Some Observations on the Care of My Mother
Since 1958 I have been active in system analysis including large scale computer modeling, multi-organizational activity in industry, academia and government. In all of my effort the role of communication has been paramount. This is said because my problems with Dr. Kato and staff suggest a problem in communication and incompetence of the part of his staff that borders on mal-practice.
The following is a brief overview of my experiences that shape some of the questions I have tried to explore regarding my mother’s health.
In 1970, while on the faculty of the Wharton School of
Business I developed a course structure in a joint University of Pennsylvania
Medical School and
In 1972 I served as an organizational consultant to the White House Special Action Office for Drug Abuse Prevention. Several tasks where performed including realigning staff functions; developing an innovative present value model for drug treatment planning which was used to change the federal funding approach in drug treatment, the changing of the federal laws in drug treatment; the transfer of Lexington Drug Treatment facility from HEW to the Bureau of Prisons.
In 1973 I was a consultant to the City of
I conducted a three day management retreat for Philadelphia Geriatrics after a review of internal operating procedure.
I was research designer and manager in a two year large study on Women In Medicine conducted by the Philadelphia Women’s College..
As a member of team I, and two physicians, reviewed the city
of
I provided the quantitative analysis to the research
principal, at
In 1975 I founded the Institute For Outdoor Awareness, Inc.
to explore the use of outdoor challenge in behavior modification in
therapy. Activities included a three
year NIDA grant involving fifteen drug abuse treatment centers in
In addition to the above I have had more than twenty contracts and follow-on efforts in companies, city and federal agencies ranging from developing the countries large solar energy training program ( a three agency joint effort), solar commercialization potential for NASA, the Department of Commerce, the Department of Energy, the Department of Interior.
Most of my efforts in the past twelve years have been
development of computer based management and data management systems. Included in the past couple of years has been
development in tele-medicine technologies wherein my programs are used to
monitor patients at a distance through internet connection. This includes
monitoring patients in Bangladesh, India, San Francisco, New Jersey and
Pittsburg from my office in Rutledge Pennsylvania – recording, retrieving and analyzing
instrumented vital signs i.e., BP, O2, etc as well as photographs/video in
wound care management. Currently I have
been supporting the development of an
automated patient evaluation and reporting procedure for a physicians group in
On the infamous date 9/11 a person I lived with for many year, whom I will call M, was scheduled for surgery to insert a feeding tube into her lower intestine. The surgery was postponed a day. M had esophageal cancer. Nothing was to enter her mouth. Her general practitioner has missed all the symptoms for eight months that most first year med students could have picked up on. (He retired shortly thereafter.) I sat with her every day for seven months. I had her put into a hospice program at home and she had private care 24 hours a day much of which I provided. Many times I changed her feeding tube, unclogged her pump, and administered her meds. I understand and applaud the role of hospice.
For the past four and half years I have been caring for my elderly mother who you have discontinued as a patient. She 93 and a half, frail, weighs 65 poiunds, She has suffered a broken hip, has dementia, an arrhythmia condition, COPD, congestive heart failure, is limited in mobility and is on oxygen 24/7. I know of her past history of arrhythmia complications and cognitive loss and behavior change both firsthand and as observed by my dad before he died. I am familiar with her alcohol history. She has not had a drop of alcohol since her hospitalization in July of 2007 after she fell and broke her hip.
------------------------------------ The Issues------------------------
Dr. Kato: the above materials are to suggest that I have tried not to waste your time and ask idle questions and that I have some appreciation of the issues and a complication of my mother’s physical being. My undergraduate work in chemistry and physics, MBA and PhD work in organization structure as influenced by needs and values and the application of that thinking in industry and government for forty years leads me to try to understand why things are the way they are.
When you signed her POLST in January of 2006, a visiting nurse and others thought mom did not have much time left. Then I took a hard look at her meds, consulted with a pharmacist and took her off the three diuretics she was on, prescribed by three different doctors! In two week she was playing bridge at the Tukwila community center.
I have asked several times to talk to you directly and not through Georgette. I have already discussed with you some issues I have with Georgette. For instance, she would ask mother questions about how she (mother) felt or why she was there. Mother’s answers are usually “just fine”. When I would answer for mother Georgette would turn around and snap, “I am not talking to you.” I suggested if she wanted to know what is going on she should ask me.
Her ruddiness when I suggested she ask me when she is trying to find out why we are in the office suggests she is going through a welcoming procedure rather than obtaining substantive information.
Another incident I talked to you concerns Georgette’s taking mom’s BP Mother was wearing a down jacket. I suggested I would help take the parka off. Georgette said not to bother because she could put the cuff over the jacket. Her reading was 30 or so points higher than the one I took before we arrived at your office. I asked you when you came into the procedure room to take the BP. Your result corresponded to the one I had obtained. Georgette’s entering her erroneous reading into mom’s record would on the face of it, in the opinions of others, constitute malpractice.
There after I always asked to speak with you.
Some of Georgette’s responses left on the answering machine suggest either she or you did not understand questions that I asked.
