YOUR RIGHT TO SAY NO

My mother Carol Ann Hutson died on May 9th 2008 at KENNEWICK GENERAL HOSPITAL IN KENNEWICK WASHINGTON. She died having said no to medical services that would prolong her life. No one heard her no, no one cared about her no, and no one protects the rights of the dead. The dead can't talk.

First let me tell you about my mother mostly because I miss her. She was born to a family that had seven children including my mother. Her father was an absent father, I think she secretly believed that one day he would rescue her. Her step father was a monster she was molested at a very early age which was for my mother the beginning of her choices being stolen from her. The start of her voice and her no being ignored. She was a tormented soul at that point enduring a lot of rejection socially and emotionally. Her mother never believed her about the molestations so she eventually ran away from home. She left in a whirlwind very angry at her mother and rightfully so leaving behind all that she cared about in order to save what little sanity she had left. Running away was for her the only way to make it stop since she couldn't trust the adults in her life to protect her and no one would stand by her. She ran away alone and confused. She stayed for a while with a wonderful family she often spoke of with envy...the Gambettys. They were so kind to her.

She eventually hooked up with my father...a marriage born out of desperation, no where to go , no skills to rely upon...she got pregnant with my sister. The marriage was full of violance not unlike the home life she had run away from. She lived in a trailer park, had another baby, myself...but the marriage was unstable and violent and eventually she ran away from that one too...mostly again to save her life and her childrens lives. She ran from one man to another. From what I understood of my mother she couldn't trust her own choices , she had her life stolen out from underneath her and her choices...she relied heavily on others to help her live her life. The abuse from her childhood left her emotionally crippled and stripped of everything she loved including her childhood possesions. She didn't have anything to gain comfort from. I know she used to go to church, I know she used to drag her sister to church. All this abuse left her completely unable to believe she could make her own choices, protect herself, all of her personal power was stripped away.

She had hopes of being cinderella but leaned too heavily upon an emotionally ill equipped husband. In the meantime they had a son. As her disappointment and despair grew she sunk deeper and deeper into depression. She eventually left her husand and they were divoriced...she did go on to get her GED...and then fell prey to illness. She used all of her strength trying to figure out how to make life work and never understanding. She once told me if I had been her mother in this life maybe she would have learned something. She never believed she could learn anything, it didn't matter what it was she had an inner belief that she could not do anything. Hook up her television, set her alarm clock, you name it she believed it was beyond her capabilites. She was told she was retarded and something inside her heart agreed with what she was told. She went to counseling for a long time, it seemed to help a little, but she never really got to the point where she could stand up fully. In her heart she believed she deserved the abuse she endured...she never believed she deserved the best. Guess what, she never got it.

She turned to medicine and doctors believing that they knew best for her...she sought to have her pain in life eased. Her soul was tormented and her body was afflicted. Her kidneys began to fail, one too many surgeries, one too many pain pills, or just pills in general...all with side effects she never bothered to check out or ones she thought would never happen to her. She struggled with her mind, paranoia, she was leery of everyone...suspected everyone...one of her greatest losses being molested was the loss of her mind...it invaded her mind. It invaded her ability to trust anyone. Unproportional fears dominated her life. Fears she fed daily by watching serial killer flicks, murder mysteries...she was so afraid of something bad happening to her she never noticed what was allready happening to her.

This dependancy on doctors led her straight into the end of her life. I think she got to the point that she just wanted to not feel it anymore. In her helplessness she couldn't do anything in her mind about it so she just wanted to be numb to it. She just didn't want to be in pain anymore. It makes me so sad, I loved my mother deeply and her life and death grieves me to no end. I am struggling with closure. In the end the doctors and hospitals she entrusted her life and choices to came and raped her choices much in the same way her step father did. Her only real peace came when she actually was finally allowed to die. Kennewick General Hospital ignored her DNR...she died on May 9th at her dialysis clinic. Sitting in her chair she fell asleep peacefully. I had spoken with her the night before for 36 minutes, I know because I looked at my phone bill, I wish I had spoken just a little longer...we talked about her next journey, she wanted to move over here by me, she was always a bit of a gypsy( it's what she called herself)...The staff at her dialysis clinic was aware of her DNR so they let her slip away. She was Cyanotic and they finally called the EMTs who also stood and watched her, until they found her file which contained an outdated form covering her desire to be revived. God himself only knows how long she was actually dead before they started CPR. Shocked her body...pumped her full of Ephinephrine...

