attorneys, elder care, Healthcare, Ian Gale, negligence, physicians, prescription medications, seniors, tort reform
My husband and I made a deal. He would take dad and stay with him for any examinations involving a Urologist. I was a 54-year-old who had not seen her father’s penis and my dad wanted to keep it that way. The initial appointment was made with a West Hills, California, doctor by the name of Ian Gale. Dad’s chief complaint was incontinence. As he would complain, “the spigot was on and wouldn’t turn off.” The referral was through his new milk-toast whiny family doctor but we had no one who had any other recommendations and the appointment was booked.
My husband and dad showed up, dad gave a urine sample, had a rectal exam and I had sent dad’s prescription list and his medical history to be reviewed by the doctor and placed in his file. A follow-up appointment was made to perform a cystoscopy (where they send a flexible tube attached to a camera through the urethra into the bladder) as standard procedure given the repeated occurrence of “flowers” in his bladder. Dad called them flowers because his first urologist referred to the distinctive shape of one as a flower. The rest of us called the growths cancer. As long as they were caught in the early stages, they were easy to remove and the hour procedure was handled as an outpatient procedure with an epidural.
Sounds simple, doesn’t it? I thought so. My husband told me that dad had been given some samples to help with the incontinence and needed heart and pulmonary approval for the surgery. I immediately booked both appointments. Because of his recent broken back, the stress test by the cardiologist was handled with a chemically induced stress procedure and the pulmonary tests were passed with flying colors by a man who had smoked for 60 years. And then dad started to have hallucinations.
These were not the same hallucinations as when he was left under the tarp at the hospital on a morphine drip but new ones. He saw a “clock maker” who was winding the giant clock at the assisted living facility. He claimed the clock maker spoke with him and told him that “time was slipping by” and my father had to do “something about it.” I questioned Dad and asked him if he might have dreamed the clock maker. He was adamant and angry that I was questioning, once again, his mental status and claimed that black ravens were attacking him in his sleep and were pecking his anus. I had been told by the staff at the assisted living that dad had asked about the clock but overall, he was able to take care of himself and mother whenever we were off site. Dad had a follow-up pre-surgical visit scheduled with Dr. Gale and my husband again attended the appointment. Again, my father was given a free sample of the incontinence medication but in a larger dosage. Within days of this visit, dad was unable to distinguish reality from fantasy. He was beyond reasoning.
I emailed and then booked an immediate appointment with mother’s neuro-psychiatrist for dad. He was placed on antipsychotics and I informed Dr. Gale of dad’s current status and the need to delay his surgery. At that time, I also asked whether the drug that dad had been given, Vesicare, could possibly caused any complications. I received a return call from Dr. Gale’s nurse that she had asked Dr. Gale and was informed that Vesicare had no side effects other than possible “dry mouth.” I failed to discuss Vesicare with the neuro-psychiatrist as dry mouth did not seem to be a problem that dad was having. But as the symptoms increased and the antipsychotic medications were being tweaked, dad was still suffering and he was entering a world similar to the one my mother was living in but his was also full of anger and agitation. More importantly, he seemed to be battling it differently, as if he knew that something was terribly wrong but couldn’t wake up from this nightmare.
And then I sat down to the computer and started researching. There was little information on Vesicare on the American sites that I checked, but it was the only thing in Dad’s life that had changed before the hallucinations had started. I left the United States and headed for England in my research. I discovered a few medical articles dealing with “BBB.” Blood brain barrier. Drugs that passed through to the brain. And one article clearly indicated that the elderly should not be using this drug because as one post indicated, if the urine is drying up, so is the fluid surrounding the brain. I immediately halted the Vesicare and informed the neuro-psychatrist and within a week or two, Dad was able to come off the antipsychotic and antidepression medications and although the memory of the clock maker and birds were still there, Bert was back. After informing Dr. Gale’s office that he was ready to go and that the Vesicare had, in fact, caused the event, I was informed that Dr. Gale wanted dad to repeat all of his pre-surgical tests.
