A Medical Misadventure

3 Aug

Suit: Over-medication cause of man’s death

Mother served as her son’s medical proxy and was unaware he was forced to take drugs without her approval.

Posted: Friday, October 30, 2009 12:00 am

Suit: Over-medication cause of man’s death By JEFF TUCKER

THE PUEBLO CHIEFTAIN The Pueblo Chieftain
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A civil suit filed in U.S. District Court in Denver details the painful death of a 21-year-old man at the Colorado Mental Health Institute of Pueblo in 2007 that his mother claims could have been prevented if she knew what medications her son was taking.

The suit was filed May 22, 19 months after Joshua Garcia died at St. Mary-Corwin Hospital from complications that were the result of a laundry list of psychotropic drugs Garcia’s mother Bonnie claims her son never consented to take and she never approved.

According to the lawsuit, the Pueblo County coroner ruled Garcia’s death was the result of a “medical misadventure at CMHIP” that caused sepsis, bowel perforation and obstruction, malignant hypothermia and hypoxic encephalopathy.

The suit claims he languished in pain at the state hospital for more than a month before his death. According to the lawsuit, the damages from the case could exceed $3 million.

The Colorado Mental Health Institute of Pueblo declined to comment on the case Thursday because it remains in litigation.

According to the suit, Garcia suffered from bipolar (manic-depressive) disorder and manic with psychosis. Garcia’s illness would sometimes manifest itself in auditory and verbal hallucinations, and an inability to voluntarily control his own actions.

The suit claims Bonnie Garcia served as her son’s medical proxy and primary medical decision maker and that Joshua was able to control his illness with careful use of prescribed medications.

He also was able to accurately predict the approach of serious episodes and knew when to seek help, the suit said.

According to the lawsuit, Garcia awoke on the morning of July 26, 2007, panicked and felt that a potentially serious manic episode was coming. He told his mother he needed to get to the hospital.

Denver’s Porter Hospital didn’t have any room that morning and referred Garcia to the state hospital in Pueblo, the suit claims.

Upon admission to the state hospital, Garcia was shown to be in good health with no gastrointestinal issues or pain, the suit claims.

Despite the fact that Garcia was admitted to the hospital as a private patient and not someone who had committed any crime or was found incompetent to stand trial, the suit claims the state hospital treated him as a prisoner anyway.

Garcia was placed in the hospital’s Geriatric Adult Adolescent Psychiatric Services ward, which limited the amount of contact Garcia had with his mother, the suit claims.

Garcia’s mother was allowed to call the facility, but her son was not allowed to call her. In most cases Mrs. Garcia was unable to speak with her son or was only able to speak with him for about five minutes, the suit claims.

According to the lawsuit, the hospital physically restrained Garcia and forced him to take a number of medications against his will. It also claims that Garcia’s mother wasn’t informed that an involuntary medication treatment was in place for her son.

By Aug. 2, the hospital filed a petition in Pueblo District Court to continue Garcia’s involuntary medication order. The suit claims the hospital’s attorney did not meet with Garcia or review his medical records, nor obtain an independent psychiatric evaluation of Garcia’s condition, prior to the hearing.

Instead, the suit claims, the attorney filed documents claiming that Garcia stipulated, or agreed, to the involuntary medication order.

Garcia’s mother was never informed of the hearing, the suit claims.

The attorney and Mrs. Garcia have since settled their suit.

By Aug. 5, 2007, Garcia complained of an upset stomach and was given Maalox to treat the problem. Three days later, he began complaining of constipation, a common side-effect of the drugs he was being forced to take, the suit claims.

The lawsuit lists 16 different types of medications that were in the order, including some that contained Haldol, Thorazine, Geodon, Seroquel, Zyprexa, Risperdal and Cogentin – all of which were administered well above dosage guidelines and in some cases dosages deemed to be dangerous, the suit claims.

“These drugs were neither carefully titrated nor monitored with laboratory testing as per manufacturer or FDA recommendations,” the suit said. “Rather, they were simply forced down Mr. Garcia’s throat or injected into his muscles as he was forcibly held down in his bed, without regard to proper monitoring.”

The suit claims there was no monitoring by the hospital despite an order from Pueblo District Court to do so.

Instead Garcia continued to complain of stomach pains, beginning Aug. 5, then on Aug. 9, 12, 19, 21 an 24, the suit said.

The suit claims Garcia’s complaints were the result of his developing fecal impaction and dehydration.

By Aug. 23, Garcia was observed to be “eating and crying” the suit said, noting it was a clear example that eating caused him extreme pain because of his condition.

“Defendants knew that food was coming in, and consciously disregarded the fact that it was not coming out,” the suit said.

By Sept. 10, lab tests were ordered for Garcia and the results showed his Haldol levels were 10 times higher than the upper limits of the therapeutic range, the suit said.

His Zyprexa level was 73 percent higher than recommended, it said.

That afternoon, Garcia threw up dried blood and was transferred to St. Mary-Corwin Hospital.

Surgeons at St. Mary-Corwin worked to rehydrate Garcia first before they could begin to deal with his gastrointestinal problem, the suit said.

Surgeons began a colonoscopy on Sept. 14 which took over an hour. During the procedure, doctors had discovered his bowel was gangrenous, the suit claims.

Another procedure was performed three days later where doctors opened Garcia and attempted to remove portions of his colon. During that procedure, the colon burst, which led to septic shock and a fever exceeding 109 degrees, the suit said.

Garcia lapsed into a coma and died Oct. 8, 2007.

A final pretrial conference on the case is set for March 15.

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