She had signed the DNR in November at KENNEWICK GENERAL HOSPITAL after a heart attack left her with one artery. She had COPD, Diabetes, Kidney failure and one artery ...Before she ever arrived at KENNEWICK GENERAL HOSPITAL the doctor accessed her medical records they were aware of a current DNR, yet no one apparently opened the file. They all dropped the ball. My sister Melinda went to the hospital screaming at them to stop, her doctor was called and she made them again aware of the DNR and yet this one invasive ER PHYSICIAN Dr James Newman continued to pursue life saving measures. He refused to listen, refused to stop. In her medical records it states she was moving her extremities and coughing...so they gave her a paralytic drug so they wouldn't have to see it anymore. WITHOUT PAIN MEDICATION. Was she trying to talk, was she trying to say "let me go" , was she protesting more pain. No one will ever know they TOOK AWAY HER FREEDOM TO RESPOND. And continued to do what they wanted to do. No one ever disclosed the paralytic drug to us. They just kept saying the prognosis was bad and that she was non-responsive. Although the nurse notes of her chart do state that due to the paralytic it was impossible to assess her pain level. Then they told us in order to honor her wishes they were going to discontinue life support. I was led to believe enroute to the hospital that they were going to discontinue life support regardless. It was never disclosed that she was on the paralytic drug and that it could not leave her system without dialysis...so essentially we made the choice under pressure from the hospital to stop life support in a patient that could not scream if they wanted to , could not breathe on their own due to the medication if they wanted to...couldnt' even blink if they wanted to...the paralytic drug doesn't stop pain, it just stops your ability to express pain.

She was resuscitated to endure God only knows how much pain in that time period...She was stripped at the end of her life of her right to refuse treatment and spare her kids the agonizing decision of disconnecting life support...she was stripped of her ability to speak and express pain, to say good-bye to her children and grandchildren...When we contacted the hospital to tell them they should not recieve payment for services she had refused in advance, it turns out almost faster than what she could be buried they were allready paid. Paid by medicare for services that were declined. The hospital doesn't get paid if the patient comes in dead.

It is an unspeakable injustice. I am plagued by what she must have endured , and tormented by the stripping of her choices. When you have a loved on who is termanilly ill the only thing you can hope for is that they will have a peaceful death. It's all thats' left. It's the prize for all the suffering by their side. Every sickness they have could be "it", every phone call after ten o'clock at night where you are convinced they are calling to say she has died....every time you tried to rehearse in your mind how it would be what you needed to do ...the trips back and fourth to visit her crying your heart out all the way home convinced it is the last time you will ever see her again. All the questions...did you say enough? Do enough? Does she know that you love her? In the final moment the hospital and one doctor, swoop down and steal your hearts desire for your loved one. We are the ones that bought her groceries, drove to see her, spent the holidays with her, cleaned her bloody bathroom and blood soaked shirt when her port opened up one night and she refused the ambulance ride because she was afraid of what it would cost. And the stranger...the doctor I have never met , never been to one family function...comes and determines the way your own mother should die. It's like being hit with a blunt object up alongside your head. I feel I was forced myself by his choice into a decision I never wanted to make. I am so against putting a person to sleep.