I was livid but didn’t have to stew about it for long as both the cardiologist and dad’s pulmonary doctor stated that no new tests were needed and dad was set to go for surgery. I was warned by the cardiologist that dad was on a beta blocker for his heart and that he would inform Dr. Gale to maintain that before surgery. I also located hospital protocols for several major hospitals in the area, and all indicated that beta-blocker medications should never be stopped and that a surgical patient should take the drug as scheduled with a sip of water. Dr. Gale informed his staff to contact me and to tell me that he and his surgical team would handle the administration of the beta-blocker.
We presented ourselves, my father, husband and I, to the hospital on the day of the out-patient procedure. Dad was in good spirits and wanted to get “the show on the road.” I had my duties to handle. I brought a copy of Dad’s Medical Directive and Durable Power of Attorney along with 3 copies of his medication list (and faxed one to Dr. Gale’s office as well) and a copy of his medical history. I was given an unsigned medical consent form with the procedure clearly indicated on it: Transurethral resection (TUR). Basically, dad would have a cystoscope inserted into his bladder through his urethra and a tool with a small wire loop on the end would be used to remove the cancer. He would receive an epidural and would be back home in the afternoon if all went as expected.
I left all the information with admissions including one copy of his medication list, and then when we were taken to the surgical waiting area, I gave a copy of the medication list to the nurse assigned to Dad. I watched her put the list inside Dad’s black binder containing his medical information. And then we waited. And waited some more. And then we were told that the surgery had been delayed. And so we waited a little longer. I repeatedly reminded the nurse that dad had not taken his beta-blocker and that I had been warned by his cardiologist. She indicated that Dr. Gale would be handling this and had been informed. And then I met Dr. Gale for the first time.
He entered the room and I couldn’t believe there was enough room for him and his ego with the rest of us present. I introduced myself and attempted to speak with him about the beta-blocker and he told me that he had a cardiac-anesthesiologist that would be handling dad’s medications and epidural and dismissed my concerns. I then attempted to discuss the Vesicare issue and he again, dismissed me and actually turned and left the room in the middle of my question to him. I was stunned. But then the nurse came and took dad off to surgery and we were told to wait.
A few hours passed and I began to worry but then Dr. Gale reappeared and said the surgery had been a complete success and that dad would now be able to urinate freely. I told him that dad was urinating ‘too freely,’ and again he ignored me. He said that he was going to hold dad overnight as a precaution. I asked about his heart medications and he told me that the anesthesiologist had handled everything and that he would see dad at his post-op visit. And away he flew. Once again, I was in the middle of a question.
Time passed and they took us to see dad in post-op where we caught him flirting with the nurses. The anesthesiologist met with us and said dad was fine and that while he had tolerated the surgery well, he was having a bit of a problem getting the feeling back to his legs post-epidural and they would be monitoring this. And off he flew. We went with dad to his room where he begged for coffee and received chipped ice and apple juice. I took my last copy of the medication list and gave it to the nurse who taped it to the outside of dad’s black binder. There. I had done my job. We stayed until dad was tucked in for the night and headed over to be with mom. After she went to bed, we headed home knowing that tomorrow would be a very busy day. Little did we know.
I was giving mom her bath and my cell phone went off. I climbed out of the tub dripping wet and answered it when I saw “West Hills Hospital” on the caller ID. Dr. Gale was on the phone and he was screaming. “You need to get over here immediately. Your father is refusing to take his medications and his heart is acting up. He claims we are poisoning him.” What? I looked at mom, at my wet clothes and told him I was 10 minutes from being there and not to move. I then helped mom out, called for assistance to aid her in getting dressed and headed over to the hospital. Brian, dad’s 6 foot, 6 inch nurse, was standing next to dad’s bed with a Dixie cup of pills shouting at dad.
“What’s going on, Brian? Where’s the doctor? Are you okay, Dad?”
“They’re trying to poison me. Those aren’t my pills.”
“What about that Brian? And where the hell is Dr. Gale?”
“He left and these are his pills. We had to put him on a monitor. His heart has been all over the place and he needs these pills. We have also put in an emergency call to his cardiologist.” Brian stated in a sing-song voice as he placed the Dixie cup in my outstretched hand.
“Take a look at dad’s medication list, Brian, and confirm that these are his pills. And Dad, what makes you think they are trying to poison you?”
