Mather Hospital

The hospital refuses to set up a payment plan that fits my budget. They will be getting there money but because it is not what they want at the amount they want my bill will be going to collections. Last time I checked money is money. So when you need help I guess its better to just die as a hospital doesnt think what you can afford to pay is good enough.

DO NOT GO TO THIS HOSPITAL!! I would prefer to give NO STARS but it is not an option. This hospital ‘says’ they send bills but does not! Then they send them to CTech Collections owned by attorney Robert Sokoloff. This agency never served me and put a hold on my bank account for TWICE the amount of money owed. I spoke with a Margaret in billing and her attitude was ‘I don’t care’. I then spoke with an Angela in Public Affairs. I explained my story and she said I should speak with Nancy Uzo, you know, the one who comments back on here. I asked if she could help. Dead silence. Got my answer. Again, I repeat, DO NOT GO TO THIS HOSPITAL! EDITED TO ADD: To humor myself, I called the number below. It is for the Patient Advocate dept. As I thought, nothing! Again, NEVER EVER GO TO THIS HOSPITAL!!! Response from the owner 37 minutes ago We would like to learn more. Please call us at (631) 473-**** x 5400.

To Whom it may concern: Back in December 2017 I went to the emergency room for Mental Health, I was taken in the back , I was greeted by a male nurse or security guy, he was excellent, went above and beyond trying to help. I was then greeted by a women social worker who wasn’t very friendly at all. I can to John T Mather Hospital because I wanted help, if I wanted to go elsewhere I would of went, but anyway I then proceeded to wait, while social worker went to speak with Doctor, which I never got to speak with a Doctor who was going to decide if I should be admitted or not, so social worker comes back and says we can help you, the doctor is admitting you. Up to this point I was put on a bed in the hallway in the locked secure mental health area. Lunch came, I had just gotten a room, it was nice and quite, I got to take one bite of food, when the social worked came in and stated “ we are sending (transferring) you to south oaks hospital” , my response was simple “ I did not go to south oaks hospital, I came here for help”, she then proceeded to lie to me and said I did not have a choice and I can’t refuse to go to South Oaks Hospital. So here I am coming to a hospital for Mental health help, and so far all I was getting was more problems. So I ask nicely to speak with a patent Advocate, and also the social workers boss Bob. She got all bent out of shape, but said “okay”, I then went to sit back down in the room I just got and try to eat some lunch and calm down, but again I was interrupted this time by a nurse or nurses assistant, she informed me I was too come with her at once, I wanted to know where I was going, she said I was being moved for a little while, I asked if I was being moved to south oaks without seeing the people I requested and against my will, she said “no”, I asked if I was going upstairs to the mental health ward and she said ‘no”, so I followed her, they placed me in the emergency room, the section right next to the secure mental health holding area. I was placed in the wide open flush against the nurses desk with zero privacy, from anyone. There where 5-6 beds in that area, all with people visiting them, the janitors, the doctors ( the doctor I wasn’t allowed to see but yet now I am around all of them) all the nurses, every worker in the hospital in and out. I was stripped of my privacy, now everyone knew my business, I was taking from the secure area of the mental health part then put in a normal area, thus causing putting myself and everyone else at risk. Nobody had any regard for my well being, or my privacy. So the hours pass, new patients in and out, more people knowing my very personal business, I came to your hospital for help and so far I was exposed to greater harm, and mental anguish. So a few hours pass and finally a patient advocate comes to see me. Now in the hours I was left there I was able to come and go as I pleased, I walked where ever I wanted without so much a person following me up to this point. Anyway now the patient advocate comes and see’s me, now I am stationed at the nurses station and in a tiny room with families, and patients and every hospital worker you can think of all within ear shot, a total violation of my confidentiality and safety, I had to proceed to get into a 60-90 minute discussion with her, which again I was lied to, everyone in the place knew my business, I was not in a secure area where I felt safe, and she told me there was nothing she could do that I had to go to South Oaks which was a lie, they can not transfer you with your permission, anyway now that everyone in the room knows my business, Bob showed up, so another 2 hrs with him in a room, that wasn’t a mental health, and we are going back and forth and back and forth, he insisted that I must go to South Oaks, I refused and it went on and on. I refused and within an a Hour they said “oh we have a bed up stairs” so 7-8 hrs in the hospital and I wasn’t getting any help what so ever, I came to YOUR hospital because I hit a rough spot in life, and I was treated very poorly and it seemed nobody wanted to help me what so ever. I voiced my concerns , everything in this letter. Finally after midnight more like 2 am I was brought upstairs, I voiced my concerns up there, I didn’t want to be in this hospital anymore, why would I, I came to the place for help and everyone of my right’s as well as my dignity was violated. So I was released for the mental ward within 12 hrs. This whole experience was horrid. We need to rectify this situation. I am disturbed that you would treat mental health patients like this, I spent more time not getting help and having my rights violated then anyone helping me. I hope you never ever put anyone coming to you for mental health through what had happened to me. No privacy, zero discretion, violating my confidentiality, failure to provide a safe environment for myself or others. Most of all failure to treat me for what I came into the hospital for to begin with. I mean serious who would want to stay after all that happened? Now the question is how far up are we going to take this? I would expect a phone call very soon about this matter. Or let me guess nobody cares about this either! Yes tried contacting them but they return no calls, or email.

Was taken there by firedepartment after falling and fracturing a bone. Two days later, I became ill. I was told I acquired a staff infection. Got stuck their for weeks. Horrible hospital.

Mather Hospital, ACLU, Justice Department, New York Attorney General. How Institutional Age Discrimination Deprives Patients of the Human and Civil Right to Healthcare and Life. N.Y. Executive Law, Article 15, S290, 3, Equal Opportunity of Health Care. Civil Rights Act of 1964. American with Disabilities Act of 1990. Is it reasonable to conclude that my mother’s premature death at Mather Hospital was a result of Institutional Age Discrimination? To answer this we must ask ourselves if is it more conceivable that: 1) Mather Hospital lacked the knowledge of medication withdrawal symptoms of the very same medications they documented to have been abruptly discontinued? 2) Mather Hospital lacked the knowledge of the resultant pain and suffering associated with discontinuing pain medications for the bone pain associated with multiple myeloma? 3) Mather Hospital lacked the knowledge to make the connection of the symptoms presented with known medication withdrawal symptoms? 4) Mather Hospital lacked the knowledge Health Care Proxy Law. I’m sure you will agree that the common medical knowledge found within topics 1,2,3 and 4, given my mothers age, makes Ageism a strong possibility. To illustrate that Institutional Age Discrimination/ Ageism is in fact responsible for Mather Hospital’s denying my Mother of her Civil Right to Health Care by intervening in her behalf as a mandatory reporter, I have substituted my Mother with a Child, keeping the actual events and circumstances exactly the same, so that an honest assessment may be made based upon age alone. Upon entering emergency room on 2/9/13, A child’s parent informs the hospital that the child is "Actively Dying" (Physician Documentation, 2/9/13, 21:04, page 1) "Requesting no "vital signs" being taken, "defers blood work and diagnostic work-ups" (Physician Documentation, 2/9/13, page 1) "HCP states she does not want anything done to patient no labs, work up or anything that will "disturb" her"( Nurses Notes, 2/9/13, 20:10, page 1 and 2 under assessment). "Parent-resistant to obtaining pt’s vital signs, I explained need for assessing vital signs and rationale for same" (Nursing Progress Note, 2/10/13, 12:33, page 1). "Pt parent declined a full body assessment", Nurses Notes, 2/9/13. page 2) "Patient was not given aspirin because parent states patient no longer takes medications". (Physician Documentation, 2/9/13, 21:08, page 2). Keep in mind the Hospital had previous knowledge and documented that the child’s medications had been "abruptly discontinued" by the parent without medical supervision. Pain Medication for Cancer, Thyroid, Anticoagulant, Antidepressant and Blood Pressure,"Consultation Report", dated 1/30/13, "Physicians Documentation", dated 1/30/13, under "Home Meds", "Discharge Summary", dated 1/30/13, under "Medications, "Discharge Summary", dated 1/30/13, under "Medications) Also at this time the Hospital had knowledge and documented that the child’s behavioral and physical condition rapidly deteriorated within a month, paralleling the medication withdrawal timetable and symptoms. "Awake, Alert and Oriented X 3 and Awake, Alert, GCS 15", Discharge Summary, 2/1/13, under neurological and Physician, 1/30/13, page 2, under neuro., "Orientation is normal, Cerebellar function: normal finger to nose testing, able to perform alternating rapid hand movements, Motor: is normal, moves all fours, strength is normal, Sensation is normal, Deep tendon reflexes are normal"(John T. Mather Hospital Physician Documentation, Constitution ***’t., 1/13/13, page 2, Neuro:)

"ROM : Intact in all extremities, Circulation: Circulation is intact in all extremities, Joints: All joints appear normal with full range of motion, neurovascular is intact distal to injury" (John T. Mather Hospital Physician Documentation, Constitution ***’t., 1/13/13, page 2, Musculoskeletal/extremity:)
"Behavior: appropriate for age, cooperative" (John T. Mather Hospital Physician Documentation, Constitution ***’t., 1/13/13, page 2, Psych:)

"Negative for Chest Pain, Palpatations", (John T. Mather Hospital Physician Documentation, Constitution ***’t., 1/14/13, page 1, Cardiovascular)

"This is a well developed, well nourished patient who is awake, alert, and in no acute distress", (John T. Mather Hospital Physician Documentation, Constitution ***’t., 1/14/13, page 2, Constitutional:)
"Unresponsive", Nursing Assessment, 2/9/13, page , under Coping,/Observed Emotional State. 2/10/13 09:00), "Non Verbal", Nursing Assessment, page 3 & 4, under Coping/ Verbalized Emotional State, "Semi Comatose" (Nursing Assessment, page 7, Cognitive/Perceptual/Neuro under level of consciousness, 2/12/13) "Disoriented x 4", Nursing Assessment, page7, Cognitive/Perception/Neuro under Orientation). Dead (Death Certificate 2/12/13.) Regardless of whether a Parent or Healthcare Proxy Agent isInvolved, It is inconceivable, under any circumstances, that any patient could be exclusively subjected to the "Diagnosis and Prognosis" of an "unlicensed" person, within a Hospital, in the absence of any diagnostic testing. However the evidence suggests that there was no Health care proxy document or advanced directives were in the record. Mather Hospital Confirms Patient not Deemed Incapacitated During Dates in Question.
"A health Agent may only take over medical decisions when a Principal is deemed incompetent by two doctors". NYSHL S 2983 (A) 1, "To commence a proxy agents authority", (Surrogate Decision Making in New York, Salvatore M Di Constanzo, McMillan, Constabile, Maker & Perone, LLP.).

"Awake, Alert and Oriented X 3, (Discharge Summary, 2/1/13 under Neurological)

"Awake and alert, GCS 15, oriented to person, place, time and situation." (Physician Documentation Cont’. 1/30/13, page 2, Neuro:) 

"Awake, Alert and oriented x 3", (John T. Mather Hospital Discharge Summary Dis Date: 2/2/13, Physical Examination:)

"No deficits noted, patient oriented X3, eyes open spontaneously and obeys commands. Level of consciousness is awake, alert". ( Mather Hospital Nurse’s Notes ***’t, 1/30/13, page 2, 17:06, Neuro:)

"Mild Dementia". (John T. Mather Hospital Admission Profile, 1/30/13, page 4, Neurological Comment.) 
"Further, on admission, your mother was found to be ALERT, and ORIENTATED and fully concurred with the visitation restrictions ". (Mather Hospital Administrative Director, Maryanne B. Gordon, letter, 7/17/13, page 1).

