diabetes How Should I File For Dic

[KHJH]

I have been looking over my husbands medical records and I'm not sure how I should file for DIC.

My husband has been on a diabetic diet for probably 2 years and it is even in his medical records that he is on a diabetic diet. He never filed for diabetes because I thought his A1C had to be 7 or higher. His highest one was 6.4. But he was on a diabetic diet so wouldn't this make his A1C lower. His Glucose was 144 right before he died and he hadn't had anything to eat in over 24 hours. It is also in his medical records that he has diabetic feet and that he is a diet controlled diabetic. The third time he was in the hospital in the last month and half his diagnosis was: Chronic renal failure, Depression, Chronic pain and Diabetes.

There was several doctors in the last couple months that said his renal failure was because of his pain medications he was taking for his SC back, hip and knee. Some quotes from his medical records: "Possible drug induced. Should reevaluate and adjust his meds. "On methadone chronically, Methadone levels increase with renal insufficiency." "Possible pain medication toxicity, on methadone & vicodin. "will continue to hold methadone, not a good choice with renal insuffiency continue with vicodin." "The patient has been taking a lot of pain medication was advised to cut down on his pain medication and make sure he drinks a lot of liquids." Hold nephrotoxic meds Lisionopril, colchecine, piroxicam." "He also carries a history of major depression and PTSD, chronic pain for which he is taking numerous pain medications. He was admitted for chronic renal failure and possible drug toxicity. He takes around the clock methadone and vicodin. Pain medications and other sedating medications continue to be on hold. Methadone is not a good choice for him due to his acute on chronic renal failure. Methadone is one that can build up to toxic levels. It was felt that the pain medications were too oversedating and he was not drinking enough fluids. Advised to use routine morphine, and as needed vicodin for pain."

My husband had several different doctors his primary doctor, his renal doctor and 4 different doctors each time he was admitted. They kept switching his pain medications around one would put in on one and the other would take him off and put him on another.

My husband was not abusing his pain medications. When he died he still had 2 bottles of vicodin with 180 pills in each bottle, 2 bottle of piroxicam, 2 bottles of methadone and 3/4 bottle of long acting morphine and 3/4 bottle of fast acting morphine.

His records also states "History of CHF but Echocardiogram done in Oct 06 show EF of 60% and concentric LVH.

"Patient has PTSD and Depression which seems to have an impact on his other medical conditions."

"Major depression, recurrent: patient has been on quietapine: It can cause hypotension and increased creatinine in rare cases: wonder if it is contributing to patient's repeat admissions for ARF."

On 11/5 he had creatinine of 6.47, bun 95, hgb 10.8. Records state "if needed arrange for dyalisis. Dyalisis was never discussed with us. And he was admitted 2 more times after this for renal failure. They were getting ready to send him for dyalisis when he went into cardiac arrest.

The cause of death on his death certificate is: Cardio-Pulmonary Arrest.

Can I file for Death due to renal failure secondary to pain medications,medications for PTSD and Depression and Diabetes. Would this be hard to prove?

Do I need to send in his medical records when I file for DIC.

Do I need to get an IMO before I file for DIC?

Do I get to keep ChampVa?

Any help would be appreciated.

I just received a phone call that my best friends husband died last night of a heart attack he was in his late 40's. She had a stroke about 6 years ago and is partially paralyzed on one side. They have a 9 year old son.

Kathy

[KHJH]

Berta

My husband died at the VA hospital, his autopsy was done at the VA hospital. I'm not sure who made out the death certificate. On the death certificate is says Was Coroner or Medical Examiner notified? NO.

No I don't live in NY I live in Illinois.

I thought he was wrong about trying to connect diabetes to his death.

He wanted me to file a claim right then and I told him I wanted to look over my husband medical records more before I filed a claim. So he gave the form I need to fill out so I could take it home.

Kathy

[Berta]

"17.170 Autopsies.

(a) Except as provided in this section, no autopsy will be performed by the Department of Veterans Affairs unless there is no known surviving spouse or known next of kin; or without the consent of the surviving spouse or, in a proper case, the next of kin, unless the patient or domiciled person was abandoned by the spouse, if any, or, if no spouse, by the next of kin for a period of not less than 6 months next preceding death. Where no inquiry has been made for or in regard to the decedent for a period of 6 months next preceding his death, he or she shall be deemed to have been abandoned."

From:

http://www.warms.vba.va.gov/Regs/38CFR/Boo...t17/s17_170.doc

Did you request this autopsy or was it their idea?

I am quite wrong I guess on this- but here in NY and in many other states both the coroner and the ME have to be notified.

My husband died in the barn but they would not even take him to the VA- they took him to a private hospital to be pronounced dead.

