hypertension Question On Death Certificate

[jessejames]

The Death Certificate reads under "cause of death" a. uncontrolled seizures b. CVA (which means stroke) c. Hypertension Under Part II "other significant conditions contributing to death, but not resulting in the underlying cause, acute renal failure, IDDM (Insulin Sependent Diabetes, ASCVD (cardiovascular Disease), PTSD. This veteran was service connected for 20% Diabetes, 100% PTSD, 30% Liver Cirrohis, the seizures started shortly after the liver problems were found...he was a drinker up until then, but the VA had been prescribing Klonopin for anxiety and even doubled it before I told his wife the Klonopin labels said to NOT give to anyone with liver problems. The VA removed him from klonopin and he started having seizures, which were later controlled with 2400mg of gabapentin daily and topomax. He had never been diagnosed with either hypertension or cardiovascular disease. The reason he went to a local hospital was his kidneys began failing and he was admitted and dialysis was done twice, then his kidneys starting functioning and he was removed from dialysis. When he was first taken to the emergency room, they called the VA and they told them to admit him that they had NO room at the VA hospital. He stayed for approx 3 weeks in the hospital and the private doctor cut his seizure medicine down from 2400mg per day to 300mg. He was taking 1200mg in the mornibg and 1200 mg of gabpentin each day. On the day he was discharged to a Nursing Home (for physical therapy and care to try to help him grow stronger), he was not given any seizure medicine that morning and we don't know if the Nursing Home gave him any at all. He began having seizures on the 80 mile ambulance drive to the Nursing Home and that night his seizures became serious and the hospital was called and they took him back there. By this time, his kidneys were failing again, he was in full blown seizures, his blood pressure dropped and they could not get him revived. A Nurse pronounce him dead and the Nurse stated he had a stroke, the Doctor who had been his attending physician told the spouse he did NOT have a stroke...but it shows up on the Death Certificate.

I think the spouse has a case against the hospital for reducing his seizure medicine when he had been on 8 times the dosage for over 3-4 years, and uncontrolled seizures is listed as Number 1 cause of death.

My question is: since none of his s/c conditions are listed as "immediate cause" of death, although the seizures were no doubt related to the treatment of his liver problems....can any of the "other" s/c conditions listed as "contributing to death, but not resulting in underlying cause" can these be used for the increased benefit for Burial Benefits, ie the $2,000 vs the normal $600????

[Berta]

The wife- based on what you said the Death Certificate stated- should had no problem getting DIC-

if the VA can read this properly-

SC conditions "contributing to death" can render a SC death.

The wording here is a little different-when they say contributing to but not resulting to underlying cause ---that could give the widow problems with DIC-

I think it is about 2000 bucks for the funeral expenses----

I am surprised however that PTSD was listed on the death certificate and that they actually put all of that information on it-DCs dont have much room for death causes- have you seen the actual death certificate yourself?

I have read many- and always want to see the actual certificate- because sometimes it is not quite what the widow says it states-only because the med terms etc can confuse many-

"A Nurse pronounce him dead and the Nurse stated he had a stroke, the Doctor who had been his attending physician told the spouse he did NOT have a stroke...but it shows up on the Death Certificate"

I am volunteer with local Fire/EMS- no nurse, PA, or EMS etc ever pronounces anyone dead-

ALS can tell the coroner the patient is dead but it takes a medical doctor to make the legal pronouncement-

even with Rod- I knew he died while I gave him CPR-but the ALS would not confirm he was dead- yet they rushed him to a real hospital instead of the VA ER- to get a doctor to pronounce him dead.

There is definitely something highly unusual about his treatment and his death-

and you see it -----

one question- the nursing home- was this private or VA?

VA nursing homes are umbrellaed into regulations that give the VA a way out in deaths resulting from VA Nursing home problems.

Nevertheless -VA might well have some liability here-he was only at a nursing home a short period of time-

I suggest that the widow file the 21-534 ASAP and maybe she needs to file a Section 1151 also-

will read this all again----

WAs he autopsied and does she have the complete autopsy yet?

you said:

"I think the spouse has a case against the hospital for reducing his seizure medicine when he had been on 8 times the dosage for over 3-4 years, and uncontrolled seizures is listed as Number 1 cause of death"

Looks to me that he had CAD due to the DMII- and I dont see any SC rating for that-

"He had never been diagnosed with either hypertension or cardiovascular disease"

I see more than just the medical drug error here-

this is major malpractice in my opinion-

almost exactly like my case over Rod's wrongful death-

he was never diagnosed with CAD yet the med recs revealed they knew he had CAD and althought his HBP was recognized, the meds were totally ineffective-way too low a doseage-thus causing his CVA stroke.

She needs his entire clinical medical file- all VA and private records-

She could file the 21-534 without them- but best to get them all before she considers 1151 claim or FTCA claim for wrongful death.

But best yet to see the actual death certificate wording- because this is worded in a way I have never seen before----and VA will see the landmine I saw in the way it was worded.

Was the DC signed by a VA doctor?

[Berta]

Jesse-I have no doubt that you extended this vets life when you questioned the med he was on---

http://www.drugs.com/klonopin.html

Klonopin most probably had an adverse reaction with the anxiety med as well as with the kidney problems-

Gabapentin can actually cause seizures itself- that dosegae was very high-

http://www.nlm.nih.gov/medlineplus/druginf...694007.html#how

and even topomax could have been wrongly prescribed:

http://www.drugs.com/topamax.html

In my opinion you saved his life-re that med ----Klonopin---- only to have the VA itself put him on ice-

I know the feeling- the VA corrected some problems I griped about with Rods care

only to find they were totally overlooking- in spite of clear med evidence- the major disabilities he had.And lying to us ---when they knew he would not live much longer.