Mather Hospital Admits Not Having in Possession a Health Care Proxy Document From 1/15/13 through 7/17/13.
After a 2 month long hospital investigation, Maryanne B. Gordon, Administrative Director confirms the fact that Mather Hospital cannot verify the date of execution, an essential element of a legal HCP, by stating: "Therefore, we can only conclude that at some point, your mother revoked her prior proxy and executed a new one".Essential Elements- Principal’s Signature and Date of signature, and execution", signature of 2 witnesses, neither of which can be an agent or alternate agent". (New York State Department of Health, "Filing a Healthcare Proxy in the Medical Record, Essential Elements of a Health Care Proxy). 

Mather Hospital Reaffirms That They "Routinely" Violate New York State Consolidated Laws Public Health. 
New York State Consolidated Laws Public Health S 2984, Providers Obligations" 1: Requires a "Healthcare Provider who is provided with a health care proxy shall arrange for the proxy or a copy to be inserted in the principals record".

Mather Hospital Official Response: "Further, hospitals do not routinely maintain copies of proxy documents for patients when they are executed, because patients often revoke and/or change agents over the course of time as circumstances change". (Letter, Maryanne B. Gordon, MA, RHIA, CHCQM, Administrative Director, Mather Hospital, 1/17/13, page 1, Response to complaint #1, You were your mothers Health Care Proxy effective 2007 and were denied the right to act as her proxy agent during her final hospitalization.) 

Mather Hospital Confirming No New Health Care Proxy Agent or Document Provided on Dates when Medications were documented to be discontinued without medical supervision."Your sister advised the staff upon your mother’s final admission that she was your mother’s Health Care Proxy and provided a copy of the proxy document". (Mather Hospital Administrative Director, Maryanne B. Gordon, letter, 7/17/13), page 1, response to complaint: You were your mother’s Health Care Proxy effective 2007 and were denied the right to act as her proxy agent during her final hospitalization".)

Final Admission Date Confirmed By Mather Hospital.

"Admit Date: 2/9/2013 22:08, Discharge Date: 2/12/2013 19:42 (John T. Mather Hospital Admission Reconciliation, 2/13/2013,page 1, 5:46, Visit ID: 13599****.)

ADM DATE: 2/9/13, DIS DATE:2/12/13. (John T. Mather Hospital Discharge Summary, 2/9/13, page 1,)

"Hospital stay was uneventful. On February 13, 2013, the patient expired" (John T. Mather Hospital Discharge Summary, 2/9/13, page 1, HOSPITAL COURSE:)

Certificate of Death, 2/12/13, Mather Hospital Physician, Natalya Titakeuko certifies the immediate "Cause of Death" as "Cardio Pulmonary Arrest" due to or as a consequence of: "Coronary Artery Disease, COPD, Dementia and Failure to Thrive", Pronounced Dead at Mather Hospital, 2/12/13, 2:50PM.) Additional Evidence of No "New" Health Care Proxy Document in the Records.After my mother’s passing on 2/12/13, I filed for Authorization for Release of Health Information Pursuant to HIPAA on 3/27/13 at Mather Hospital. (OCA Official Form No.: 960) I obtained my mothers medical records from Mather Hospital on 4/22/13, ( John T. Mather Memorial Hospital Customer Receipt, #2227****, 4/22/13, Account Number 72860****, $112.50) ironically on the Legal Basis that I was acknowledged by Mather Hospital, to be my mother’s rightful representative. (Documents Provided Mather Hospital, "Health Care Proxy Agent" since 11/10/07 as recognized by Mather Hospital, Brookhaven Memorial Hospital and my mothers Primary Care Physician. (Mather Hospital Nurses Notes, 1/13/13, Page 1, Brookhaven Memorial Hospital Case Management, 6/30/10, 3:30 PM, No. 9804, also was her "Durable General Power of Attorney", 11/10/07, designated as the "Medicare Information Recipient", Medicare Information Release Form, 11/3/10 and authorized by my mother’s Primary Care Physician to "discuss any medical problems, tests and results", Communication Consent, Dr. Michael Rodriguez. I was recognized by Mather Hospital as my mother’s Health Care Proxy Agent as of 1/11/12. ("Patient has a health care proxy. Name of Health Care Proxy: followed by my name and phone number, Mather Hospital Nurses Notes, 1/13/13, print time 1/15/13, 14:18:28, page 1.) In the absence of any other Document to contradict my Legal Status, including a "New" Health Care Proxy in the medical records, I was granted my legal right to obtain my mothers medical records. Department of Health Memorandum Access to Patient InformationSection 18: Access to Patient Information is available in Portable Document Format (PDF, 35KB, 5pg.)Patients and other qualified persons have a right to access patient information under Section 18 of the Public Health Law. Section 18 contains the procedures for making records available and the conditions under which a provider can deny access. If access is denied, the patients or other qualified persons are afforded the right of appeal to a Medical Record Access Review Committee (MRARC).Mather Hospitals Failure to diagnose and Prognose. Specifically by not obtaining a diagnosis or prognosis, the hospital did not act in accordance with New York's "Family Health Care Decision Act" ("hospital’s must give surrogates access to the patient’s medical information, medical records, diagnosis, prognosis, the nature and consequences of the health care, and the benefits and risks of the treatment. The surrogate is required, after review of the medical information, to base decisions on the patient’s known religious and moral beliefs. If the religious and ethical beliefs are not known, the decision is required to be made according to the patient’s "best interest".) As well as New York's "Health Care Proxy Law", 
("Physicians may honor decisions by a health care agent in the emergency room if the patient's diagnosis and prognosis can be determined, enabling the agent to make an informed decision. If delay to obtain information will harm the patient, treatment should be provided in accord with accepted medical standards"). In the absence of a diagnosis and prognosis to present to an agent, Mather Hospital had no legal authority to have that agent deny my mother with oxygen, medication, nutrition and hydration. Mather Hospital was the legally recognized Health Care Authority in this case. And as such should not have followed exclusively the "Diagnosis and Prognosis" of a layperson, when the layperson was not first provided with a conventional Diagnosis and Prognosis from Mather Hospital. As a result my mother died prematurely from a combination of medication withdrawal, pain, carbon monoxide exposure, dehydration and starvation. 1) She was abruptly taken off Vicodin, Prednisone, Levothyroxine, Lopressor, Celexa and Lovanox while being awake, alert, appropriate for age. 2) She was exposed to carbon monoxide, which hospitalized 4+ other cohabitants in her apartment, much younger in age. 3) She was denied Hydration and Nutrition while suffering from the previous assaults. If you conclude that somehow my mother was immune to the overwhelming assaults to her health, one must ask honestly if anyone at any age would be able to survive such conditions. Medication withdrawal, carbon monoxide exposure, starvation and dehydration are all reversible.When the hospital knew the patient was experiencing severe withdrawal symptoms and did not rectify the problem, the hospital was negligent. When the hospital did not fulfill it's duty and perform diagnostic testing, acquiring an accurate prognosis could not be reached. Without a diagnosis or prognosis, carbon monoxide exposure was not revealed. Without a diagnosis or prognosis the extent of carbon monoxide was not known, leaving the troubling question, could the effects of exposure been reversed? In the absence of A Health Care Proxy Document authorizing the denial of Nutrition, Hydration, Medication, Oxygen and Diagnostics, only Institutional Age discrimination can explain the lack of healthcare that was not a specified wish and not in the patients "best interests". CLS Educ. S6521 "Practice of Medicine", N.Y. Executive Law Article 15, S290, 3, Equal Opportunity of Health Care Civil Rights Act of 1964 and the American with Disabilities Act of 1990 What is the Human Right to Health and Health Care?According to the National Economic & Social Rights Initiative the Human Right to Health and Health Care is "The human right to health means that everyone has the right to the highest attainable standard of physical and mental health, which includes access to all medical services…The human right to health care means that hospitals, clinics, medicines, and doctors’ services must be accessible, available, acceptable, and of good quality for everyone, on an equitable basis, where and when needed. The design of a health care system must be guided by the following key human rights standards:

