of issues with addicted patients ER-shopping for controlled substances (not saying at all this is the case here), so most hospitals have put in place measures to prevent diversion.

Most modern ER's have either automated "vending machine" type prescription filling machines (the ER doc electronically sends the script to the machine, and family use a unique patient-specific code, with cash or credit card, to fill a small amount of meds until an office visit can be made.) Or, they order 24-48 hours of meds in a pre-filled pharmacy bottle (stored in the ER) and give to patient. OR-- a prescription is called in, or electronically sent, to the pharmacy of choice for the family. Especially with controlled substances, I haven't seen an ER write a paper script for controlled substances, and send people on their way, for many years now. The potential for tampering with paper prescriptions, and drug diversion, has forced a lot of changes within the medical industry in recent years. So the story of being given a paper prescription for a controlled substance, that they had to "race to the pharmacy" from the ER to fill before they closed, just clangs my hinky meter. That part of the story sounds very wrong to me.

Then the writer says husband Robert came out of the pharmacy to the car to find LA "unconscious and not breathing", called 911, and LA was rushed back to the hospital they had just left 15 min before, and "rushed into surgery" for an ectopic pregnancy.

So now I'm wondering, did she have a SECOND pregnancy that was ectopic that was missed, because everyone saw the intrauterine pregnancy, and stopped looking? Was OB consulted before they left the hospital the first time? Why would they give controlled substances to a woman with a known first trimester pregnancy, acute abdominal pain, and discharge her? What did the original ER docs tell them was the source of the acute pain? Did they do any lab work? Urinalysis? What kind of discharge instructions were given? There are SOO many things to rule out in a pregnant woman with abdominal pain, that it would take several hours to do all the work ups to rule everything out. Sending her out with a Percocet prescription (or MSO4, or whatever controlled substance it was) just doesn't sound at all right. What did they give her for pain in ER? How busy is this ER?

Why does the family say they tried "three times" to have her admitted? What was going on that there appears to be an antagonistic relationship between the husband and the staff? I also have to wonder what her medical history is, and what the course of her previous pregnancies was. Did she have c-sections, or vaginal deliveries? Did the ER staff have access to any of her past records?

There is just so much that doesn't add up for me in the family's story of what happened. Let alone what happened with the second admission via EMS.

ETA: Here is a good article from only 5 days ago about controlled substance prescribing from ER's in the Los Angeles area.

http://www.scpr.org/news/2015/03/20/50478/county-and-private-hospital-er-s-join-forces-to-co/





Example of automated discharge medication machines:

http://instymeds.com/

I agree that where DH practices, it's all Electronic medical records and electronic prescriptions straight to the pharmacy. My sister is a RN in Norcal and they are JUST starting the process of learning how to implement EMR.

i do suspect they are well behind everyone else for that.


ETA: yes, I have fraternal twins where one was clearly older than the other by at least 5 days. With her age and as many pregnancies as she has had, I do suspect she was pregnant with fraternal twins and one implanted correctly and one didn't.

This would be not as much of a screw up as before, but still a screw up. A critically thinking intern or ER doc may have suspected multiples and kept looking. I wonder if the doc who saw her was inexperienced.


ETA: the script they showed on the news was your typical ER prescription with a sticky label with her information stuck at the top. I'll try to find the link.

 

[jjenny]

The hospital should have suspected an ectopic pregnancy when she showed up in a lot of pain.
So it's a major screw up regardless if she were pregnant with one fetus or two.
I wonder if the hospital wrongly decided she was seeking pain meds instead of actually being in pain.

 

[gitana1]

So, I'm still trying to understand and piece together what happened before the diagnosis of brain death, because the stories from family just do not add up for me. I realize that this family is not highly educated, and some of the info is probably second or third hand, so may not be accurate.

I found a family support site page (weebly), which I'm not sure is allowed here, so I won't link it. The writer says 2 days prior to Valentine's day, LA had a doc visit and ultrasound. So the pregnancy was apparently medically verified BEFORE the events Feb. 14. The writer says "all was well" at that visit-- so understanding that, an intra-uterine pregnancy with a heartbeat must have been visualized. (10 weeks is definitely easy to see on U/S, and she appears relatively thin in pictures.) The original articles say she was 12 weeks pregnant, this source says 10 weeks.

Then the writer says LA and husband were at a restaurant when the abdominal pain began, and they went to the ER. The writer describes it as extreme pain. A woman who has had 8 pregnancies definitely knows what early pregnancy feels like (and her youngest was only 6 months old, according to this, so this pregnancy came VERY soon after the last baby-- she would have become pregnant only about 3-4 months after giving birth to the last baby.)

The writer says the ER did an U/S, "due to the fact that she was 10 weeks pregnant." Then the writer has some discussion that the hospital told them the pain would pass, they wouldn't take their word for it, and they had to give LA pain medicine to "quiet her down".



So my questions based on this story are, did OB see her? Why was a paper prescription for a controlled substance given to the patient/ family? Unless Anaheim is very far behind the times, that just never happens at an ER anymore. There are a lot of issues with addicted patients ER-shopping for controlled substances (not saying at all this is the case here), so most hospitals have put in place measures to prevent diversion.