Sounds like major malpractice to me-

but then again- I get many malpractice issues locally and from vet orgs-

95 % of the time they are not really malpractice at all-and not borne out at all by the VA medical evidence-

I think this vet is definitely in the 5 % however.

Edited June 8, 2007 by Berta

[Pete53]

Berta:

Thanks for the post it is really a good one. MedLine does a good job and I appreciate the link.

Pete

[jessejames]

Berta; I DO have the Death Certificate and it reads axactly as stated. He was NOT in a VA Nursing Home. The night he began having the major seizures, the Private Nursing Home sent him to a very small rural local Hospital Emergency Room, who in turn called the VAMC, the VA told them NOT to bring him there as they had no room....the VA advised the ER to send him back to the private Hospital (a major facility where he had been for approx 20 days immediately before being transferred to the private nursing home) 70 miles away. The VAMC was only about 50 miles further than the one they sent him to. I have requested all Medical Records from the Nursing Home, the rural hospital ER, and the Attending Physician at the major hospital....I asked him point blank, what caused the seizures since it was listed as number 1 cause of death. The Death Cert. has 3 spaces for immediate cause of death, and then a section under that for contributing causes of death. Taking the 2400MG of Gabapentin daily for 3-4 years had kept his seizures under control, I just feel that a sudden withdrawal down to 300 mg per day and we don't even know if he was given ANY on the day of his death, I feel if the records bear this out, then someone should be held accountable. He was getting the 2400mg from the VAMC and the Doctor stated that since he was such a huge man, that was the reason or the large dosage.

[Alex]

"My question is: since none of his s/c conditions are listed as "immediate cause" of death, although the seizures were no doubt related to the treatment of his liver problems....can any of the "other" s/c conditions listed as "contributing to death, but not resulting in underlying cause" can these be used for the increased benefit for Burial Benefits, ie the $2,000 vs the normal $600????"

A death can be service connected if service-connected disabilities caused or contributed to death. 38 CFR 3.312 ("the death of a veteran will be considered as having been due to a service-connected disability when the evidence establishes that such disability was either the principal or a contributory cause of death. The issue involved will be determined by exercise of sound judgment, without recourse to speculation, after a careful analysis has been made of all the facts and circumstances surrounding the death of the veteran, including, particularly, autopsy reports."

Alex

[jessejames]

Thanks Alex; I had included a full copy of 38 cfr 3.312 in my letter to the physicain who had treated him in the hospital for the 20 days before he was transferred to a private nursing home and immediately after he was transferred back to the same hospital with seizures that the Nursing Home nor the rural hospital ER could get controlled. The Death Certificate states an RN pronounced death, and looks like later the Coroner was called in even though he was in a major Baptist Hospital at time of death. The seizures were listed as the NUMBER 1 cause of death, I hope the Doctor will be able to explain WHAT was causing the seizures, and if it was related to the s/c liver or Diabetes, that he will put in writing making for more evidence before I file the claim. There was NO autospy performed.

Alex; One question, if the Medical Records show that the Rural Hospital ER called the VAMC for permission to send him there because he was in very serious condition, if teh records show the VAMC told them to send him to the ER at Baptist Hospital.....would the VA be responsible for ambulance fees and Baptist Hospital fees since they never got his seizures under control and he died there.

§3.312 Cause of death.

(a) General. The death of a veteran will be considered as having been due to a service-connected disability when the evidence establishes that such disability was either the principal or a contributory cause of death. The issue involved will be determined by exercise of sound judgment, without recourse to speculation, after a careful analysis has been made of all the facts and circumstances surrounding the death of the veteran, including, particularly, autopsy reports.

( Principal cause of death. The service-connected disability will be considered as the principal (primary) cause of death when such disability, singly or jointly with some other condition, was the immediate or underlying cause of death or was etiologically related thereto.

© Contributory cause of death.

(1) Contributory cause of death is inherently one not related to the principal cause. In determining whether the service-connected disability contributed to death, it must be shown that it contributed substantially or materially; that it combined to cause death; that it aided or lent assistance to the production of death. It is not sufficient to show that it casually shared in producing death, but rather it must be shown that there was a causal connection.

(2) Generally, minor service-connected disabilities, particularly those of a static nature or not materially affecting a vital organ, would not be held to have contributed to death primarily due to unrelated disability. In the same category there would be included service-connected disease or injuries of any evaluation (even though evaluated as 100 percent disabling) but of a quiescent or static nature involving muscular or skeletal functions and not materially affecting other vital body functions.

(3) Service-connected diseases or injuries involving active processes affecting vital organs should receive careful consideration as a contributory cause of death, the primary cause being unrelated, from the viewpoint of whether there were resulting debilitating effects and general impairment of health to an extent that would render the person materially less capable of resisting the effects of other disease or injury primarily causing death. Where the service-connected condition affects vital organs as distinguished from muscular or skeletal functions and is evaluated as 100 percent disabling, debilitation may be assumed.

(4) There are primary causes of death which by their very nature are so overwhelming that eventual death can be anticipated irrespective of coexisting conditions, but, even in such cases, there is for consideration whether there may be a reasonable basis for holding that a service-connected condition was of such severity as to have a material influence in accelerating death. In this situation, however, it would not generally be reasonable to hold that a service-connected condition accelerated death unless such condition affected a vital organ and was of itself of a progressive or debilitating nature.

[26 FR 1582, Feb. 24, 1961, as amended at 54 FR 34981, Aug. 23, 1989; 54 FR 42803, Oct. 18, 1989]

Cross references: Reasonable doubt. See §3.102. Service connection for mental unsoundness in suicide. See §3.302.