Universal Access: Access to health care must be universal, guaranteed for all on an equitable basis. Health care must be affordable and comprehensive for everyone, and physically accessible where and when needed." (NESRI – National Economi#569F24)Civil Rights and Healthcare"The Civil Rights Division (CRD) in the Office for Civil Rights (OCR) promotes and ensures that people have equal access to and opportunity to participate in certain health care and human services programs without facing unlawful discrimination. CRD carries out this mission by enforcing Federal laws and regulations that prohibit discrimination, including health care provider conscience rights, on the basis of race, color, national origin, disability, age and, in certain circumstances, sex and religion, in programs and activities that receive financial assistance from HHS. CRD also enforces a Federal law and regulation that prohibit discrimination on the basis of disability in health care and social service programs of state and local governments."What is Ageism?According to "Penson, Daniels, & Lynch, Jr., Ageism is: "prejudice toward, stereotyping of, and/or discrimination against any person or persons directly and solely as a function of their having attained a chronological age which the social group defines as old" " (Penson, Daniels, & Lynch, Jr., 2004, p. 347). Prevalence of Ageism in Health CareAccording to Chelsea L. Simkins, University of Pennsylvania, "Nurses, like the general public and even the elderly themselves, discriminate against older patients (Cooper & Coleman, 2001). Cooper and Coleman (2001) explored the extent to which society influences hospital nurses’ perceptions and examined how the demands of the profession influenced nurses’ opinions about elderly patients. They found evidence that nurses prefer patients who defy society’s negative ageist stereotypes: notably, patients who are mentally intact." (1-29-2008 Ageism’s Influence on Health Care Delivery and Nursing Practice Chelsea L. Simkins University of Pennsylvania)."A Specific Example"Peake, Thompson, Lowe, and Pearson (2003) performed a national questionnaire-based study of lung cancer patients divided into three groups: under 65 years, 65-74 years, and 75 years and older. Quite simply, Peake et al. found that "older patients were less likely to receive active treatment of any sort," (p. 174)" (1-29-2008 Ageism’s Influence on Health Care Delivery and Nursing Practice Chelsea L. Simkins University of Pennsylvania).Ageism and the Failure to Report and Intervene in cases of Elder Neglect. Establishing the association between Institutionalized Age Discrimination, Ageism and the Failure to Report and Intervene in Elder Neglect or Abuse one must first recognize the similarity of Child and Elder Abuse Laws. According to Elder Abuse Treatment & Management, Author: Monique I Sellas, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP . "The laws created for elder abuse were based upon child abuse laws; therefore, the inability of patients to make decisions in their own best interests was presumed." Ageism as a causative factor in the Failure to Report and Intervene in Elder Abuse or Neglect is well documented. In the article Elder Abuse Treatment & Management, Author: Monique I Sellas, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP states,"Various factors serve as barriers to reporting elder abuse. These include lack of knowledge, denial, ageism, fear of making the situation worse, desire to maintain family relationships, fear of ending up in court, or lack of belief that the situation will improve. The key to eradicating these barriers is education that increases both public and professional awareness." Ageism influences the way human rights and citizenship are articulated for older people. Ageism entails prejudices and actions against older people that result in older adults being socially marginalized and devalued. It is argued that these attitudes provide a "covert basis for societal tolerance of elder abuse" Phelan, A. (2008). "Elder Abuse, Ageism, Human Rights and Citizenship: Implications for Nursing Discourse." Nursing Inquiry, 15: 320–329. doi: 10.1111/j.1440-****.2008.00423.x). "It is argued that a lack of honor and respect of older individuals results in permissive attitudes of, and societal blindness to, disrespect and even violence against older adults. Addressing ageist attitudes within society may begin to reduce the occurrence." of elder abuse, or at least increase the public outcryAgainst it." National Center on Elder Abuse, Prevention Strategies. Mather Hospitals Failure to Report and Intervene in Elder Neglect of Medications. 10NY CRR 415.4, Reporting Neglect. New York Soc. Serv. Law, Art 9B 73 (5). "Reporting". In order to demonstrate "Failure to Report or Intervene in Elder Abuse or Neglect", the required "Reasonable Suspicion" from "Assessment Indicators" must be present. (Elder Abuse an Introduction for the Clinicians, Dr. Ronald A. Chez, Center on Elder Abuse . org)Documented Assessment Indicators of Abuse, Neglect and Denial of Civil RightsDenial of Medical Care- (Elder Abuse an Introduction for the Clinician, Slide Presentation, Center on Elder Abuse.org.)Under Utilization of Prescription Medications- (Elder Abuse, The Pharmacist’s Role, Center on Elder Abuse.org.)Prompted by "Reasonable Suspicion" of the "Assessment Indicators" A competent Health Care Institution is compelled to "Confirm the Diagnosis" with "Direct Questioning". Mather Hospital did indeed proceed to the "Direct Questioning" stage, as evident by the documented model questions;1 "Are you or have you been threatened or abused?"2 "Does anyone try to keep you from having / contacting other friends or doing things outside the home?"In both cases my mother replied YES, affirmatively to the "Direct Questioning", "Confirming the Diagnosis". New York State Consolidated Laws Public Health, S2982 (2), "Decision Making Standard" does not include inducing pain and suffering."Denial of Pain Medication is Elder Abuse", Elder Abuse, the Pharmacist’s Role."Denial of Pain Medication is Elder Abuse", Elder Abuse, the Pharmacist’s Role, Center on Elder Abuse.org, Center on Elder Abuse.org, "Denying Access to Pain Medication"."Denying Access to Pain Medication", Elder Abuse, Center on Excellence on Elder Abuse & Neglect.. "Under Treatment of Pain Equals Elder Abuse", Chronic Neuroimmune Disease, 1/13/13."Denying access to pain medication is physical abuse", Laura Mosqueda, M.D., Director of Geriatrics, University of California, Irvine School of Medicine.]Assessment Indicator Mather Hospital Recognized and Confirmed the Diagnosis by the Direct Questioning Method. "Are you or have you been threatened or abused?",My Mother Replied YES! (Mather Hospital, Admission Profile, 1/30/13, page 6, under Self-Perception.) DOROTHY-Enc #13595****-IPT-MED-1/30/2013 JOHN T. MATHER MEMORIAL HOSPITALPORT JEFFERSON, N.Y. 11777 CONSULTATION REPORT NAME : MR NO : 79-41-38ACCOUNT NO: 135958**** CONSULTING PROVIDER: SHAMIM KAHN, M.D.PROVIDER ID: 006093 DATE OF CONSULT: 01/30/2013 REASON FOR CONSULTATION: CHEST PAIN MEDICATIONS: AT home are vitamin D, Valium, Remeron, vitamin B12, Tylenol, and Keppra. The patient apparently was also on high dose of vicodin, which she has been abruptly discontinued for the last three days. SOCIAL HISTORY : The patient lives with her daughter. No smoking, alcohol or drug abuse. NorthShore Hematology/ Oncology AssociatesNSHOA 235 North Belle Meade RdEast Setauket NY 11733Phone: 631-751-**** Patient Name: Patient Number: 345**** HOSPITAL FOLLOWUP Michael Rodriguez, D.O. History of Present Illness Dear Dr. Rodriquez: Review of previous records from Dr. Boglia showed normal albumin; however, an SPEP revealed monocional free light chain and a Bence Jones protein that was positive for lambda type. She comes to the office today stating she feels well. She is tolerating the Lovenox at renal dosing. She denies any bleeding. Assessment: Coagulation defects,other Recommendation/Plan:An 85-yar-old lady with past medical history of seizures and anemia secondary to chronic kidney disease who presents with an acute DVT. I will perform a hypercoagulable workup, as she does have a family history of DVT’S. She also has an anemia likely secondary to kidney disease; however, she has Bence Jones protein suspicious for multiple myeloma. Multiple Myeloma Ignored. Symptoms Multiple MyelomaBy Mayo Clinic Staff Kidney (renal) failure. High levels of certain types of abnormal monoclonal proteins (M proteins), which are called light chains or Bence Jones proteins, damage the kidneys.Sign In Register Signs and symptoms of multiple myelomaThe osteoblasts do not get a signal to put down new bone, so old bone is being broken down without new bone to replace it. This can cause areas of bone weakness that are painful. Any bone can be affected, but pain in the bones in the back, the hips, and skull is particularly common with this disease. Multiple myeloma can also weaken bones all over (osteoporosis). Any of these changes increase the chance that the bones will break (fracture). Sometimes bones break from only a minor stress or injury.Bone problemsThe weak areas are often painful. These changes increase the risk of broken bones from minor stress or injury. Any bone can be involved, but pain in the backbone, hip bones, and skull is most common. Multiple Myeloma SymptomsBone pain, especially in the middle and/or lower back, rib cage or hips. Memorial Sloan Kettering Cancer Center Multiple Myeloma:Pain ManagementA majority of patients with multiple myeloma report that they experience some pain related to the disease. The pain may be a result of a bone fracture or of a tumor pressing against a nerve. Analgesics, or pain relievers, remain the mainstay of bone pain treatment. The strongest analgesics, called opioids or narcotics, are often prescribed to control pain in myeloma patients. The most commonly prescribed drugs are codeine, morphine, and morphine-like synthetic compounds. Avoiding Over-the-Counter DrugsOver-the-counter medications for managing pain, such as nonsteroidal antiinflammatory drugs (NSAIDs, including aspirin and ibuprofen), should be avoided unless your doctor specifically tells you that you may take them. These drugs can interfere with cancer treatments or interact with other medications in harmful ways. Mayo Clinic ProceedingsVolume 81, Issue 6 , Pages 825-828, June 2006 Mather Hospital Ignoring Withdrawal Symptoms Presented."Broken Heart Syndrome" After Separation (From OxyContin)People who abruptly discontinue opiods may experience "Broken Heart Syndrome" increasing their risk of cardiac event. "Though most Broken Heart Syndrome patients regain full cardiac function some die and others suffer life-threatening complications." (Mayo Clinics June issue of the Mayo Clinic Proceedings) "Broken Heart Syndrome" Can Result From Opioid Withdrawal, Cocaine Use• Heart Disease news • Jun 22, 2006 People who experience abrupt withdrawal from high-dose opioids or use cocaine increase their risk of cardiac event, according to two new studies published in the June issue of Mayo Clinic Proceedings.The findings shed light on "broken heart syndrome," a still somewhat uncommon disorder first described in Japan 15 years ago that mimics a heart attack. Patients may experience shortness of breath and chest pain and, upon hospital admission, go through extensive tests to determine a diagnosis and rule out heart attack.In a case report outlined in Mayo Clinic Proceedings this month, physicians describe a 61-year-old woman who was treated for broken heart syndrome at Mayo Clinic Rochester after abruptly discontinuing use of the opioid, OxyContin. It’s the first report of broken heart syndrome resulting from opioid withdrawal in an adult. Other Withdrawal Symptoms.What Are Vicodin Withdrawal Symptoms?Withdrawal symptoms can begin as soon as six hours following a dose of Vicodin. The severity depends on how long you have been taking Vicodin and the amount of the dosage per day. Symptoms will intensify for a few days before beginning to subside and can last for several weeks. Some of the symptoms that can occur include:Fatigue. Fatigue and tiredness are prevalent in Vicodin withdrawal. It doesn’t seem to matter how much you rest or sleep, you will still experience a low energy level.Headache. Vicodin is used for pain management, so when its use is stopped, a common reaction in the brain is severe headache.Emotional distress. As your body is searching for a new normal without the control of Vicodin, you may experience symptoms such as frustration, depression, rapid heartbeat and muscle jerking.Psychological reactions. Panic, anxiety, insomnia, paranoia, hyperactivity and a feeling of helplessness are possible with Vicodin withdrawal.Physical signs. Vomiting, diarrhea, abdominal cramps, excessive sweating, dilated pupils, runny nose, body chills and loss of appetite are common signs of Vicodin withdrawal.Dangers of WithdrawalWhile withdrawal symptoms from Vicodin are generally not life-threatening, they can be extremely uncomfortable. Some of the dangers that can arise during withdrawal occur are complications of symptoms, such as aspiration of stomach contents into the lungs if you vomit, choking, and dehydration from vomiting and diarrhea. Dehydration can lead to a chemical imbalance in your body, which can cause cardiac and other system problems. Treating Withdrawal SymptomsMany who attempt to get off Vicodin on their own return to taking the drug to avoid the withdrawal symptoms. The best way to successfully withdraw from Vicodin is under the care and supervision of a team of medical professionals (See: Vicodin Detox). Chances are that you started the drug to treat some type of ongoing pain. In addition to managing the withdrawal symptoms, you will need an alternate type of pain control introduced, or you will likely go right back to Vicodin to obtain relief. Going back on the drug following detox presents a serious danger. Your tolerance for the drug is reduced, which makes it easy to overdose, even if you take the same amount as before.Successfully treating withdrawal symptoms includes treating the whole person. You need mental, physical and social support to make the transition through withdrawal and into living a drug-free life. Treatment of Vicodin addiction withdrawal doesn’t end with the completion of detox. We offer a full range of treatment options with qualified professionals to guide you every step of the way. Mather Hospital Ignores Recommended Tapering off. "You should never try to quit taking Vicodin on your own; reduction of the medication and detoxification must be supervised by a doctor. Addiction experts and clinicians recommend a gradual reduction of the medication, as sudden cessation can trigger severe withdrawal symptoms."
"Withdrawal symptoms usually start within a day or two of stopping the medication".
© 2014 Addiction Vicodin. All Rights Reserved. Home | XML Site Map | RSS 
Get Off Hydrocodone (Not Cold Turkey)
Why did Mather Hospital Ignore Medical Protocol with 90 Year Old Patient."Clinical experts prefer it that you don’t get off hydrocodone cold turkey. They feel that withdrawal doesn’t have to be a painful and debilitating process. Instead, you can slowly lower hydrocodone doses over time to lower risk of severe symptoms of withdrawal. Always check with your prescribing doctor and ask for a hydrocodone tapering schedule when coming off hydrocodone. Tapered hydrocodone doses should be medically supervised in the case that tweaking and adjustments are required.In general, some guidelines for getting off hydrocodone include":
1. A 2 to 3 week hydrocodone tapering regimen should be adequate in most cases
2. Reduce the hydrocodone dose by 10% at each interval
3. Reduce the hydrocodone dose by 20% every 3-5 days
4. Reduce the hydrocodone dose by 25% per week
5. Avoid reducing the daily dose by > 50% at any given interval



Painful Symptoms of Unsupervised Vicodin Withdrawal. 
Mather Hospital Documents the Knowledge of Discontinued Medications on Admission Dates 1/30/13 and 2/9/1Mather Hospital, "Nurses Notes", 1/13/13, page 1, under "Home Meds" hospital staff document the patient as taking; Keppra, Vicodin, Lopressor, Remeron, Valium, Amitiza, Prednisone and Levothyroxine.

Mather Hospital "Physicians Documentation", 1/30/13, under "Home Meds", Hospital staff documented; Valium, Remeron, Keppra. 

 Mather Hospital "Admission Reconciliation", dated 1/30/13 at 18:15, under "Home Medications", again confirmed reduction to Keppra, Remeron and Valium. 