Dad’s skin was clammy and clearly he was in distress. He told me that the pills didn’t look like the ones he normally takes and I queried Brian who was looking at his computer on wheels that listed dad’s medications. He was doing some mental checklist and then confirmed that all the pills in the cup were on “the list” and that they looked different because in many instances the hospital uses a different manufacturer and the pills do not look the same as the ones we might purchase through a pharmacy. I asked dad if that was satisfactory and he took the cup and swallowed all the pills at once. He then laid his head on his pillow and appeared to fall asleep.
At that moment, the cardiologist entered the room and was extremely agitated. He said that he had reviewed the file and that dad had not received his beta-blocker as “we had discussed.” I explained the numerous times I had given the information to the staff and doctors and he set about with intravenous medications to bring dad’s heart under control. He couldn’t wake dad and I explained the recent events and he then turned to Brian and told him that he had left specific directions an infant could carry out and questioned whether Brian could handle it. The tension in the room was palpable. Brian nodded and the cardiologist left. Dad looked like he was having the best sleep of his life, so I headed out informing Brian that I could be reached by cell.
I returned in the late afternoon to find Dad in the exact position as I left him except there was a halo of sweat staining the pillow and bed sheets around his body and head. I screamed for Brian when I couldn’t wake dad and he slowly sauntered in as if he hadn’t a care in the world, including my father or me. He told me that dad’s heart was fine and I asked him about his inability to wake up. He looked totally unconcerned. I told him I wanted to know exactly what pills dad had taken. He told me he would get to it when he “had the time.” I demanded them now. He laughed. I followed him and he actually approached a nurse’s aid and loudly said: “Is SHE still behind me?” And then laughed again.
“No Brian, SHE is leaving and will find help from some place else,” I responded through clinched teeth as I headed for the elevator.
He chased me and I screamed for him to leave my father and me alone. I headed down to the main floor and to the administrators’ offices. It was locked but I could see a group of people in suits sitting around a conference table. I knocked and when the door was opened, the woman who answered asked if she could help me. I explained that my father appeared to be comatose and that I was concerned he had been overdosed with the wrong medications. I then said, “Contrary to my outfit and the way I look today, we should all be on the same playing field. I am a medical malpractice attorney and I do not come here with claims of malpractice lightly.” Every single person at the conference table stood up. The head of the hospital introduced himself and also informed me that the head of nursing was who had answered the door. They listened and then the head of nursing accompanied me to the 5th floor.
She called an emergency and sought the doctor on call. He eventually would be the doctor who ushered both dad and then mom from this life to whatever roads they were set to travel. He arrived at the same time my husband arrived. The room was spinning in my head and I just wanted to see the list of pills that dad had been given. My husband followed Brian to his station and demanded them. I looked at the list and bile rose in my throat. They were not my father’s medications. They were massive doses of antipsychotics, antidepressants and other drugs that were not present on any list I had brought or faxed. They had been sent by Dr. Ian Gale’s office and were placed in the computer superseding all drug lists that I had brought to the hospital.
Dad didn’t wake up until the next day. When he did, he wasn’t the dad that had been brought to the room. He couldn’t focus, his hearing, already poor, was non-existent and he was unable to speak coherently and would grunt. Dr. Ian Gale never returned to see what he ‘had created.’ He sent a sub who stood in the doorway to authorize a weekend discharge of a man who couldn’t walk or talk and asked me whether he had urinated. I explained that dad was wearing a diaper and he indicated that was enough information and signed his discharge papers. It listed follow-ups with the cardiologist, the pulmonary doctor, Dr. Gale and dad’s whiny family practitioner. We took dad back to the assisted living and placed him on the couch. He never slept in his bed again.
I made the appointments all for the same day in the same medical center area. I went from doctor to doctor with Ian Gale saved for last. It was clear that the man slumped over in the wheelchair drooling was not the man who they had met prior to surgery. No one could look me in the eyes. Simple instructions regarding medications but nothing else. Certainly no hope. The family doctor stated in a flat tone as if ordering cold cuts from a butcher that the elderly in dad’s condition rarely lasted 6 months although he had seen some last for as long as 2 years–but that was rare. No one spoke to dad who was hunched over and looking off into space, somewhere we couldn’t reach.