For example, last fall after a drop in mom’s saturated O2 from 98 to 77 because the portable tank we were using was inappropriate for her needs (not your fault) and we spent an extra two hours going back and between your office and the specialists wherein a direct referral would have been sufficient. I called you to explore the utility of a blood study to determine her red blood cell level and whether or not supplements might increase the efficacy of her oxygen treatment.
I have had 58 years of mountain climbing experience recreationally and professionally and am mindful of the role of blood structure in adapting to altitude. Dr. Piro Kramar’s, a physician in Seattle who was a member of the 1972 Women’s climb of Annapurna, was invited to participate on the trip to study, the blood characteristics of climbers at different altitudes, in my 1981 climb of Mt. Rainier by a team of handicapped individuals including 7 blind, 2 deaf one person with epilepsy and one amputee. ( Project Pelion).
My interest in mom’s blood structure was to better understand what would help her and might be of use for all elderly using oxygen therapy. I understand that dead brains cells are for all practical purposes gone (this is a response to an assertion by Georgette)..
Georgette’s message left on mom’s answering machine follows:
“Hello, this is
Georgette at Dr Kato’s and Dr. Kato saw you note about you mom and feeling her
oxygen level drops in the evening or at bed time she is pulling the canula off
and it drops down to 78 to 80 and I am
sure you know that if the O2 drops that low that she is losing some brain cells. Your question was “Does she need any blood studies?” Actually no. Nothing we do can
change or reverse that has been done. It
seems that is just a terminal progression of the heart failure that your mom
has. We did receive also a call, a
while back, from Penny at Hospice indicating you were refusing Hospice at this
time. I just wanted to encourage you, that
it is just a wonderful program. There is
just so many wonderful benefits that could be of assistance to your mom. If you would like that it is a wonderful way
to give someone you love dignity in their last days and help them to be
comfortable ….. At this point Dr Kato said there is really not much we can do
for changing anything that has happened and that is just the normal progression
of the
heart failure that you mom has.” *
Obviously my question, or my efforts to ask the question, was not understood. I am also left with the distinct impression that mom has been written off by your office off as someone who is dying and nothing can be done.
This past week, Aug 28th, I stopped by your office and indicated I was interested in talking with you about the sequence of events associated with the meds that have been prescribed including the increase in mom’s thyroid medication. I have several questions raised by the elevation in manic behavior that followed the administration of the Klonopin and increase in thyroid above that following the use of Ambien (3/8), Hydrozine (8/11) and Temazepam (8/14). I had wanted to discuss the expected impact of increased thyroid and whether reactions to the “sleep” agents were being exacerbated by the increase in thyroid.
You were not available. I suspended the Klonopin on the 19th and the extra thyroid on the 25th. . I did review the situation with a close friend of thirty years, a psychiatrist. On the 27th mom settled down, has slept soundly and has not manifested any “ornery” behavior since.
On Friday the 29th (Aug) Georgette called.
“Hi Mr. Bartow, this
is Georgette in Dr. Kato’s Office. We
did get your message, from yesterday that you would rather talk to Dr. Kato rather
than myself. Dr. Kato asked me to call
to find out if you had taken your mom to the sleep doctor as he
recommended. He was saying that he
doesn’t know what else he can do for her other than we ask if the medicine did
not work if you could please make an appointment to bring her in. There is very
good possibility that she could have something as simple as a urinary tract
infection. That is one of the first
things that people get checked for when they start having erratic behavior. So
if you are at all able to call back and make an appointment for her to come in
and be seen we would appreciate that and then if you wanted to speak with him
that would be the best way for you speak with him, if you make an appointment
to bring your mom in. If you have more questions you can call back.”*
This message raises a couple of questions. The first is whether or not sleep is the germane issue. Her behavior seems to be more drug interactions. I have contacted Dr. Chang’s office, the sleep specialist you and their instrument has yet to be received.
Another question I had wanted to ask had to do with the
possibility that her metabolism is such that the sleep drug(s) have an on-off
effect wherein she bypasses any slow recovery and goes immediately into abrupt
withdrawal with the resulting “rare” side effects. For me the impact of metabolism on drug
recovery could be an important issue.
The more interesting question has to do with Georgette’s comment that “…That is one of the first things that people get checked for when they start having erratic behaviorr” referring to urinary tract infection. If that is the case, why was it not raised as an issue starting in March after the Ambien was prescribed and the agitation was noted, or on Aug 11 after the Hydroxyzine , Aug 14 after the Temazepam, and Aug 18 after the Klonopin?
Going back to my introductory remarks: failed communications has been the demise of many programs I have observed. Examples from my experiences are the topic in courses I have taught at the University level, city government, and national level. Let there be no misunderstanding on your part. I consider the failures in communication in your office to have put my mother’s health and well being in jeopardy.
Your failure in understanding the issues of mother’s reaction to your prescriptions led you to believe that a citation for Elder Abuse was warranted. Your assertion that I was not following through with administering of specific medications is without evidence and mother probably would have been in the emergency room had I not. I dislike answering to false allegations, especially when they appear as a preemptive effort to avoid criticism.
Your gesture at avoiding criticism of Patient Abandonment falls short on a couple of issues.
PB
*Quotes are transcriptions of messages left on answering machine.