Hospital "Admission Reconciliation", 2/9/13, 5:15:46 AM hospital staff document just Valium.

"At home are vitamin D, Valium, Remeron, vitamin B12, Tylenol, and Keppra. The patient apparently was also on high dose of vicodin, which she has been abruptly discontinued for the last three days." (Mather Hospital, Consultation Report", dated 1/30/13, page 1, heading Medications.)

Hospital "Admission Reconciliation", 2/9/13, 5:15:46 AM hospital staff document just Valium.

"Patient was not given aspirin… states patient no longer takes medications". (Mather Hospital, Physician Documentation, 2/9/13, 21:08, page 2). Symptoms of other medications withdrawalAre There Side Effects When You Stop Taking Metoprolol?
Last Updated: Mar 24, 2011 | By Kitsey Canaan, RN, CLNC

"Abrupt withdrawal from metoprolol may cause heart disease to get worse".
Chest Pain "According to the FDA, patients who suddenly stopped metoprolol have experienced increases in chest pain."
"Prednisone, If you abruptly stop taking the drug or taper off too quickly, you might experience prednisone withdrawal symptoms: Severe fatigue, Weakness, Body aches, Joint pain". (Prednisone withdrawal: Why do I need to slowly taper down the dosage? Answers from April Chang-Miller, M.D.)
"Withdrawal of the levothyroxine would also lead to increased depression and anxiety among the patients." (MD health.com)


"Stopping citalopram abruptly may result in one or more of the following withdrawal symptoms: irritability, nausea, feeling dizzy, vomiting, nightmares, headache, and/or paresthesias."

(Celexa ® (citalopram) - NAMI: National Alliance on Mental ...

"You feel like you have the flu, or a stomach bug, or perhaps you find it hard to think and have disturbing thoughts." You’re probably having antidepressant withdrawal.

"Antidepressant withdrawal, more correctly called antidepressant discontinuation syndrome, refers to a unique set of symptoms that can develop after you stop taking an antidepressant. It most often occurs in those who abruptly quit the medication". (WebMD.com)
LOVENOX® helps reduce the risk of deep vein thrombosis
"Do not stop taking LOVENOX® without first talking to the doctor who prescribed it for you".
Mayo Clinic Proceedings
Volume 81, Issue 6 , Pages 825-828, June 2006

"Broken Heart Syndrome" After Separation (From OxyContin)
People who abruptly discontinue opiods may experience "Broken Heart Syndrome" increasing their risk of cardiac event." "Though most Broken Heart Syndrome patients regain full cardiac function some die and others suffer life-threatening complications." (Mayo Clinics June issue of the Mayo Clinic Proceedings)"Broken Heart Syndrome" Can Result From Opioid Withdrawal, Cocaine Use
• Heart Disease news • Jun 22, 2006 People who experience abrupt withdrawal from high-dose opioids or use cocaine increase their risk of cardiac event, according to two new studies published in the June issue of Mayo Clinic Proceedings.

The findings shed light on "broken heart syndrome," a still somewhat uncommon disorder first described in Japan 15 years ago that mimics a heart attack. Patients may experience shortness of breath and chest pain and, upon hospital admission, go through extensive tests to determine a diagnosis and rule out heart attack.

Mather Hospital Documentation of Patients Symptoms Associated with All Medication’s Withdrawal and Rebound Effects .
"Chest Pain, Shortness of Breath" (Mather Hospital "Discharge Summary", dated 1/30/13, page 1), "Pain Radiating down left arm" (Mather Hospital Nurse’s Notes, dated 1/30/13, page 1). She was admitted and later experienced "Depression" (Mather Hospital "Discharge Summary", dated 1/30/13, page 1,) "Back and Bilateral Extremity discomfort" ( Mather Hospital "Nursing Progress Note" dated 2/2/13 03:54, page 2)
 "Anxiety" (Mather Hospital Nursing Assessment, dated 1/30/13, page 5),
"Difficulty Falling Asleep" (Mather Hospital Nursing Assessment, 1/30/13), Loss of appetite, "Did not eat" (Mather Hospital Nursing Assessment, page 20, 1/30/13).] "Awake, Alert and Oriented X 3", (Mather Hospital Discharge Summary, 2/1/13, under Neurological, Mather Hospital Physician Documentation, 1/30/13, page 2,'under NEURO, Alert GCS 15, (Mather Hospital Physician Notes, 1/30/13, page 2, under Neuro), "Unresponsive", (Mather Hospital Nursing Assessment, 2/9/13, page , under Coping,/Observed Emotional State. 2/10/13 09:00),"Non Verbal", (Mather Hospital Nursing Assessment, page 3 & 4, under Coping/ Verbalized Emotional State),"Semi Comatose" (Mather Hospital Nursing Assessment, page 7, Cognitive/Perceptual/Neuro under level of consciousness, 2/12/13) "Disoriented x 4" (Mather Hospital Nursing Assessment, page 7, Cognitive/Perception/Neuro under Orientation). in 8 days,"Deceased" 3 days later ( Death Certificate 2/12/13).

Symptoms Presented And WithThe Results.

1/14/13: While Patient was taking All Prescribed Medications: Vicodin, Prednisone, Levothyroxine, Lopressor, Keppra, Remeron and Valium Under my Care.

"Negative for Body Aches", "Negative for Pain", 

"Negative for Pain with Movement","Negative for Chest Pain", 
"Negative for Shortness of Breath","Negative for Headache",
 "Negative for Anxiety, Depression" ( John T. Mather Hospital Physician 
Documentation, 1/13/13, page 1, ROS:, 32:31, Constitutional:)

"The patient appears in no acute distress, alert, awake, (John T. Mather Hospital Physician Documentation, Constitutional ***’t., page 2)

"The patient does not display signs of respiratory distress, Respirations: normal, Breath sounds: are normal, clear throughout, no rales, rhonchi, no wheezing." (John T. Mather Hospital Physician Documentation, Constitutional ***’t., 1/13/13, page 2, Respiratory:)

"Rate: normal, Rythym: regular, Heart Sounds: normal, normal S1 and S2." John T. Mather Hospital Physician Documentation Physician Documentation, Constitutional ***’t., 1/13/13, page 2, Cardiovascular:)

"Pain, that is mild of the thoracic area, ROM normal"(John T. Mather Hospital Physician Documentation ***’t., 1/13/13, page 2, Back:)

"Orientation is normal, Cerebellar function: normal finger to nose testing, able to perform alternating rapid hand movements, Motor: is normal, moves all fours, strength is normal, Sensation is normal, Deep tendon reflexes are normal"(John T. Mather Hospital Physician Documentation, Constitution ***’t., 1/13/13, page 2, Neuro:)
"ROM : Intact in all extremities, Circulation: Circulation is intact in all extremities, Joints: All joints appear normal with full range of motion, neurovascular is intact distal to injury" (John T. Mather Hospital Physician Documentation, Constitution ***’t., 1/13/13, page 2, Musculoskeletal/extremity:)
"Behavior: appropriate for age, cooperative" (John T. Mather Hospital Physician Documentation, Constitution ***’t., 1/13/13, page 2, Psych:)

"Negative for Chest Pain, Palpatations", (John T. Mather Hospital Physician Documentation, Constitution ***’t., 1/14/13, page 1, Cardiovascular)

 "This is a well developed, well nourished patient who is awake, alert, and in no acute distress", (John T. Mather Hospital Physician Documentation, Constitution ***’t., 1/14/13, page 2, Constitutional:)

While Patient was Known by Mather Hospital to have been "abruptly" taken off Prescribed Medications without Medical Supervision: Vicodin, Prednisone, Levothyroxine, Celexa and Lopressor, while Not Under my Care.

"SAO2 41% @15%" (Terryville Fire Department, Hospital Patient Record Copy, 1/30/13)

"Chest Pain" …" (John T. Mather Hospital Discharge Summary, 1/30/13, page 1, Chief Complaint.)
"Chest pain… the pain radiates down left arm…""Pertinant positives:shortness of breath". 

"Modifying factors: The Symptoms are alleviated by nothing. The symptoms are aggravated by nothing."
"The patient has not experienced similar symptoms in the past".

The patient has not recently seen a physician…" (John T. Mather Hospital Physician Documentation, 1/30/13, HPI, 15:35)

"S1 and S2 Positive". …" (John T. Mather Hospital Discharge Summary, 1/30/13, page 1, Heart.)

"Abnormal ECG" (John T. Mather Hospital Nurse’s Notes, 1/30/13, page 1, Diagnosis:)

"Rythym is atrial fibrillation With PVC’s" (John T. Mather Hospital Nurse’s Notes Cont, 1/30/13, page 2, Assessment:, Cardiovascular:)

"17:18 Notified ED physician of critical lab value positive troponin reported to dr. morgan 0.07. (John T. Mather Hospital Nurse’s Notes, 1/30/13, page 2, ED Course:)


"CARDIAC MARKERS, Troponin 1, 0.06 H, 1/31/13 11:27, BNP 260 H, 1/31/13 09:01". 
(John T. Mather Hospital Chemistry, Cardiac Markers, 1/31/13, page 2.) 15:39 "abnormal EKG, acute myocardial infarction, acute pericarditis, anxiety, atypical chest pain, coronary artery disease chest wall pain. (John T. Mather Hospital Physician Documentation ***’t., 1/30/13, page 2, Differential diagnosis:)
"Unresponsive", (Mather Hospital Nursing Assessment, 2/9/13, page , under Coping,/Observed Emotional State. 2/10/13 09:00),
"Non Verbal", (Mather Hospital Nursing Assessment, page 3 & 4, under Coping/ Verbalized Emotional State),

"Semi Comatose" (Mather Hospital Nursing Assessment, page 7, Cognitive/Perceptual/Neuro under level of consciousness, 2/12/13)

"Disoriented x 4" (Mather Hospital Nursing Assessment, page 7, Cognitive/Perception/Neuro under Orientation). "Deceased" within a month, (Death Certificate 2/12/13).
Mather Hospital Documenting the Medically Unsupervised Discontinuation of other Medications.
"The patient has not recently seen a physician…" (Physician Documentation, 1/30/13, HPI, 15:35)

 The point is, as a Mandatory Reporter and a Health Care Provider this would never have been allowed to happen to a child with cancer! No Health Care Proxy Document or Advanced Directives authorize the discontinuation of medications while the patient is Awake, Alert, and Appropriate for Age, causing known pain and suffering leading to a rapid death. An inmate sentenced to death would have had they’re civil right to Healthcare protected, providing a pain free life leading up to an execution. And if pain medication for cancer was found to have been "abruptly discontinued", there would be a public outcry and justice would have been served. As for the elderly there is little public outcry. In my mother’s case, it was the lack of interest and intervention on my mother’s behalf, which proved to be her painful death sente

From 9:00am to 10:25am continues call to below mentioned number 009148****4840 but not answering and purposefully disconnect the line.

Well my dad was left with no food no antibiotics hardly any fluids for nearly one week disgrace.we fought for my father but shouldn't have to but unfortunately he died. I and my family feel it was discrimination because of hie age.he died at the age of 77 not 107 .i can only say at the end the nurses are only amazing and couldnt do enough for my father and our family.