Dr. Ian Gale. I sat with dad and my husband in his office as Dr. Gale’s nurse entered and said she needed a urine sample from dad. I explained that dad would not be giving a urine sample but she could wring his diaper. She wheeled dad away with my husband and then they came right back. Shortly thereafter Dr. Ian Gale entered the room. He spoke to dad in a jolly voice asking how he was and did he have any questions. My head was about to explode and I only prayed that I would have enough self-control not to hit the shit-head. I explained that dad wouldn’t be talking today and then Gale turned and told my husband about the 6 month plan of chemotherapy that he had scheduled for dad. Chemo once a week in his office for 6 weeks and then once a month for the 6 months following. I told him to “talk to me.” He looked at me and I then got up close enough for the spittle on my lips to reach his face and stated: “We are not here for chemotherapy. I brought dad here so you could see what you did.”
He just went on talking about the treatment and why he recommended it, completely ignoring the obvious fact that dad wasn’t actually present in the room with us. I then told him again, we would not be having any chemotherapy and that I was there to fire his sorry ass. And he responded that he thought I might be angry but hoped I would reconsider. I told him I would not be reconsidering.
As dad’s condition began to improve it was only by baby steps. He needed someone with him to change him, take care of his skin, help to change clothes and aid in his feeding. The assisted living facility would provide the help but our bill would increase by $800 a month. Dad continued to sleep on the couch and finally they had to move them downstairs to the first floor for safety reasons. Dad could never help himself in case of a fire and was too large to be carried by the staff down the stairs. We handled the move ourselves. It was backbreaking but we no longer could afford any extras, like a moving company. Dad had good days and bad and I had my husband contact Dr. Ian Gale and ask that he voluntarily pay for dad’s extra care in lieu of a lawsuit. He informed my husband that he chose door number two: A medical negligence lawsuit. So I filed one immediately. I didn’t want to disappoint the man.
Mom had an action pending against her orthopedic from Crazyville and now dad had one against Dr. Ian Gale. His attorney called and said there would be “no settlement.” He claimed Gale wanted to clear his name in court. I then obtained the medical records—and what do you think I found? I discovered that Dr. Ian Gale had NOT simply performed the TUR procedure as signed off on by me, he had performed two additional surgeries, a TURP (a transurethral resection of the prostate) and a bladder neck reconstruction. Neither consented to by me or my father. Upon presenting these documents to Gale’s attorney, I received a call from my husband who said he had just received the most amazing settlement request in his entire legal career. Dr. Gale’s attorney claimed that Dr. Ian Gale had gone to India and returned after he had “a religious epiphany” and was hoping that the offer of settlement was still open. We settled immediately withOUT a confidentiality agreement. I wanted the world to know, on behalf of my father, exactly what happened.
And while Dad made a few more baby steps, he never was able to tend to his personal needs with the exception of crudely feeding himself with his hands.
Dad was amazing–even as his body was shutting down. My husband and I were speaking to both he and mom and told them that their depositions were set. I didn’t think he could pull it together and then he looked at me and said, “I want my deposition taken.” And he gave the deposition of his life–literally. He expended all the energy he had left. We took him to several specialists afterwards but no one even called us back after they completed their series of tests. Painful tests. His body was shutting down and he was living in a shell that no longer provided him with any natural movement. His head listed to the side and his muscles tightened and he only felt pain. Pain when we attempted to move him. Pain during the tests and once, he tipped over as I was moving him from the car to his chair following an appointment, and he fell. My arm got tangled in the seat belt and I could feel the weight of him breaking it. I begged him and we were inches from each other…”Please daddy, you have to help. My arm is breaking.” And I could see tears in his eyes and as hard as he tried, he couldn’t help. And then an angel (with her baby) appeared, parked the stroller and grabbed my dad from the other side and helped. His time was near.
