Archive for Wednesday, July 21, 2004

Fighting for Alene

Woman working to change ambulance protocol

July 21, 2004

If not for the wisdom of 8-year-old Logan Potts, the death of his grandmother, Alene Wilson, might have been a mournful procession rather than a celebration of life. Instead of tears, Logan felt family members gathered near his grandmother's deathbed should rejoice by commemorating her entry into heaven.

"We sang her happy birthday because she had just gone to heaven," said Alene's daughter, Tammy Potts of Basehor. "It was a celebration. We sang to her. I'm a real believer my mother was welcomed by my dad on the other side."

The late Wilson, a Basehor resident of 33 years, lost her battle with pneumonia on a cool Saturday afternoon in December of last year. She was 68 years old and in two weeks she would have celebrated her actual birthday.

Fate smiled upon her when she died: her two grandsons, Logan and big brother, Jake, just returned home from ball games that day and other family members were nearby. Alene was not alone when she left this world.

"They were all able to be there for her last heartbeat," Potts said. "It was almost like she waited for them to get there."

While the events on the day of her passing are steeped in more joy than sadness, the circumstances leading to it are not. The case of Alene Wilson is a political gray area and one that is currently under review by the state board of emergency medical services.

At best, it's a landmark case that could have ripple effects statewide for patients and family members entrusted with their care. At worst, Alene's story serves as a precautionary tale for families dealing with the illnesses of loved ones.

Potts and her brother, Jim Wilson Jr., are taking up the cause to ensure their mother didn't die in vain and that what happened to her won't ever happen to anyone else.

Potts said she's trying to protect her mother in death because not enough people did in life.

The story begins Sunday, Nov. 23, 2003, in the kitchen of Alene Wilson's home at 1119 N. 150th Street in Basehor.

Who has the power?

On that Sunday afternoon Jim Wilson, who at the time was living with his mother, called his sister with bad news. Their mother had fallen in the kitchen and was in unbearable pain. He feared she had broken her hip.

Potts called 911 and rushed over. Her fears were confirmed when she witnessed her mother lying on the floor in agony. She braced herself for a trip to the emergency room.

In 1994, Potts had hired a Jackson County attorney to write a durable power of attorney agreement granting her financial and medical decision-making powers for her mother. Alene had begun experiencing several health problems. In preparation for more complications down the road, Alene and Tammy had the power of attorney document prepared. In neat cursive penmanship, Alene Wilson signed the agreement Oct. 4.

Years later, in 1998, Potts began using the power of attorney privileges for her mother, who began suffering strokes and lost some mental faculties. Alene could no longer care for herself and her children split responsibilities in caring for her.

"My mom had been suffering from mini-strokes the last years of her life," Potts said. "She battled dementia. She saw people that weren't there. She made sandwiches for children that didn't exist."

Leavenworth County paramedics arrived at the scene to treat Alene. What they did next altered her life forever and that of her daughter.

Potts told the paramedics she wanted Alene transported to the hospital. She showed them the power of attorney agreement.

"(The lead attendant) pushed the agreement back in my face and said patients' rights to say 'no' override any paper," Potts said.

Leavenworth County Emergency Medical Service officials would not comment for this story.

Earlier, Potts and Jim Wilson moved their mother from the kitchen to her bedroom. She was still feeling excruciating pain. On the scene, Potts informed the lead paramedic of her mother's dementia.

After routine questions, he disagreed.

"He said there's no way she's got dementia," Potts said. "So now I've argued legally and argued medically with him."

A St. John Hospital medical assessment, taken the following day, indicates Alene suffered from dementia, hallucinations and a broken hip.

Alene refused medical treatment at the home and dotted a refusal of transport or treatment document in printed, block letters.

Potts said there was no possibility she would allow her mother not to seek treatment for the broken hip and wanted her mother sent to the hospital.

"They told me to wait until she's unconscious and call them back," she said.

"She was totally in denial. She couldn't get up. She was confused and had they made a proper evaluation, they would have seen that."

Despite the power of attorney, the patient's current and past medical conditions and Potts' wishes, the paramedics left Mrs. Wilson where they found her. "That was a decision that killed my mother," Potts said.

After the medics left, Potts began scrambling, making telephone calls to try to find alternative means of care that would come to the house.

"I'm fighting a battle against time," Potts said. "At this point she's going to die just from the lack of treatment."

On a Sunday afternoon, she had little luck finding another means of health care. When that failed, she tried locating a gurney or a wheelchair she could purchase to transport her mother to the hospital. Hours later, she found one.

Potts loaded her mother into her mini-van and took her to the family doctor, who was waiting on stand-by. He did a quick X-ray and found that Alene had "shattered the entire ball of her hip, it was nothing but dust," Potts said.

Alene died of pneumonia, according to her death certificate. It is one of the side effects from a broken hip and it is caused by prolonged immobility.

17 hours later

Alene Wilson wouldn't arrive at the hospital until 17 hours after her fall. At the front door of the hospital, Potts and her mother were greeted by a familiar face -- one of the attendants who failed to treat Alene at her home a day earlier.