My name is joan o.droscoll and im am a cancer patient i was to have an operation on the 10 off this month and i was cancelled to the 19 of this month went to hospitals at 6.30 to be there early staff only came to me at 8.45 and told me that it wont be getting done because of there failt not booking me in im not an happy person and my family is very up set because of this

Mather Hospital, Failure to Report, Failure to Intervene, Fails a 90 Year Old Patient. Confirming the Diagnosis of Elder Abuse can be made Exclusively by Documenting "Abruptly Discontinued Pain Medications" without Medical Supervision. "Under treatment of pain equals elder abuse." Chronic Neuroimmune Disease 1/13/13 "Under utilization of prescription drugs" is a sign of physical abuse. (National Centers on the Elder Abuse Administration on Aging). "Denial of Pain Medication is Elder Abuse", Elder Abuse, the Pharmacist’s Role, Center on Elder Abuse.org, "Denying Access to Pain Medication", Elder Abuse, Center on Excellence on Elder Abuse & Neglect, "Denying access to pain medication is physical abuse", Laura Mosqueda, M.D., Director of Geriatrics, University of California, Irvine School of Medicine.Mather Hospital Documenting the Knowledge of Pain Medications being "Abruptly Discontinued". "At home are vitamin D, Valium, Remeron, vitamin B12, Tylenol, and Keppra. The patient apparently was also on high dose of vicodin, which she has been abruptly discontinued for the last three days." (Mather Hospital, Consultation Report", dated 1/30/13, page 1, heading Medications.) Mather Hospital Documenting the Medically Unsupervised Discontinuation of Pain and other Medications. The patient has not recently seen a physician…" (Physician Documentation, 1/30/13, HPI, 15:35) Mather Hospital "Confirming the Diagnosis" by Utilizing the "Direct Questioning" Method. (Elder Abuse an Introduction for the Clinicians, Dr. Ronald A. Chez, Center on Elder Abuse . org)"Are you or have you been threatened or abused?" The patient replied YES! (Mather Hospital Admission Profile, 1/30/13, page 6 under Self-Perception.) Mather Hospital’s Policy Regarding Mandatory Reporting in Conduct and Compliance Manual In Overview, Introduction, Page 2, B. "The importance of the compliance program moreover, compliance with state and federal rules and regulations is essential because of our potential civil or even criminal liability if we were found to have violated the applicable standards." Page 6, III section ,"Standards Related to Quality of Care", DMandatory Reporting. "The hospital will ensure that all incidents and events that are required to be reported under federal and state mandatory reporting laws, rules and regulations are reported in a timely manner". Section D continued, Page 7, "The compliance officer or his designee will validate that appropriate systems are in place for identifying and reporting incidents that require reporting. "The compliance officer will conduct periodic reviews to monitor the hospital’s compliance with such requirements in connection with, but not limited to, the following": #3, "Elder Abuse". WHY DISCONTINUING PAIN MEDICATION WHILE NOT MEDICALLY SUPERVISING TAPERING, IS ABUSE! Patient’s Pain, Suspected Multiple Myeloma Mather Hospital Not Addressing Pain, Withdrawal and Rebound Effects. "Complaint: Your Mother’s medications were not appropriately adjusted, causing her condition to be effected". "Response: Your mother’s medications were in fact appropriately adjusted in accordance with laboratory results." (Letter, Maryanne B. Gordon, MA, RHIA, CHCQM, Administrative Director, Mather Hospital.) Which of the following "Laboratory Test Results" done at Mather Hospital, (CMP, APTT, BNP, CBC W/DIFF, Magnesium, Prothrombin Time, Troponin, TSH, Urine Admission, Troponin, Basic Metabolic Panel, CBC, Phosphorus, John T. Mather Encounter Summary, 1/30/13, page 1, Orders:) based upon Medical Science, justifies the "Abrupt Discontinuance" of Vicodin and Prednisone for Cancer Pain, without a substitute, while not tapering off under Medical Supervision? Looking specifically at pain medications for cancer, due to it’s debilitating effects.Mather Hospital Establishes Timeline of Discontinued Pain Medication. "At home are vitamin D, Valium, Remeron, vitamin B12, Tylenol, and Keppra. The patient apparently was also on high dose of vicodin, which she has been abruptly discontinued for the last three days." (Mather Hospital, Consultation Report", dated 1/30/13, page 1, heading Medications.) Withdrawal Symptoms Appear Exactly 2 Days As Would Be Expected. "Withdrawal symptoms usually start within a day or two of stopping the medication".© 2014 Addiction Vicodin. All Rights Reserved. Home | XML Site Map | RSS "Withdrawal symptoms typically begin within a day or two of stopping the medicine" "I urge anyone in this situation to stop their narcotic medication under their doctor’s supervision". (Living Well Expert, Dr. Jennifer Shu) "15:35 The patient reports chest pain that is located primarily in the substernal area. Onset Yesterday", John T. Mather Hospital Physician Documentation, 1/30/13, page 1,)Abruptly Discontinued 1/27/13, Symptoms 2 Days Later, 1/29/13. Mather Hospital’s Knowledge of Vicodin Usage Confirmed."Apparently was on high dose of Vicodin" (Mather Hospital, Consultation Report", dated 1/30/13, page 1, heading Medications.) Prescription given at discharge of Mather Hospital ER, Discharge Instructions, 1/13/13, Vicodin 5-500 mg. Oral Tablet, take 1 tablet(s) by ORAL route every 6 hours as needed; Quantity: 20 tablet(s). Vicodin 5 mg. 1q6h prn since 6/30/11, Prednisone 5 mg., 1 in AM and 2 at PM, since 5/31/11, (Primary Care Physician Face Sheet for patient, printed April 16, 2013.) "Vicodin daily for 3 years", (John T. Mather Memorial Hospital Admission Profile, 1/30/13, page 4, Street Drug/Medication/Inhalent Use, Frequency of Street Drug/Medication/Inhalent.) Cancer Pain Established, "Symptoms and Laboratory Results" indicative of Multiple Myeloma. "Generalized Bone Pain", (John T. Mather Memorial Hospital Admission Profile, 1/30/13, page 2, Medical Surgical History.) Mather Hospital Reference Lab Testing, 2/2/2013, 07:00, "Serum IFE reveals the presence of monoclonal free lamba light chains". Mather Hospital Affiliated Physician. "Recommendation/Plan: An 85-yar-old lady with past medical history of seizures and anemia secondary to chronic kidney disease who presents with an acute DVT. I will perform a hypercoagulable workup, as she does have a family history of DVT’S "however, she has Bence Jones protein suspicious for multiple myeloma."( David Chu, Northshore Hematology/ Oncology Associates, Recommendation/ Plan, 1/23/12, page 3.) Mather Hospital Physician. "Immunofixation, urine. Bence Jones Protein Positive Lamba Type." (Joseph P. Boglia, M.D., P.C.) Patient’s Pain was from Suspected Multiple MyelomaMemorial Sloan Kettering Cancer CenterMultiple Myeloma:Pain Management"A majority of patients with multiple myeloma report that they experience some pain related to the disease. The pain may be a result of a bone fracture or of a tumor pressing against a nerve."Universally Accepted Treatment of Multiple Myeloma PainMemorial Sloan Kettering Cancer CenterMultiple Myeloma: Pain Management "Analgesics, or pain relievers, remain the mainstay of bone pain treatment. The strongest analgesics, called opioids or narcotics, are often prescribed to control pain in myeloma patients. The most commonly prescribed drugs are codeine, morphine, and morphine-like synthetic compounds." Medically Supervised Tapering; Universally Recognized Protocol for Discontinuing Vicodin not Established at Mather Hospital. "You should never try to quit taking Vicodin on your own; reduction of the medication and detoxification must be supervised by a doctor. Addiction experts and clinicians recommend a gradual reduction of the medication, as sudden cessation can trigger severe withdrawal symptoms." "Withdrawal symptoms usually start within a day or two of stopping the medication".© 2014 Addiction Vicodin. All Rights Reserved. Home | XML Site Map | RSS Get Off Hydrocodone (Not Cold Turkey) "Clinical experts prefer it that you don’t get off hydrocodone cold turkey. They feel that withdrawal doesn’t have to be a painful and debilitating process. Instead, you can slowly lower hydrocodone doses over time to lower risk of severe symptoms of withdrawal. Always check with your prescribing doctor and ask for a hydrocodone tapering schedule when coming off hydrocodone. Tapered hydrocodone doses should be medically supervised in the case that tweaking and adjustments are required. In general, some guidelines for getting off hydrocodone include": 1. A 2 to 3 week hydrocodone tapering regimen should be adequate in most cases2. Reduce the hydrocodone dose by 10% at each interval3. Reduce the hydrocodone dose by 20% every 3-5 days4. Reduce the hydrocodone dose by 25% per week5. Avoid reducing the daily dose by > 50% at any given interval Painful Symptoms of Unsupervised Vicodin Withdrawal. Stopping Hydrocodone Cold Turkey Risks"Stopping hydrocodone cold turkey can be a unpredictable process. While opiates are known to provoke general symptoms during withdrawal, the fact remains that everybody is different. And depending on your current mental and physical health, stopping hydrocodone cold turkey can be more or less successful. The possible ricks you run quitting hydrocodone suddenly includes the following:" • coma• confusion• erratic and uncontrollable moods• hallucinations• increased heart rate/blood pressure• relapse do to inability to handle pain• seizurestremors Mayo Clinic ProceedingsVolume 81, Issue 6 , Pages 825-828, June 2006 "Broken Heart Syndrome" After Separation (From OxyContin)"People who abruptly discontinue opiods may experience "Broken Heart Syndrome" increasing their risk of cardiac event. "Though most Broken Heart Syndrome patients regain full cardiac function some die and others suffer life-threatening complications." (Mayo Clinics June issue of the Mayo Clinic Proceedings) "Broken Heart Syndrome" Can Result From Opioid Withdrawal, Cocaine Use• Heart Disease news • Jun 22, 2006 "People who experience abrupt withdrawal from high-dose opioids or use cocaine increase their risk of cardiac event, according to two new studies published in the June issue of Mayo Clinic Proceedings". "Patients may experience shortness of breath and chest pain and, upon hospital admission, go through extensive tests to determine a diagnosis and rule out heart attack." Mather Hospital Documentation of Sudden Onset of Cardiac Event Associated with Vicodin, Metroprolol and Prednisone Withdrawal and Rebound Effects and Characteristics of "Broken Heart Syndrome". "The patient was admitted for possible" acute coronary syndrome."(John T. Mather Hospital Discharge Summary, 1/30/13, page 1, Hospital Course.) "SAO2 41% @15% O2" (Terryville Fire Department, Hospital Patient Record Copy, 1/30/13) "Chest Pain" …" (John T. Mather Hospital Discharge Summary, 1/30/13, page 1, Chief Complaint.) "Chest pain… the pain radiates down left arm…" "Pertinant positives:shortness of breath". "Modifying factors: The Symptoms are alleviated by nothing. The symptoms are aggravated by nothing." "The patient has not experienced similar symptoms in the past". The patient has not recently seen a physician…" (John T. Mather Hospital Physician Documentation, 1/30/13, HPI, 15:35) "S1 and S2 Positive". …" (John T. Mather Hospital Discharge Summary, 1/30/13, page 1, Heart.) "Abnormal ECG" (John T. Mather Hospital Nurse’s Notes, 1/30/13, page 1, Diagnosis:) "Rythym is atrial fibrillation With PVC’s" (John T. Mather Hospital Nurse’s Notes Cont, 1/30/13, page 2, Assessment:, Cardiovascular:) "17:18 Notified ED physician of critical lab value positive troponin reported to dr. morgan 0.07. (John T. Mather Hospital Nurse’s Notes, 1/30/13, page 2, ED Course:) "CARDIAC MARKERS, Troponin 1, 0.06 H, 1/31/13 11:27, BNP 260 H, 1/31/13 09:01". (John T. Mather Hospital Chemistry, Cardiac Markers, 1/31/13, page 2.) 15:39 "abnormal EKG, acute myocardial infarction, acute pericarditis, anxiety, atypical chest pain, coronary artery disease chest wall pain. (John T. Mather Hospital Physician Documentation ***’t., 1/30/13, page 2, Differential diagnosis:) Mather Hospital Confirming "Acute Coronary Syndrome" Associated with Withdrawal and Rebound Symptoms. "1/30/13 17:38 Admit ordered for Kanakoudas, Dimos. Preliminary diagnosis are Chest Pain, Abnormal ECG. Problem is new." (John T. Mather Hospital Physician Documentation ***’t., 1/30/13, page 4, Disposition:). Mather Hospital Confirming "Acute Coronary Syndrome" as Withdrawal and Rebound Symptoms by Restoring Opiates and Relieving Symptoms. "16:49, Morphine 2 mg., Sub-Q, upper left arm" (John T. Mather Hospital Nurse’s Notes Cont., 1/30/13, page 2, Administered Medications:) "17:35, The Patients symptoms have improved, morphine markedly releived the patient’s pain. Symptoms have improved. Pain Meds Pain medication ordered, see orders" (John T. Mather Hospital Physician Documentation ***’t., 1/30/13, page 2, Medication Response.) "17:35 Moderately improved", John T. Mather Hospital Physician Documentation ***’t., 1/30/13, page 2, Response to treatment:) Mather Hospital Not Addressing the "Abrupt Discontinuation" of Pain Medications for Cancer and the need for Immediate Medical Supervision for the Continuation of Pain and Withdrawal. "16:49, Morphine 2 mg., Sub-Q, upper left arm" (John T. Mather Hospital Nurse’s Notes Cont., 1/30/13, page 2, Administered Medications:) "16:49, Morphine 2 mg., Sub-Q, ONCE" (John T. Mather Hospital Nurse’s Notes Cont., 1/30/13, page 2, Order Name.) "The Patient was Discharged", 2/2/13. (John T. Mather Hospital Discharge Summary, 1/30/13, page 2, DISPOSITION:) FOLLOWUP: "Followup in one or two weeks with primary care physician". (John T. Mather Hospital Discharge Summary, 1/30/13, page 2,) MEDICATION: "As per medical reconciliation list." (John T. Mather Hospital Discharge Summary, 1/30/13, page 2,) Only 3 Medications on Reconciliation List Given In Hospital, Pain Medications Neglected for Cancer Pain at Home. "Verified Keppra 500mg. orally 2 times a day, 1/30/13, continued as the inpatient order levetiracetam." (John T. Mather Memorial Hospital Admission Reconcilliation, 1/30/13, Admit Date: 1/30/2013, Discharge Date: 2/2/2013, Att: Kanakoudas, Dimos). "Verified Remeron 15mg. orally 2 times a day, 1/30/13, Remeron continued as the inpatient order mirtazapine." (John T. Mather Memorial Hospital Admission Reconcilliation, 1/30/13, Admit Date: 1/30/2013, Discharge Date: 2/2/2013, Att: Kanakoudas, Dimos). "Verified Valium 2.5 mg. tablet