Question: Please review the uploaded report which shows an MRI report of a patient s spine. How severe are these 3 compression fractures in the uploaded MRI report and what would be the recommended treatment for each of these compression fractures?

Hi,

Please review the uploaded report entitled " XXXXXXX 20 2014 COPD FROM OVERSEDATION VERSES HEART FAILURE FROM PAIN"

This patient had complained of Norco making her overly sedated but Tylenol not helping for the pain. This resident was beinng administered increasing amounts of Norco pain meds to treat the unrelieved lower back pain. But the Norco was not effective in treating this type of 10/10 unrelieved lower back pain. This patient had 3 acute respiratory failure events XXXXXXX 20 2014, Feb 2 2014, and Feb 6 2014 during the last month of her life when she was left in 10/10 unrelieved severe lower back pain. These acute respirator failure events were related to the patient's 10/10 unrelieved lower back pain and it's treatment (being over sedated with Norco pain meds).

Too much Norco had caused this patient to become extremely lethargic and may have caused COPD exacerbation leading to heart failure exacerbation on XXXXXXX 20 2014, Feb 2 2014, and Feb 6 2014. I

n addition, despite Norco 10/325 pain meds being prescribed every 4 hours (as needed), this patient was complaining that these meds were still NOT EFFECTIVE. Because the pain meds were NOT EFFECTIVE at treating this type of pain, this patient risked myocardial ischemia, acute heart failure, a heart attack, and acute respiratory failure.

Knowing the (above) what would you do in this situation?

Hi,

You stated "In this situation,i would have gradually tried to taper off the pain medications slowly to the lowest possible dose and given more of physiotherapy and spine support braces".

Please review the "Feb 6 2014 Primary Care Physician Note"

Are you stating that the primary care physician should NOT have increased this patients pain medication on Feb 6 2014 when this patient was complaining about being in unrelieved lower back pain?

This doctor also prescribed "physical therapy" for this patient. Physical Therapy "encouraged" resident to do "sit to stands" on Feb 15 2014 in which afterwards this resident was complaining about being in "terrible" pain. She died hours later.

After reviewing the Feb 14 2014 MRI and seeing the severity of these 3 compression fractures do you think "encouraging" this patient to do "sit to stands" on Feb 15 2014 would worsen these compression fractures and contribute to the "terrible pain" this patient complained about afterwords? Do you think "sit to stands" were the WRONG type of exercises for Physical Therapy to be "encouraging this patient to be doing on Feb 15 2014?

Dear, Dr. Mahaveer XXXXXXX

Please review the newly uploaded file entitled "Feb 6 2014 Norco overdose"

On Feb 4 2014, this patient was released from the hospital “even though” she “could not identify her location” . later that evening on Feb 4 2014 this patient “complains she is seeing things on her wall" and "States she is scared”.

Hours later on Feb 6 2014, we see this patient suffer another acute hypoxic event. On Feb 6 2014 the primary care physician states in her progress note that “Color is pale. She is really quite tired. She falls asleep frequently while I am talking to her”. But despite this patient fell “asleep frequently while” the doctor was “talking to her”, this patient’s Norco pain meds were increased from 7.5mgs every 4 hours as needed to “Norco 10 every 4 hours”.

This patient this is to the hospital ER on Feb 6 2014. While in the hospital ER on Feb 6 2014 the ER doctor stated “Unable to obtain a review of systems because of underlying dementia”. This patient saw a psychiatrist monthly for a year who NEVER diagnosed my mother with “dementia” and in fact had ruled “dementia” out 9 months earlier.

In your personal professional opinion do you think that the "acute respiratory failure" and “underlying dementia” which happened on Feb 6 2014 were signs that this patient was over-sedated/overdosed on Feb 6 2014?

Thanks