"He saw my mother and said, 'Well, Mrs. Wilson, I see you're finally here. Maybe next time you'll take the easier route,'" Potts recalled. "My mother didn't even recognize him and he'd been at her house the day before."

At the hospital, Alene's blood pressure had risen to such levels that doctors couldn't operate. Pneumonia had threatened to set in. It wouldn't be until Nov. 28, the day after Thanksgiving, when doctors performed surgery.

Potts said doctors and medical personnel at the hospital never once questioned the power of attorney privileges. "They honor a DPA," she said. "They were totally respectful."

Although the hip replacement surgery was a success, Alene never regained her mental faculties -- she no longer called her children by their names but she did have conversations with people who weren't there.

"It was a successful surgery but the woman I knew was no longer," Potts said.

On Dec. 3, Alene was allowed to go home under Hospice care.

She was to be transported by Leavenworth County EMS. After three calls for transport went unanswered, Potts took her mother home the same way she got her to the hospital.

By mini-van.

At home, Alene's condition improved for fleeting instants, but for the most part, "she seemed closer to death than to life," her daughter said. Three days later, on Dec. 6, Alene Wilson died. Potts buried her mother two days later; the funeral followed the same philosophy of celebration that Logan implored family members to use on his grandmother's deathbed.

'A trap door'

Since her mother's death, Potts and Jim Wilson have questioned state health officials on the procedures used by Leavenworth County EMS in dealing with their mother. An official complaint has been lodged with the Kansas State Board of EMS. Last month, a five-member panel of the board's investigations committee heard Potts' side of the case.

They recessed until Aug. 5, when they are expected to announce a formal decision.

During the hearing, the legal counsel for the board determined the power of attorney document to be a valid one. Jerry Cunningham, an investigator with the Kansas Board of EMS, said he could not comment on his findings until after the board announced its decision.

He said the complaint centers on circumstances surrounding the initial visit by Leavenworth County EMS personnel on Nov. 23 and the failure to pick up and transport Alene Wilson from the hospital on Dec. 3.

Richard Foster, a member of the board of directors and legal counsel for Kansas Health Ethics Inc. in Wichita, said he's aware of the case pending with the state EMS board.

Foster said the case is unique and represents a legal gray area. He called the case "not so much a loophole as it is a trap door."

Foster said he's unaware of any penalties for medical personnel ignoring power of attorney privileges, mainly, he said, because he's unsure if it's ever been challenged before now.

"It's the first time I've ever heard of this coming up," Foster said.

It could be a landmark decision in how power of attorney privileges are looked upon in Kansas.

"Maybe (the board) will come up with some red-line fact to establish this," Foster said.

There is no easy answer to what should have transpired during the EMS visit to Wilson's home, Foster said. However, he said, it's not logical to believe a rational person would refuse treatment for an injury such as a broken hip. It's different from a patient who's been battling cancer refusing more radiation or chemotherapy treatments, he said.

Cancer patients sometimes refuse more treatments because they don't want to go through the pain, but a broken hip is a common ailment and, usually, non-life threatening and can be fixed by a simple surgery followed by rehabilitation, he explained.

"If they suspected she broke a hip, under the circumstances EMS might have been remiss," he said. "It wasn't an easy situation by any means but no person should be left unattended with a broken hip.

"They probably ought to have erred on the side of treatment."

'Fighting for Alene'

Today, Potts, and her family, fight an uphill struggle to change the procedures for how power of attorney rights are handled. She isn't asking much from the health profession.

She hasn't hired an attorney despite the advice from several legal and health experts to do so. Although it's a possibility, she hasn't filed a lawsuit against Leavenworth County EMS.

Hers and her family's wishes are to go through the proper channels to see that those responsible are held accountable and that the parameters of power of attorney rights are clearly defined and abided by. Potts said she's undaunted by the task and her requests of state health officials are simple.

"I want them to revoke the certification of Leavenworth County EMS and the two attendants," she said. "I want them to re-evaluate the standards for evaluating a patient. Basically, I want to see them change."

She also wants an answer as to why her power of attorney rights were respected by everyone except Leavenworth County. She wants to know "why it's OK for them to blow it off."

She said bringing her mother's case before the public, no matter the financial burden or time constraints, is important. If emergency personnel can ignore her wishes, and do so in such an unprofessional, cavalier way, it's reasonable to believe it will happen again, she said.

"My mother isn't going to be the only one not transported," Potts said. "If it's standard procedure are they truly looking after the patient's best interests?"

Until she gets answers to these questions, Potts said she won't stop petitioning anyone who would listen. She said she feels duped by believing the power of attorney document was worth more than the paper it was printed on and that it would be enough to protect her mother.

Instead of lying down she's standing up to a system she says is broken.

"If we can make somebody re-think how it's done, then my mother's death won't be in vain," she said. "Until somebody does that, though, we won't have any peace."

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