The Illinois ME gets involved if death is within the criteria at their web site:

http://www.co.cook.il.us/agencyDetail.php?pAgencyID=11

The Cook County Coroner gets involved when death is in this criteria:

http://www.cdc.gov/epo/dphsi/mecisp/illinois.htm

I regret if I jumped the gun -still how can a vet rep get a death certificate changed-it is beyond my comprehension there-

I found some IMO docs in Illinois-

http://expertpages.com/experts.php/indepen...er_illinois.htm

This is disturbing to me- if the VA itself potentially causes death due to medical error and then the VA autopsies the veteran=that seems like a major conflict of interest to me.

I hope they send you the autopsy report.

[KHJH]

Berta

After my husband died I had to go down and sign papers and answer questions like "Where do you want the body sent." The woman that was filling out the paperwork said "It's marked here that you don't want an autopsy." I said "No one asked me about an autopsy." Then she said "Well do you want an autopsy done." I paused for a few minutes not knowing what to do and my sister remined me that I might need one for SC. So I told her I wanted one. Me and my husband had talked about an autopsy before if I need it for SC. But I was so Confused and just wanted out of there.

Then the next morning I received a phone call from the VA hospital that I never signed a paper for the autopsy. I know I signed something. Then he said he was told that I was all confused on whether I had to pay for it or not so that is why I said no at first. No one ever asked me at first and nothing was ever said about who had to pay for it. He had to get my permission over the phone for the autopsy then they mailed a paper for me to sign.

The more I think about it the more I think the VA was at fault.

almost everytime my husband was admitted he had a different doctor. This time the doctor he got was a woman doctor that specialized in Infectious Disease. I'll call her DR. S.

At 8:40 am Patient blood pressure 82/44 Denies chest pain and discomfort. no JVD noted. Cardiac monitor shows sinus rhythm with heart rate 77.

Around noon the nurse came in and was giving him medication in his IV. I asked her what she was giving him and she said lasix. She said she had to administer it real slow because it can really lower the blood pressure. Then she said if that didn't work they were going to send him for dialysis. I asked her how long it would take before she knew if it worked or not and she said about 30 to 45 minutes.

according to his records:

1210 one-time dose of furosemide 40mg given slow IVP due to pt already exhibiting low blood pressure.

about 30 minutes later my husband said he had to throw up so I got his pan and raised his head up so he could throw up in the pan. He started to throw up and his head fell back in my arms. About that time 3 nurses came running in there yelling "Check a pressure, check a pressure." I looked up at the monitor and his blood pressure was 35/24. They started working with him and got his pressure back up. I ran out of ICU into the hallway to call my daughter and they paged me to return to ICU. When I got in ICU there were about 8 or 10 people in there recesitating him. They were all yelling to do this and that and one nurse said where is Dr. S and someone else said Dr. S said it was the furosemide that cause his BP to drop and someone else said the wife is present and they were all silent.

according to his records:

1241 (would be 31 minutes after the furosemide) this writer monitoring pt's heart rate, rhythm and blood pressures at nurses station monitors, noted to have a significant change in rhythm. Dr S. notified immediately. Strips posted in chart. Pt continue to be lethargic, but answering questions. complaining of chest pain that is worsening, but with no radiation. Diaphoric and cool to touch ashen in color.

1250 12 lead EGK done, accu check done with results of 143. ((he had not ate in 24 hours). complains of nausea vomited small amount of undigested food.

1255 call placed to Dr. S regarding pt complaints of nausea and chest pain.

1300 Dr. S here to review EKG. orders received to give pt four 81 mg chewable baby aspirins stat.

1304 pt had a 4 beat run cf v-fib/v-tach, then had another 5 beat run of v-fib/v-tach.

1305 pt had another 5 beat run of v-fib/v-tach. dopamine drip increased to 10mcg/kg/min=78.1ml/hr for blood pressure of 81/54. HR 124. Dr S. made aware

1315 pt in v-tach/v-fib. code blue called

1330 MAA notified to call anesthesia for intubation. ( The anestheoligist was 45 minutes away they did not have one at the hospital).

1340 Dr S left care of pt to Dr K (the emergency room doctor)

Dr S left and she never came back. How can a doctor just leave a patient.

1602 my husband died

Kathy

[Berta]

"The more I think about it the more I think the VA was at fault"

Yes- I know that feeling and as soon as I got the VA med recs and the autopsy results and figured some of all that out -I filed FTCA for wrongful death of my husband. The final results from VA Central office were worse than I thought as to the extent of malpractice.

Furosemide is a strong diuretic- and can cause dehydration as well as lowering blood pressure.- I see where your vet rep is going on that.

The fact that he was diaphoretic and yet still given this medication could have caused severe electrolyte imbalance, which can cause or contribute to fatal heart attack.

I believe you said the cause of death was heart attack? Did they elaborate on that with anything as contributing- on the death certificate?

Did they say when the autopsy results would be done?

I believe the Records Access Officer would send you a copy of the results upon your request.

I would add in your Section 1151 claim - that the medications administered to him by the VA during these critical last ER s and admissions had contributed to/and or directly caused his death.

Edited December 8, 2006 by Berta