bid prn anxiety, 1/30/13, Valium continued as the inpatient order diazepam. (John T. Mather Memorial Hospital Admission Reconcilliation, 1/30/13, Admit Date: 1/30/2013, Discharge Date: 2/2/2013, Att: Kanakoudas, Dimos). "diazepam (dispense as Valium) Give 5 milliGRAM(S) Oral 2 times per day for Moderate Pain PRN Special Instructions: HOLD FOR SEDATION Date Due to Review:01-Feb-2013 00:00 **Discontinued**(John T. Mather Memorial Hospital Admission Reconciliation, 1/30/13, Admit Date: 1/30/2013, Discharge Date: 2/2/2013, Additional Current Orders, Att: Kanakoudas, Dimos). "levetiracetam (Dispense as Keppra) Give 500mgs. Oral 2 times per day Priority- Time:Routine Rx Date Due to review:01-Mar-2013 00:00 (John T. Mather Memorial Hospital Admission Reconciliation, 1/30/13, Admit Date: 1/30/2013, Discharge Date: 2/2/2013, Additional Current Orders, Att: Kanakoudas, Dimos). Mirtazapine (Dispense as Remoron) Give 15 mgs. Oral 2 times per day Priority- Time:Routine Rx Date Due to review:01-Mar-2013 00:00 (John T. Mather Memorial Hospital Admission Reconciliation, 1/30/13, Admit Date: 1/30/2013, Discharge Date: 2/2/2013, Additional Current Orders, Att: Kanakoudas, Dimos). Mather Hospital Documents the Knowledge of Discontinued Medications on Admission Dates 1/30/13 and 2/9/13. Mather Hospital, "Nurses Notes", 1/13/13, page 1, under "Home Meds" hospital staff document the patient as taking; Keppra, Vicodin, Lopressor, Remeron, Valium, Amitiza, Prednisone and Levothyroxine. Mather Hospital "Physicians Documentation", 1/30/13, under "Home Meds", Hospital staff documented; Valium, Remeron, Keppra. Mather Hospital "Admission Reconciliation", dated 1/30/13 at 18:15, under "Home Medications", again confirmed reduction to Keppra, Remeron and Valium. Hospital "Admission Reconciliation", 2/9/13, 5:15:46 AM hospital staff document just Valium."At home are vitamin D, Valium, Remeron, vitamin B12, Tylenol, and Keppra. The patient apparently was also on high dose of vicodin, which she has been abruptly discontinued for the last three days." (Mather Hospital, Consultation Report", dated 1/30/13, page 1, heading Medications.) Hospital "Admission Reconciliation", 2/9/13, 5:15:46 AM hospital staff document just Valium. "Patient was not given aspirin… states patient no longer takes medications". (Mather Hospital, Physician Documentation, 2/9/13, 21:08, page 2). No Longer Taking, Home Medications:acetaminophen HYDROcodone 325 mg. 5 mg. oral tablet 1 tab orally every 4 hours, as needed. (John T. Mather Memorial Hospital Admission Reconciliation, 2/9/13, Admit Date: 2/9/2013, Discharge Date: 2/12/2013, Additional Current Orders, Att: Kanakoudas, Dimos). No Longer Taking, Home Medications:prednisone 5 mg. oral tablet 1 tab orally once a day.(John T. Mather Memorial Hospital Admission Reconciliation, 2/9/13, Admit Date: 2/9/2013, Discharge Date: 2/12/2013, Additional Current Orders, Att: Kanakoudas, Dimos). No Longer Taking, Home Medications:metoprolol succinate 25 mg. oral tablet, extended release 1 tab orally once a day.(John T. Mather Memorial Hospital Admission Reconciliation, 2/9/13, Admit Date: 2/9/2013, Discharge Date: 2/12/2013, Additional Current Orders, Att: Kanakoudas, Dimos). No Longer Taking, Home Medications:levothyroxine 25 mcg (0.025 mg.) oral tablet 1 tablet orally once a day.(John T. Mather Memorial Hospital Admission Reconciliation, 2/9/13, Admit Date: 2/9/2013, Discharge Date: 2/12/2013, Additional Current Orders, Att: Kanakoudas, Dimos). No Longer Taking, Home Medications:citalopram 20 mg. oral tablet 1 tab orally once a day.(John T. Mather Memorial Hospital Admission Reconciliation, 2/9/13, Admit Date: 2/9/2013, Discharge Date: 2/12/2013, Additional Current Orders, Att: Kanakoudas, Dimos). Verified, Valium 2.5 mg tablet bid prn anxiety (John T. Mather Memorial Hospital Admission Reconciliation, 2/9/13, Admit Date: 2/9/2013, Discharge Date: 2/12/2013, Additional Current Orders, Att: Kanakoudas, Dimos). The Results. 1/14/13: While Patient was taking All Prescribed Medications: Vicodin, Prednisone, Levothyroxine, Lopressor, Keppra, Remeron and Valium Under my Care. "Negative for Body Aches", "Negative for Pain", ( John T. Mather Hospital Physician Documentation, 1/13/13, page 1, ROS:, 32:31, Constitutional:) "Negative for Pain with Movement", "Negative for Chest Pain", ( John T. Mather Hospital Physician Documentation, 1/13/13, page 1, ROS:, 32:31, Constitutional:) "Negative for Shortness of Breath", "Negative for Headache",( John T. Mather Hospital Physician Documentation, 1/13/13, page 1, ROS:, 32:31, Constitutional:) "Negative for Anxiety, Depression" ( John T. Mather Hospital Physician Documentation, 1/13/13, page 1, ROS:, 32:31, Constitutional:) "The patient appears in no acute distress, alert, awake, (John T. Mather Hospital Physician Documentation, Constitutional ***’t., page 2) "The patient does not display signs of respiratory distress, Respirations: normal, Breath sounds: are normal, clear throughout, no rales, rhonchi, no wheezing." (John T. Mather Hospital Physician Documentation, Constitutional ***’t., 1/13/13, page 2, Respiratory:) "Rate: normal, Rythym: regular, Heart Sounds: normal, normal S1 and S2." John T. Mather Hospital Physician Documentation Physician Documentation, Constitutional ***’t., 1/13/13, page 2, Cardiovascular:) "Pain, that is mild of the thoracic area, ROM normal"(John T. Mather Hospital Physician Documentation ***’t., 1/13/13, page 2, Back:) "Orientation is normal, Cerebellar function: normal finger to nose testing, able to perform alternating rapid hand movements, Motor: is normal, moves all fours, strength is normal, Sensation is normal, Deep tendon reflexes are normal"(John T. Mather Hospital Physician Documentation, Constitution ***’t., 1/13/13, page 2, Neuro:) "ROM : Intact in all extremities, Circulation: Circulation is intact in all extremities, Joints: All joints appear normal with full range of motion, neurovascular is intact distal to injury" (John T. Mather Hospital Physician Documentation, Constitution ***’t., 1/13/13, page 2, Musculoskeletal/extremity:) "Behavior: appropriate for age, cooperative" (John T. Mather Hospital Physician Documentation, Constitution ***’t., 1/13/13, page 2, Psych:) "Negative for Chest Pain, Palpatations", (John T. Mather Hospital Physician Documentation, Constitution ***’t., 1/14/13, page 1, Cardiovascular) "This is a well developed, well nourished patient who is awake, alert, and in no acute distress", " (John T. Mather Hospital Physician Documentation, Constitution ***’t., 1/14/13, page 2, Constitutional:) While Patient was Known to be off Prescribed Medications: Vicodin, Prednisone, Levothyroxine and Lopressor, Not Under my Care, Just 16 Days Later "SAO2 41% @15% O2" (Terryville Fire Department, Hospital Patient Record Copy, 1/30/13) "Chest Pain" …" (John T. Mather Hospital Discharge Summary, 1/30/13, page 1, Chief Complaint.) "Chest pain… the pain radiates down left arm…" "Pertinant positives:shortness of breath". "Modifying factors: The Symptoms are alleviated by nothing. The symptoms are aggravated by nothing." "The patient has not experienced similar symptoms in the past". The patient has not recently seen a physician…" (John T. Mather Hospital Physician Documentation, 1/30/13, HPI, 15:35) "S1 and S2 Positive". …" (John T. Mather Hospital Discharge Summary, 1/30/13, page 1, Heart.) "Abnormal ECG" (John T. Mather Hospital Nurse’s Notes, 1/30/13, page 1, Diagnosis:) "Rythym is atrial fibrillation With PVC’s" (John T. Mather Hospital Nurse’s Notes Cont, 1/30/13, page 2, Assessment:, Cardiovascular:) "17:18 Notified ED physician of critical lab value positive troponin reported to dr. morgan 0.07. (John T. Mather Hospital Nurse’s Notes, 1/30/13, page 2, ED Course:) "CARDIAC MARKERS, Troponin 1, 0.06 H, 1/31/13 11:27, BNP 260 H, 1/31/13 09:01". (John T. Mather Hospital Chemistry, Cardiac Markers, 1/31/13, page 2.) 15:39 "abnormal EKG, acute myocardial infarction, acute pericarditis, anxiety, atypical chest pain, coronary artery disease chest wall pain. (John T. Mather Hospital Physician Documentation ***’t., 1/30/13, page 2, Differential diagnosis:) "Unresponsive", (Mather Hospital Nursing Assessment, 2/9/13, page , under Coping,/Observed Emotional State. 2/10/13 09:00), "Non Verbal", (Mather Hospital Nursing Assessment, page 3 & 4, under Coping/ Verbalized Emotional State), "Semi Comatose" (Mather Hospital Nursing Assessment, page 7, Cognitive/Perceptual/Neuro under level of consciousness, 2/12/13) "Disoriented x 4" (Mather Hospital Nursing Assessment, page 7, Cognitive/Perception/Neuro under Orientation). "Deceased" within a month, ( Death Certificate 2/12/13). Mather Hospital Libel for 90 Year Old Patient’s Death Due to New York Health Care Proxy Law. Mather Hospital Confirms Patient not Deemed Incapacitated During Dates in Question. "A health Agent may only take over medical decisions when a Principal is deemed incompetent by two doctors. NYSHL S 2983 (A) 1, "To commence a proxy agents authority", (Surrogate Decision Making in New York, Salvatore M Di Constanzo, McMillan, Constabile, Maker & Perone, LLP.). "The confirmation sall be stated in writing and shall be included in the principal’s medical record." NYSHL S 2983 (D) 6, "Confirmation of lack of capacity".) "Awake, Alert and Oriented X 3, (Discharge Summary, 2/1/13 under Neurological) "Awake and alert, GCS 15, oriented to person, place, time and situation. (Physician Documentation Cont’. 1/30/13, page 2, Neuro:) Awake, Alert and oriented x 3, (John T. Mather Hospital Discharge Summary Dis Date: 2/2/13, Physical Examination:) No deficits noted, patient oriented X3, eyes open spontaneously and obeys commands. Level of consciousness is awake, alert. ( Mather Hospital Nurse’s Notes ***’t, 1/30/13, page 2, 17:06, Neuro:) "Mild Dementia". (John T. Mather Hospital Admission Profile, 1/30/13, page 4, Neurological Comment.) "Further, on admission, your mother was found to be ALERT, and ORIENTATED and fully concurred with the visitation restrictions ". (Mather Hospital Administrative Director, Maryanne B. Gordon, letter, 7/17/13). Mather Hospital Admits Not Having in Possession a Health Care Proxy Document From 1/15/13 through 7/17/13. After a 2 month long hospital investigation, Maryanne B. Gordon, Administrative Director confirms the fact that Mather Hospital cannot verify the date of execution, an essential element of a legal HCP, by stating: "Therefore, we can only conclude that at some point, your mother revoked her prior proxy and executed a new one". Essential Elements- "Principal’s Signature and Date of signature, and execution", signature of 2 witnesses, neither of which can be an agent or alternate agent". (New York State Department of Health, "Filing a Healthcare Proxy" in the Medical Record, Essential Elements of a Health Care Proxy). Mather Hospital Reaffirms That They "Routinely" Violate New York State Consolidated Laws Public Health. New York State Consolidated Laws Public Health S 2984, Providers Obligations" 1: Requires a "Healthcare Provider who is provided with a health care proxy shall arrange for the proxy or a copy to be inserted in the principals record". "Further, hospitals do not routinely maintain copies of proxy documents for patients when they are executed, because patients often revoke and/or change agents over the course of time as circumstances change". (Letter, Maryanne B. Gordon, MA, RHIA, CHCQM, Administrative Director, Mather Hospital, 1/17/13, page 1, Response to complaint #1, You were your mothers Health Care Proxy effective 2007 and were denied the right to act as her proxy agent during her final hospitalization.) Mather Hospital Confirming No New Health Care Proxy Agent or Document Provided on Dates in Question. "Your sister advised the staff upon your mother’s final admission that she was your mother’s Health Care Proxy and provided a copy of the proxy document". (Mather Hospital Administrative Director, Maryanne B. Gordon, letter, 7/17/13), page 1, response to complaint: You were your mother’s Health Care Proxy effective 2007 and were denied the right to act as her proxy agent during her final hospitalization".) Final Admission Date Confirmed By Mather Hospital, 2/9/13-2/12/13. "Admit Date: 2/9/2013 22:08, Discharge Date: 2/12/2013 19:42 (John T. Mather Hospital Admission Reconciliation, 2/13/2013,page 1, 5:46, Visit ID: 13599****.)ADM DATE: 2/9/13, DIS DATE:2/12/13. (John T. Mather Hospital Discharge Summary, 2/9/13, page 1,) "Hospital stay was uneventful. On February 13, 2013, the patient expired" (John T. Mather Hospital Discharge Summary, 2/9/13, page 1, HOSPITAL COURSE:) Certificate of Death, 2/12/13, Mather Hospital Physician, Natalya Titakeuko certifies the immediate "Cause of Death" as "Cardio Pulmonary Arrest" due to or as a consequence of: "Coronary Artery Disease, COPD, Dementia and Failyure to Thrive", Pronounced Dead at Mather Hospital, 2/12/13, 2:50PM.) Remember it is the "End Which Unjustified the Means". The Center for Advocacy for the Rights and Interests of the Elderly (CARE), in solidarity, conferred the following statement to me, "We wish you luck and fortitude in advocating for the rights of older adults". "Those who fail to learn the lessons of history are doomed to repeat them". George Santayana In light of the fact that Mather Hospital did not obtain a legal Health Care Proxy Document and was fully aware that the patient had been on "High Dose" of Vicodin for "3 Years" when it was known to have been "Abruptly Discontinued", It’s obvious that Dr. Koumakodis and Mather Hospital were negligent in not identifying and alleviating the painful withdrawal symptoms. Additionally it was negligent to discharge the patient without supervising the patient, tapering off of Vicodin and Prednisone.Also not ordering medication for Cancer Pain and replacing them with a suitable replacement is another issue of concern. With this knowledge, discharging the patient in this condition and instructing the patient to wait 1-2 weeks to "follow up" with her Primary Care Physician proved to be the inaction which was responsible for the patient to require Hospice Care on 2/7/13, just 5 days later. (2/10/2013, 12:36:03 AM, EMSCHARTS, History of Present Illness, Line 1 and 2.) Evidently Valium could not mask the withdrawal symptoms and Tylanol was inadequate for the Bone Pain associated with Multiple Myeloma. Unfortunately the frail 90 year old patient could not withstand the inevitable withdrawal symptoms and Pain and expired. I highly doubt that this conduct would have been tolerated if the patient were a child or a dog for that matter. So I think there may be some Ageism and Civil Rights Issues as well.

