APDU Alert to Baptist Health in Kentucky — Patient Mr. Robert Rhoden (DOB 11/24/1940): Improper DNR Designation

The Following APDU Alert was sent to Ms. Janet Norton, Chief Legal Officer and General Counsel to Baptist Health system in Kentucky on behalf of the family of patient Mr. Robert Rhoden, deceased.This Alert letter was generated after review of records voluntarily provided to the APDU by the family. It is published here of the public record with the full consent of the Mrs. Faye Rhoden, wife of the later Mr. Robert Rhoden.

Ms. Janet Norton

Chief Legal Officer and General Counsel

Baptist Health System

2701 Eastpoint Parkway

Louisville, KY 40223

November 7, 2017

RE: Mr. Robert Rhoden (DOB: 11/24/1940)

Dear Ms. Norton,

You are receiving this letter from The American Patient Defense Union on behalf of the family of a deceased Baptist Health patient, Mr. Robert Rhoden, at your Corbin facility. Mr. Rhoden’s family has filed a complaint with The Union regarding serious concerns they have surrounding his death at your facility on the morning of September 22, 2017.

The Union represents the interests of individual American patients who reach out to us voluntarily for help. Our objective is to provide transparent feedback to specific providers, hospitals, insurers and drug/device manufacturers, on behalf of individual patients and their families when grievances arise. The goal is to improve our nation’s Healthcare establishment by addressing real or perceived safety hazards, and ethics or legal violations across the United States — in order to create a maximally patient-centered corporate healthcare environment in deeds, not just in words. The Union is focused on identifying medical ethical violations and corrupted or unsafe practice patterns within our corporate healthcare establishments. Please note that The Union is NOT a legal firm, but in cases where litigation becomes appropriate, we do support our members in seeking robust legal support.

Mr. Rhoden’s family has voluntarily shared pertinent parts of his medical records with The Union in order that we may concisely and publicly communicate their concerns to you. Here, we request your immediate attention on behalf of the Rhoden family.

Briefly, Mr. Rhoden presented to your facility’s Emergency Department on September 20, 2017 with a chief complaint of several days of abdominal pain, profuse diarrhea and vomiting. Prior to the onset of his symptoms he was, according to his family, in his usual state of health and had been reasonably active and free of debilitating symptoms.

Mr. Robert Rhoden (right) with his son-in-law (left) on Saturday September 16, 2017 on a family outing. Picture provided and published with permission from Ms. Catherine Rhoden-Goguen, Mr. Rhoden’s daughter.

On admission to Baptist Health Corbin, he seems to have been dehydrated with an elevated WBC count. His congestive heart failure seems to have been under control and he was reportedly not in acute failure. It appears that he was not evaluated by a surgeon or a gastroenterologist at your facility — despite a CT scan read that is suggestive of a missed incarcerated left inguinal hernia, along with his acute onset GI symptoms and abdominal pain.

Irrespective, on the morning of September 21, 2017 the family was shocked, when they arrived to visit Mr. Rhoden and were reportedly informed by members of your staff that Mr. Rhoden had passed away earlier in the morning — in room 307, on 3 South in your Corbin facility.

The family’s shock and grief turned into pure confusion when thirty minutes later they witnessed Mr. Rhoden in a wheelchair being transported for a swallow study — alive. At this juncture they were informed that a mistake had been made and that it was, in fact, another patient in room 307 who had died. Mr. Rhoden had apparently been transferred, in the night, to room 310 without the family being informed. One can only imagine the tremendous grief, shock and confusion your staff’s seemingly careless handling of this situation must have caused the family on the morning of September 21st.

Nevertheless, Mr. Rhoden was alive on September 21, 2017. His daughter states that when the family left that evening, he had been evaluated by the cardiologists and was on the mend. His labs were “improving” and he was “feeling better”.

But on the early morning of September 22, 2017 Mr. Rhoden’s daughter received a call from a nurse at your facility informing her that her father was bradycardic — and that he was dying. When she insisted that he be treated with all available resources and transferred to the ICU, the nurse informed her that Mr. Rhoden has a “DNR” status and that nothing more could be done. Mr. Rhoden expired shortly thereafter, reportedly not having undergone any resuscitation attempt to rescue him — and in the absence of his family. It remains unclear what precipitated his bradycardic event — almost immediately after his a.m. lab draw at 5:02 a.m according to the records provided by the family.

The serious trouble, and the main reason for this family’s complaint, is that the Rhoden family was not aware of Mr. Rhoden ever electing a DNR status. In fact, the family is adamant that neither he, nor any next-of-kin, ever elected a DNR status for him. In addition, they claim that the medical records staff, at Corbin, has not been able to place any record of this patient or his healthcare proxy ever consenting to DNR. They claim that there is no way he would have elected a DNR status given that he came into the hospital for evaluation and treatment of acute onset GI complaints and abdominal pain — and because he had not recently experienced any dramatic deterioration in his health warranting consideration of a DNR status.

As you know, the above charge by a patient family is, legally, a very serious one — particularly as Mr. Rhoden was covered under a MediCare Health plan. The Union sincerely hopes that Baptist Health can pinpoint and clarify exactly when and how the patient’s, or his family’s, consent was obtained for assigning him a DNR status, by locating a copy of his signed DNR form in his medical records.

It is The Union’s understanding that all DNR designations must be made with full, documented informed consent from the patient or his/her next of kin. Was this the case with Mr. Rhoden at your Corbin facility? Based on the record provided to us by Mr. Rhoden’s family, one of your practitioners seems to have placed an active DNR order into your computer system, upon which the clinical team seems to have acted on the morning of September 22, 2017.

Therefore, it is The Union’s sincere hope that you can clarify how and why Mr. Rhoden was not resuscitated from his bradycardic state on the morning of September 22, 2017 — and why he was designated a DNR status by your practitioners.

In Summary, the Rhoden family wishes for your providers to clarify the following serious questions as they grapple with the death of their loved one this past September: 1) Was Mr. Rhoden evaluated by your surgical or Gastroenterology services given his significant GI symptoms and CT scan findings of a potential incarcerated Left inguinal hernia, 2) Why was no due diligence exercised when informing the family, erroneously, of his death on September 21, 2017, and 3) Why was he designated in a DNR category without a formal consent of which his family would be aware, and thus, actively, not resuscitated from the bradycardic state that claimed his life on the morning of September 22, 2017?

Please note that this letter is submitted to you based on a detailed communication with the patient’s daughter and review of medical records voluntarily provided to us by the patient’s family. It is publicly archived here with the full consent of Mr. Rhoden’s next of kin. In addition, with the enclosed consent form, the family of Mr. Rhoden is providing The Union permission to communicate with you on their behalf and to discuss the details of Mr. Rhoden’s medical records.

The Union trusts that you will take the contents of this letter under serious advisement and review the patient’s medical record carefully with the providers involved with his care. As you know, any breach of informed consent in assigning a patient to a DNR status is a very serious legal violation — and any patient allegation to this effect requires immediate and definitive internal and external investigations. We sincerely hope that Baptist Health has not committed such a breach and that your office, and Mr. Rhoden’s clinicians, will be able to alleviate the grievance expressed by the family to their satisfaction by explaining their loved one’s sudden death.

We look forward to hearing from you in the near future. Please do not hesitate to contact The Union at info@patientrights.org.

Sincerely,

Hooman Noorchashm, Founder

American Patient Defense Union.