Most modern ER's have either automated "vending machine" type prescription filling machines (the ER doc electronically sends the script to the machine, and family use a unique patient-specific code, with cash or credit card, to fill a small amount of meds until an office visit can be made.) Or, they order 24-48 hours of meds in a pre-filled pharmacy bottle (stored in the ER) and give to patient. OR-- a prescription is called in, or electronically sent, to the pharmacy of choice for the family. Especially with controlled substances, I haven't seen an ER write a paper script for controlled substances, and send people on their way, for many years now. The potential for tampering with paper prescriptions, and drug diversion, has forced a lot of changes within the medical industry in recent years. So the story of being given a paper prescription for a controlled substance, that they had to "race to the pharmacy" from the ER to fill before they closed, just clangs my hinky meter. That part of the story sounds very wrong to me.

Then the writer says husband Robert came out of the pharmacy to the car to find LA "unconscious and not breathing", called 911, and LA was rushed back to the hospital they had just left 15 min before, and "rushed into surgery" for an ectopic pregnancy.

So now I'm wondering, did she have a SECOND pregnancy that was ectopic that was missed, because everyone saw the intrauterine pregnancy, and stopped looking? Was OB consulted before they left the hospital the first time? Why would they give controlled substances to a woman with a known first trimester pregnancy, acute abdominal pain, and discharge her? What did the original ER docs tell them was the source of the acute pain? Did they do any lab work? Urinalysis? What kind of discharge instructions were given? There are SOO many things to rule out in a pregnant woman with abdominal pain, that it would take several hours to do all the work ups to rule everything out. Sending her out with a Percocet prescription (or MSO4, or whatever controlled substance it was) just doesn't sound at all right. What did they give her for pain in ER? How busy is this ER?

Why does the family say they tried "three times" to have her admitted? What was going on that there appears to be an antagonistic relationship between the husband and the staff? I also have to wonder what her medical history is, and what the course of her previous pregnancies was. Did she have c-sections, or vaginal deliveries? Did the ER staff have access to any of her past records?

There is just so much that doesn't add up for me in the family's story of what happened. Let alone what happened with the second admission via EMS.

ETA: Here is a good article from only 5 days ago about controlled substance prescribing from ER's in the Los Angeles area.

http://www.scpr.org/news/2015/03/20/50478/county-and-private-hospital-er-s-join-forces-to-co/





Example of automated discharge medication machines:

http://instymeds.com/

I have seen people treated without compassion and rudely by various professionals. That hospital is very close to my home and not one of the best. It has some pretty horrible reviews too: http://www.yelp.com/biz/anaheim-regional-medical-center-anaheim

I have no reason to doubt that this family were treated in a manner they shouldn't have been.

 

[gitana1]

The hospital should have suspected an ectopic pregnancy when she showed up in a lot of pain.
So it's a major screw up regardless if she were pregnant with one fetus or two.
I wonder if the hospital wrongly decided she was seeking pain meds instead of actually being in pain.

Well they weren't interested in the pain meds and kept insisting she be admitted, but the hospital refused. I think they got kicked out. I hope, that if this is all true, whoever treated this family in the manner they did, is having sleepless nights.

 

[gitana1]

I'm glad the family had an independent test done and feels secure in the diagnosis of brain death and is planning to let her be disconnected. But I'm so sad for them. I do hope they sue the heck out of that hospital. Reading the yelp reviews, rough or indifferent treatment is not abnormal there. It's not known as a great hospital. I went once and wasn't impressed. Happy my family has Kaiser now because Anaheim Regional Medical Center is the closest hospital to my house (right up the street) and that's where we'd go otherwise, in an emergency.

 

[Hiandmighty]

It's over. sad for her family

 

[al66pine]

It's over. sad for her family

I'm a verified dumdum on some searches, not pulling up anything on google and a few news sites..
Anyone?

 

[Hiandmighty]

It's on a facebook page so I don't think I can link it.

 

[nrdsb4]

http://www.myfoxla.com/story/28605663/family-fighting-to-keep-mother-of-7-on-life-support

"If it was up to the family we would keep Lisa on life support and continue fighting for her life. But unfortunately, under California law, we have exhausted all options in our legal rights to keep her on life support," Lisa uncle Larry Terry said.

RIP Lisa Avila and condolences to the family.

 

[al66pine]

http://www.myfoxla.com/story/28605663/family-fighting-to-keep-mother-of-7-on-life-support....

More bad reporting re being in a coma, from ^ link, instead of accurately reporting 'brain death' :
"The hospital planned to remove Avila from a ventilator on March 20 after two doctors declared her brain dead. It wasn't until the family then brought in their own neurologist who also found no brain activity that the decision to remove life support was made."

So sad for family and all involved.

 

[nrdsb4]

More bad reporting re being in a coma, from ^ link:
"The hospital planned to remove Avila from a ventilator on March 20 after two doctors declared her brain dead. It wasn't until the family then brought in their own neurologist who also found no brain activity that the decision to remove life support was made."

So sad for family and all involved.

Yeah, it's pretty amazing how many lay people understand the difference between coma/pvs/brain death, and yet people making their living from investigating and reporting the news, i.e. journalists, cannot be bothered to educate themselves before putting pen to paper (so to speak).