our recent stay at Mather hospital was great in most respects. The nurses and staff were excellent. Everyone was very friendly,but the house keeping was poor. In the three day stay, the room was never cleaned, the trash pail overflowed with garbage.My wife slept with the same sheets the entire stay. All in all the hospital is still one of the best. My wife has stayed at Mather several times and has had no complaints. She prefers going to Mather,even though we do not live in the area. With a few changes in house keeping, it can be a great hospital again.

The Fundamentals: Mather Hospital’s Reason to suspect Carbon Monoxide Exposure. Sudden Change in Behavioral and Physical Condition. Patients Condition as recent as 1 week prior to Carbon Monoxide Exposure. 1/30/13 Admission at Mather Hospital

“Awake, Alert and Oriented X 3, (Discharge Summary, 2/1/13 under Neurological)

 “Awake and alert, GCS 15, oriented to person, place, time and situation. (Physician Documentation Cont’. 1/30/13, page 2, Neuro:) 
 “Awake, Alert and oriented x 3″, (John T. Mather Hospital Discharge Summary Dis Date: 2/2/13, Physical Examination:)

 “No deficits noted, patient oriented X3, eyes open spontaneously and obeys commands. Level of consciousness is awake, alert”. ( Mather Hospital Nurse’s Notes Con’t, 1/30/13, page 2, 17:06, Neuro:)

 “Mild Dementia”. (John T. Mather Hospital Admission Profile, 1/30/13, page 4, Neurological Comment.) 