I am outraged that this can happen. I am adding in my correspondance with Trish Mendoza , damage control is her specialty...her responses are outrageous and our questions were never answered...she even goes so far as to suggest we were not aware of our own mothers wishes. How can she know that I called her every day...my loss of relationship , loss of conversation, has left me devastated and heart broken. My mother was not a saint ...but she did love people she would have given anyone the shirt off her back and she always worried about everyone else and not herself...These people pretend they knew her when they never even met her...and there is this insinuation that her DNR that she signed in THEIR facility six months prior was not accurate instead she really just wanted the old 2006 document....AREN'T WE ALL JUST SICK AND TIRED OF HOSPITALS AND DOCTORS JUST COVERING THEIR BUTTS? Heres where I share my coorespondance with the hospital...as you can see most of the questions we had were never answered...

I am personally so sick of hospitals and doctors...paying outrageous amounts to have the truth be evaded and in the end they cover themselves...I have sent a copy of this blog to Trish Mendoza at Kennewick General Hospital lets see how she responds, if she does at all...the last time I contacted her even though she said "if you have any further concerns or questions please contact me" I never got any kind of response. That was my letter to her on the Fourth of July .

Hello Angela,
First and foremost I would like to send along the heartfelt condolences of everyone here at KGH.
We are in receipt of your email and we will respond to your concerns no later than Monday June 23, 2008.
Thank you,
Trish Mendoza
Patient Relations
From: Angela [mailto:angcumpston@aol.com?] Sent: Monday, June 16, 2008 12:44 PMTo: Mendoza, TrishSubject: Fwd: Carol Ann Hutson
-----Original Message-----From: Angela <angcumpston@aol.com>To: info@kennewickgeneral.com <info@kennewickgeneral.com>; melindarouse2@msn.com; angcumpston@aol.com; mothergoose_3@msn.comSent: Mon, 16 Jun 2008 10:54 amSubject: Carol Ann Hutson
I am aware that you have been in contact with my sister Melinda Rouse of Pasco Washington regarding the administration of life saving measures provided to our mother Carol Ann Hutson of Kennewick Washington, on May 9th, 2008. I am offended at your hospitals lack of response concerning our mothers last wishes. According to medicare and medicaid policies our mother had the right to refuse treatment that would prolong her life in a medically futile situation. Medicare/Medicaid requires you to provide information to their patients since you receive reimbursement ,stating their legal right to refuse treatment. I am deeply concerned at your apathy regarding our mother. My sister relayed to me that in the meeting that took place at your facility on June 13th 2008 that she was informed that your hospital has now changed how a DNR is listed...how many patients prior to our mother have had their constitutional rights violated at your facility. Honestly it really isn't good enough that you change your policies now, since my mothers constitutional rights have already been violated. According your web site you state and I quote , it is your policy concerning advance directives to " RESPECT EACH ADULT INDIVIDUALS RIGHT TO SELF DETERMINATION IN ACCORDANCE WITH THE REVISED CODE OF WA.70.122 AND THE 1990 FEDERAL PATIENT SELF-DETERMINATION ACT"...as well as you pledge that Kennewick General Hospital 'SHALL COMPLY WITH WASHINGTON STATE LAWS, FEDERAL LAWS, AND COURT DECISIONS REGARDING ADVANCED DIRECTIVES" According to the law "each American has the Constitutional Right , established by a Supreme Court decision to request treatment to be withdrawn or withheld. The right remains valid even if you become incapacitated." Your facilities negligence regarding our mothers end of life wishes and legal directive have caused extreme emot i onal duress to be an added burden upon my sister and myself. Under normal circumstances it would be emotionally distressing to deal with the death of your mother two days before Mothers Day. However, your facility placed my sister and I in the position of having the added burden of upholding our mothers final wishes. Despite the fact she had the foresight to take care of matters in advance in your facility when she was admitted for a heart attack in 2007 at which point she signed a DNR. Trusting your facility physicians, and staff to see to it that the paperwork was updated and filed accordingly. She also trusted that her final wishes would be upheld and that the DNR was indeed a legally binding document. My mothers final wishes were to spare her children of the additional burden of dealing with their grief and having to make the decision to pull the plug. It has caused me personally extreme duress. I adamantly do not believe in ess entially putting an individual to sleep. Your hospital has placed me in the position , due to your gross negligence in keeping updated files on your patients, and your attending physicians failure to honor your own hospitals legal and moral ethics...to violate my own personal ethics, religious and moral beliefs.