I received a call in early June, 2010, in the early morning from the assisted living staff. Dad was having problems breathing. When I arrived Dad was laying in his bed, completely relaxed, and breathing easily. The fire department and paramedics were there and I knew that this was dad’s last ride to the hospital. I asked them to step out of the room. I brought mom in and told her she needed to tell dad good-bye. She was in her own world and laughed. “He’s not going anywhere. Wake up, Bert. Quit kidding around.” But daddy didn’t wake up, not then.
We met the ambulance at the hospital and the same doctor that had helped us after the medication overdose was on duty. So was a nurse I had never met. And we had met most of the ER nurses after the numerous visits we’d made with mom and dad. Over Thanksgiving in 2009, my son with a rare bowel infection, my mother with pneumonia and dad, who was attempting to help mom and forgot he couldn’t walk, fell out of his wheelchair and split his head wide open, were all in the ER and on the 5th floor together for the entire holiday week. Everyone knew us. But not this nurse. She whispered: “Have him admitted. Then tell them no more tests. Demand hospice.” She showed me a list of tests that they had scheduled for dad. It was a cruel list. But mom and dad had Medicare PLUS a private insurance and everything was covered 100 percent. Dad was an ATM machine. And they were going to make a withdrawal.
I followed her instructions to the letter. And they stopped everything and admitted him to the 6th floor hospice. Just before they moved us to his room, dad woke up. He looked at my husband and then at me and said, “Psst….over here.” I leaned down to hear his once booming voice whisper: “How big of a check do I have to write to get out of this joint.” My husband and I actually laughed. It was such a Bert moment. And then he looked at my husband and said, “Are we at the hospital or in a hotel?” My husband responded, “At a hotel Dad and they are taking you to the penthouse.” Dad never regained consciousness again. He passed 3 or 4 days later, it’s a blur. I played country and western songs for him and my husband soaked Q-tips with really expensive bourbon and wiped his lips. He seemed to really enjoy that. I know if he had his druthers, he never would have been sick a day in his life and always hoped that he would die in his sleep or have a sudden heart attack while gardening–and be dead before he hit the ground.
He left us on June 9, 2010. Dad’s journey here was over. But he never let me forget that Mom still needed someone and that someone was me and I certainly needed her.
To be concluded: Part VI-Mom and Dad, together again.
Mary MacAdam said:
Oh, I am so sorry for you. I have just read all the blogs regarding your parents (mis)treatment and I am crying for them and for you. Our health system is so wrong. It’s not just the cost – it’s the size. My sisters’ family doctor resigned her practice in Indianapolis and went to work on an Indian Reservation because she wanted to practice medicine and work with people. She was tired of regulations, health insurance and corporate ownership of hospitals. Everyone I know, including my family, have horror stories of treatment of elderly patients. Apparently you live in southern California. I have heard that Los Angeles is notorious for poor treatment in the hospital. I don’t know the answer. All I can offer is my sympathy and if you ever need to rant to someone, I am here to listen.
Thank you Mary….I have sat down a dozen times to finish this series…and well…it is still waiting for me to find my courage. Your kind words are music to my heart. I work daily with many that have been shuffled away…and I get some “do-overs” and I’m trying to make sure I don’t waste a single one.
Mary: That is all over, last December I spent over a week fighting with House Staff at our local VA Hospital (my husband is “service connected” over their wish to “just make him comfortable and let him go, because he is old and sick” when he had a totally curable condition (massive UTI plus a lung infection induced by careless entubation because it was a totally different bacteria from the UTI/Septic Shock that hospitalized him in the first place. I won but for 9 solid days I got ‘ganged up’ every time I set foot in ICU.
Kaylynne Karoly said:
Words fail me to describe my feelings at your courage and ability to even write this down. I lost my beloved dad 16 years ago and am tearing up just thinking about that. You are a rare and wonderful being and give so much to all. Please accept some love and praise which is all I, who don’t know you personally can give. Hugs.
Terry Moran said:
I stumbled across your blog and couldn’t stop reading. What a strong person you are! I have taken care of two elderly family members and it is a constant battle making sure that they are properly taken care of.
Bravo to you for the job you did, and for doing something about those who didn’t do their jobs. I will be waiting for the final blog.
I am also sorry for the loss of your parents in such a tragic way. Enjoy your own family now that you have your own life back.