I am deeply offended that your facility has already received money from Medicare/Medicaid for services illegally performed. I am equally offended at the battery and suffering my mother endured physically for a service she refused in advance.

Mrs. Angela Hutson-Cumpston body.hmmessage{FONT-SIZE: 10pt;FONT-FAMILY:Tahoma}
Hi Trish, I have had a chance to go over some of my mothers chart and have discovered several discrepancies: 1. Time on Code blue sheet does not match those on Dr. Newmans chart papers. Dr Newmans times do not correlate with the EMS record of events. 2. Why are there 2 separate "Medication and fluid Administration Record Emergency Department forms" with the first two entries on both the same forms matching as if copied, but then each paper has different entries that start at 0930 and one sheet has an extra entry that starts at 0950. It appears that some chart alteration has occurred. 3. Dr. Newmans progress notes have no times written, and in his progress notes he states that he has had a "lengthy discussion with Dr. Ang" and states that Dr. Ang "claims pt is a no code." So he was aware of my mothers no code status and made a conscious decision to ignore this. He then states further on down the progress notes that he had a lengthy discussion with family. When I spoke with Dr. Newman he led me to believe that he had not been in contact with Dr. Ang yet.His charting does not match his spoken word. 4. Why was a paralytic drug (Dr Loera's words), Pavilon, given with absolutely no pain killer? You're letter stated that you would address my concerns by the 30th of June. I will wait for your response before taking furtheraction. Sincerely.Melinda L. Rouse =
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KENNEWICK GENERAL HOSPITAL
P.O. Box 6128 · 900 South Auburn Street, Kennewick, WA 99336
Tel 509-586-6111 / Fax 509-586-5892
www.kennewickgeneral.com




June 30, 2008


Ms. Melinda Rouse

Mrs. Angela Hutson-Cumpston

Dear Ms. Rouse & Mrs. Hutson-Cumpston:
I am writing to you to address the concerns that you both expressed regarding your Mother's end of life. Your Mother apparently suffered a cardiac arrest at an independent kidney dialysis center. The center had your Mother's 2006 Physician Orders for Life Sustaining Treatment {POLST} form and not the more recent 2007 one. Apparently upon arrival, the paramedics noted that the 2006 POLST form asked for life support for a week. The paramedics initiated CPR, intubated your Mother and transported her to KGH.
On arrival to our hospital, your Mother was already intubated and had an IV running. Her care was assumed by Dr. Jim Newman who continued the CODE as per standard medical practice.
Ms. Rouse, you have raised questions about the times in the code sheet compared to Dr. Newman's and EMS. The times listed are within a few minutes of each other. This is very typical for code situations in particular. Clocks vary and some people go by their own watches. Note the ED received a call prior to the patient's arrival. Because of advanced notification, it can appear that the records started before the patient arrived. When any ED receives a call from EMS, a record is immediately generated and staff members prepare to receive the patient.
As to your question about Dr. Newman's knowledge of your Mother’s wishes, we would not expect Dr. Newman or any other treating physician to withdraw life support in progress without seeing the updated POLST form, particularly in light of some lack of clarity at the time about the patient's current wishes. Dr. Newman provided the appropriate standard of care.
In your email you question why there are two separate medication forms. There is one medication form signed by the nurse involved in your Mother’s care, and the second form is a billing sheet signed by both the nurse attending your Mother, and the Director of the ED who finalizes the charges.
On admission to the ICU, Dr. Ellen Ang assumed your Mother's care and consulted with an intensivist, Dr. Dan Niendorff. After discussion with family, the decision was made to withdraw the ventilator. Due to the fact that your Mother had “been down” approximately ten minutes prior to initiation of CPR at the kidney dialysis center, that decision was very reasonable due to the likelihood of profound brain damage. Dr. Loera reviewed the care and discussed the case with Ms. Rouse and opined that it was clinically appropriate. The paralytic drug Pavulon has a half life of 110 minutes which is multiplied in patients with renal compromise. In these cases the drug can remain in the system from 14 to18 hours. Pain medication was not administered due to the fact that your Mother was unconscious and unresponsive.
As was discussed, The Washington State On-Line Will Registry will help clarify these situations for future patients. Patients do not always share their instructions with all of those who may be involved when the time comes.
Again, we are very sorry for your loss. You did your best to support your Mother's wishes, particularly in light of the confusion over what she wanted.
Sincerely,


Glen Marshall, CEO

cc: Dr. James Newman

Dr. Ellen Ang

Ms. Connie Pitts

Dr. Joe Loera

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Mrs. Mendoza, I hope that you realize that it is my mother you are referring to in your letters. You and your hospital did not have the right to bring my mother back to be in the state you left her in. She deserved better than that. She suffered so much during her time on dialysis, so much physical pain, so much stress, fears...you weren't there during that time. My sister and I were. We stayed by our mothers side helping her in every way we could while she struggled with her failing health and all of her stages of grieving. You really don't know what my mother wanted. She wanted peace and rest. She was so tired of having to go to dialysis and have a full time job visiting physicians. On her dialysis arm she had a lump the size of a fist, and she suffered terrible nerve pain. My mother deserved better. None of you had any right to rob her of peace and freedom. She had the right to pass peacefully. You robbed her and you robbed us. You robbed us of her peaceful passing...a pain free passing. Your physicians inadequacy and incompetancy...and your facilities lack of preparation, negligence and grossly inappropriate abuse of a dead body broke our hearts. We don't have the closure nor the peace we should have had and would have had. Our grief has intensified due to the negligence of your staff. I can't begin to tell you the absolute heartbreak we have since endured. I hope at some point you can grasp the gross injustice. Your letters come across as very cold, she deserves to be addressed with respect...spoken of respectfully. Not just a learning experience for your staff. She was a person. You are talking about my mother and her wishes as if you knew her, you never knew my mother, probably never even took the time to walk upstairs to meet her...on any of her visits to your facility. You hide behind your negligence and protocol and don't treat your patients at your facility with the respect and dignity they deserve. She would have called you honey. I want you to know what you have done,and all the years that we suffered right along side of her...we deserved peace too. Not to instead have to know she suffered more. She suffered more because you chose to revive her. She had allready died. It's just not right. You did not have the right to over ride her wishes, you did not have the right to put my family through that, you did not have the right to decide that she should endure any more pain...In her final moment you took her only choice she had left, she didn't have any say or control over anything else and you came like a thief and snatched the last choice she had. what you have done is wrong. Mrs. Hutson-Cumpston

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Know your rights and how to enforce the rights of your loved ones. You can contact s several places to report hospitals and physicians such as your omsbudmans, quality assurance commisioner, the attorney general, RAC (who independantly audits hospitals to see if they are ripping off medicare) If you have had a similar experience I would love to hear from you and if you are in the process please get your medical records before the staff can alter them. Know your choices and don't allow anyone to take your choices from you. Where would you take your family members in a life threatening situation? Would you take them to a hospital that has an issue understanding the difference between 2006 and 2007? Think of the implications on that one, the implications of not noticing outdated medicines, mistaken dosages due to errors in being able to read numbers accuratley...consider you choices here. Do you go to the hospital you HAVE to go to or do you risk paying more and going someplace else? How much is your life your sanity and your families peace of mind worth? Choose for yourself where you are willing to spend your money and whom you trust your life to in a situation where you cannot decide for yourself...or maye you allready did decide and then who do you trust to honor your wishes...Your last wish.