 Patients Symptoms Presented Immediately after Carbon Monoxide Exposure. “Weakness, No Meds/ Blood Drawn, wants comfort care, Palliative Care” John T. Mather Memorial Hospital ER Enc, 2/9/13, page 3 of 3). “90 YO presents w Fatigue/ weakness-Pt/family would like end of life care”: 1 Admit to Med/Surg -comfort Care-0 Labs-Meds PRN-Palliative Consult(Problem List and Plan/Recommendation: John T. Mather Memorial Hospital ER Enc, 2/9/13, page 3 of 3). “Weakness/ Fatigue” (John T. Mather Hospital ER, 2/9/13, page 1, Chief Complaint.) “Unresponsive”, (Mather Hospital Nursing Assessment, 2/9/13, page , under Coping,/Observed Emotional State. 2/10/13 09:00), “Non Verbal”, (Mather Hospital Nursing Assessment, page 3 & 4, under Coping/ Verbalized Emotional State 2/12/13) “Semi Comatose” (Mather Hospital Nursing Assessment, page 7, Cognitive/Perceptual/Neuro under level of consciousness, 2/12/13) “Disoriented x 4” (Mather Hospital Nursing Assessment, page 7, Cognitive/Perception/Neuro under Orientation). Carbon Monoxide Poisoning Symptoms Symptoms By Mayo Clinic Staff Signs and symptoms of carbon monoxide poisoning may include: • Dull headache • Weakness • Dizziness • Nausea • Vomiting • Shortness of breath • Confusion • Blurred vision Loss of consciousness Red Flags: No fever associated with symptoms, history of exposure, multiple patients with similar complaints. CARBON MONOXIDE EXPOSURE WARNING SIGNS Even doctors can have trouble making a carbon monoxide poisoning diagnosis. Experts say two sure signs that carbon monoxide may be at play is when multiple people in the same building begin to experience similar symptoms at the same time. Another sign is that the symptoms seem to disappear or lessen when the person leaves a certain area and gets fresh air. John T Mather Mem Hospital Doctor: Kanakoudas,dimos Mather Hospital Neglects Diagnosing Carbon Monoxide Exposure. 
 New York, Port Jefferson Hospital Service: No Comment Occur date: Feb 09 2013 Post date: Jun 27 2014, 03:31:46 PM “On or about 2/7/13, my Mother was exposed to Toxic Levels of Carbon Monoxide. On or about 2/7/13, 4+ Patients Admitted to Mather Hospital, Diagnosed and Treated for Carbon Monoxide Poisoning. Poisoned were 3 individuals from within my mother’s apartment and a family in an apartment directly above my mother, necessitated they’re hospitalization.” “Confirmation of my mothers residence is found in a Mather Hospital letter dated 7/17/13, where the Hospital Administrative Director Maryanne B. Gordon, states: “Further, she advised your mother resided with her, which you do not dispute”. Also Port Jefferson Volunteer Ambulance Corps. Invoice, 2/11/13, for services rendered for my mothers transport to Mather Hospital on 2/9/13, confirms this address as well as the Certificate of Death.” The “Standard” Diagnostic Exam for Carbon Monoxide Exposure Carboxyhemoglobin (COHb) Test” was not performed. Respir Care. 2013 Oct;58(10):1614-20. doi: 10.4187/respcare.02313. Epub 2013 Mar 19. Emergency department management of suspected carbon monoxide poisoning: role of pulse CO-oximetry. Sebbane M1, Claret PG, Mercier G, Lefebvre S, Théry R, Dumont R, Maillé M, Richard JP, Eledjam JJ, de La Coussaye JE. Author information Abstract BACKGROUND: The RAD-57 pulse CO-oximeter is a lightweight device allowing noninvasive measurement of blood carboxyhemoglobin (S(pCO)). We assessed the diagnostic value of pulse CO-oximetry, comparing S(pCO) values from the RAD-57 to standard laboratory blood carboxyhemoglobin (COHb) measurement in emergency department patients with suspected carbon monoxide (CO) poisoning. METHODS: This was a prospective, diagnostic accuracy study according to the Standards for the Reporting of Diagnostic Accuracy Studies criteria in consecutive adult emergency department patients with suspected CO poisoning. S(pCO) was measured with the RAD-57 simultaneously with blood sampling for laboratory blood gas analysis. We made no changes to our standard management of CO poisoning. Blood COHb > 5% for non-smokers, and > 10% for smokers were applied as the reference standard. RESULTS: We included 93 subjects: 37 smokers and 56 non-smokers. CO poisoning was diagnosed in 26 subjects (28%). The S(pCO) values ranged from 1% to 30%, with a median of 4% (IQR 2.7-7.3%). The COHb values ranged from 0% to 34%, with a median of 5% (IQR 2-9%). The mean differences between the COHb and S(pCO) values were -0.2% ± 3.3% (95% limits of agreement of -6.7% and 6.3%) for the whole cohort, -0.7% (limits of agreement -7.7% and 6.2%) for the non-smokers, and 0.6% (limits of agreement -5.0% and 6.2%) for the smokers. The optimal thresholds for detecting CO poisoning were S(pCO) of 9% and 6% for smokers and non-smokers, respectively. CONCLUSIONS: S(pCO) measured with the RAD-57 was not a substitute for standard blood COHb measurement. However, noninvasive pulse CO-oximetry could be useful as a first-line screening test, enabling rapid detection and management of CO-poisoned patients in the emergency department. KEYWORDS: CO poisoning; CO-oximetry; carbon monoxide; emergency department; pulse oximetry; sensitivity; specificity PMID: 2351**** [PubMed – indexed for MEDLINE] Free full text Mather Hospital’s Failure to perform other tests to determining the degree of potential damage of Carbon Monoxide Exposure. Stephen R. Thom, M.D., Ph.D. Carbon Monoxide Poisoning Testing for CO Poisoning Doctors typically measure the patient’s levels of carboxyhemoglobin (COHb) to confirm the diagnosis of CO exposure.(61) EKGs and plasma screens are also done, both because of the risk of circulatory system damage from CO and in light of the fact that those who suffer an acute cardiac injury from CO poisoning have an increased risk for cardiovascular-related death in the following 10 years. A chest X-ray also should be part of the ER evaluation, especially in cases of smoke inhalation.(62)(63) Confirmation of diagnosis • The key to confirming the diagnosis is measuring the patient’s carboxyhemoglobin (COHb) level. Carbon Monoxide levels can be tested either in whole blood or exhaled air. It is important to know how much time has elapsed since the patient has left the toxic environment, because that will impact the COHb level. If the patient has been breathing normal room air for several hours, COHb testing may be less useful. • The most common technology available in hospital laboratories for analyzing the blood is the multiple wavelength spectrophotometer, also known as a CO-oximeter. Venous or arterial blood may be used for testing. • A fingertip pulse CO-oximeter can be used to measure heart rate and oxygen saturation, and COHb levels. The conventional two-wavelength pulse oximeter is not accurate when COHb is present. An elevated COHb level of 2% for non-smokers and >9% COHb level for smokers strongly supports a diagnosis of CO poisoning.
 COHb levels do not correlate well with severity of illness, outcomes or response to therapy so it is important to assess clinical symptoms and history of exposure when determining type and intensity of treatment. Other testing, such as a fingerstick blood sugar, alcohol and toxicology screen, head CT scan or lumbar puncture may be needed to exclude other causes of altered mental status when the diagnosis of carbon monoxide poisoning is inconclusive. Guidance for Management of Confirmed or Suspected CO Poisoning • Administer 100% oxygen until the patient is symptom-free, usually about 4-5 hours. Serial neurologic exams should be performed to assess progress, and to detect the signs of developing cerebral edema. • Consider hyperbaric oxygen therapy (HBO) therapy when the patient has a COHb level of more than 25- 30%, there is evidence of cardiac involvement, severe acidosis, transient or prolonged unconsciousness, neurological impairment, abnormal neuropsychiatric testing, or the patient is ≥36 years in age. HBO is also administered at lower COHb(<25%) levels if suggested by clinical condition and/history of exposure. • Hyperbaric oxygenis the treatment of choice for pregnant women, even if they are less severely poisoned. Hyperbaric oxygen is safe to administer and international consensus favors it as part of a more aggressive role in treating pregnant women. Other Considerations • Cardiac injury during poisoning increases risk of mortality over 10 years following poisoning, so in patients with severe CO poisoning, it may be important to perform an EKG and measurement of troponin and cardiac enzymes. • Chest radiography is recommended for seriously poisoned patients, especially those with loss of consciousness or cardiopulmonary signs and symptoms. Brain computed tomography or MRI is also recommended in these cases; these tests may show signs of cerebral infarction secondary to hypoxia or ischemia. • All discharged patients should be warned of possible delayed neurological complications and given instructions on what to do if these occur. Follow-up should include a repeat medical and neurological exam in 2 weeks. While Medical Records Suggest that Carbon Monoxide Exposure was Not Disclosed and Diagnosed, it also Demonstrates the Rapid Deterioration in Health from 8 Days Prior to Carbon Monoxide Exposure. Admission 1/30/13- Not Deemed Incapacitated / Not meeting the Requirements for Hospice Care. Additionally Medicare and AARP United Healthcare Summary’s do not reflect Hospice Care (Medicare Hospice Benefit) or Physician visit from 1/25/13 to ER visit and admission 2/9/13. “Cardiovascular: Positive for chest pain, of the mid-sternal area. Respiratory positive for shortness of breath, negative for cough. All other systems were reviewed and are negative”. (Physician Documentation, 1/30/13, page 1 of 4, ROS:) “pt is awake alert and comfortable”, (Physician Documentation, 1/30/13, page 1 of 4, Constitutional) ”The patient has not recently seen a physician…” (John T. Mather Hospital Physician Documentation, 1/30/13, HPI, 15:35)

 “Pulses equal, no cyanosis. Neurovascular intact. Full, normal range of motion. (Physician Documentation, 1/30/13, page 2 of 4, MS/Extremity) “Awake and alert, GCS 15, orientated to person, place, time, and situation. Cranial nerves II-XII grossly intact. Motor strength 5/5 in all extremities. Sensory grossly intact. Cerebellar exam normal. Normal gait. (Physician Documentation, 1/30/13, page 2 of 4, Neuro.) “Mild Dementia”. (John T. Mather Hospital Admission Profile, 1/30/13, page 4, Neurological Comment.) “Awake, alert, with orientation to person, place and time. Behavior, mood, and effect are within normal limits”. (Physician Documentation, 1/30/13, page 2 of 4, Psych.) “17:38 Critical Care not applicable. Condition is improved, problem is new, symptoms have improved.” (Physician Documentation, 1/30/13, page 3 and 4, disposition). “The Patient was Discharged”, 2/2/13. (John T. Mather Hospital Discharge Summary, 1/30/13, page 2, DISPOSITION:)

 FOLLOWUP: “Followup in one or two weeks with primary care physician”. (John T. Mather Hospital Discharge Summary, 1/30/13, page 2,)
 10 Days Later, following Carbon Monoxide Exposure and the Continuation of Mather Hospitals lack of Intervention of the Documented “Abrupt Discontinuation” of Medications. “Child states the patient is dying” (Nurses Notes 2/9/13). “Patient is actively dying, as per daughter” (Physician Documentation, 2/9/13, 21:04, page 1) “Weakness/ Fatigue, pt.is a 90 YO F, brought in by her daughter. Pt. palliative/ end of life care @ home-lives with daughter lost power @ home, pt’s daughter would like her mother to be confortable here- does not want any invasive care. Pt. DNR/DNI. Pt confortable @ this time”. (John T. Mather Memorial Hospital ER Enc, 2/9/13, page 1 of 3). “Pt’s Family/ HCPXY- refusing labs”, (Medical Decision Making Information: John T. Mather Memorial Hospital ER Enc, 2/9/13, page 3 of 3) “90 YO presents w Fatigue/ weakness-Pt/family would like end of life care”: 1 Admit to Med/Surg -comfort Care-0 Labs-Meds PRN-Palliative Consult(Problem List and Plan/Recommendation: John T. Mather Memorial Hospital ER Enc, 2/9/13, page 3 of 3). “Weakness, No Meds/ Blood Drawn, wants comfort care, Palliative Care” (John T. Mather Memorial Hospital ER Enc, 2/9/13, page 3 of 3). “0 LABS”, (John T. Mather Memorial Hospital, ER Problem List and Plan/Recommendation, page 2, 2/9/13) “Requesting no “vital signs” being taken, “defers blood work and diagnostic work-ups” (Physician Documentation, 2/9/13, page 1) “HCP states she does not want anything done to patient no labs, work up or anything that will “disturb” her”, (Nurses Notes, 2/9/13, 20:10, page 1 and 2 under assessment). “Daughter-resistant to obtaining pt’s vital signs, I explained need for assessing vital signs and rationale for same” (Nursing Progress Note, 2/10/13, 12:33, page 1). “Pt daughter declined a full body assessment” (Nurses Notes, 2/9/13, page 2). “Unable to assess- family does not want pt undressed” (John T. Mather Admission Profile, Skin Symptoms, 2/9/13, page 5). Unfortunately : Severe Carbon Monoxide Poisoning can be Reversed. “70% of patients treated with SEVERE (C0) poisoning survive,”Carbon Monoxide Poisoning”, The Internet Journal of Emergency and Intensive Care Medicine, 1997. 

Vol.1 N2. at a COHb level of about 40%, Carbon Monoxide starts to cause Coma and Collapse.” Am J Emerg Med. 1993 Nov;11(6):616-8. Coma reversal with cerebral dysfunction recovery after repetitive hyperbaric oxygen therapy for severe carbon monoxide poisoning. Dean BS1, Verdile VP, Krenzelok EP. Author information Abstract The accepted beneficial effects of hyperbaric oxygen (HBO) include a greatly diminished carboxyhemoglobin (COHgb) half-life, enhanced tissue clearance of residual carbon monoxide (CO), reduced cerebral edema, and reversal of cytochrome oxidase inhibition, and prevention of central nervous system lipid peroxidation. Debate regarding the criteria for selection of HBO versus 100% normobaric oxygen therapy continues, and frequently is based solely on the level of COHgb saturation. Patients who manifest signs of serious CO intoxication (unconsciousness, neuropsychiatric symptoms, cardiac or hemodynamic instability) warrant immediate HBO therapy. An unresponsive 33-year-old woman was found in a closed garage, inside her automobile with the ignition on. Her husband admitted to seeing her 6 hours before discovery. 100% normobaric oxygen was administered in the prehospital and emergency department settings. The patient had an initial COHgb saturation of 46.7%, a Glasgow coma score of 3, and was transferred for HBO therapy. Before HBO therapy, the patient remained unresponsive and demonstrated decerebrate posturing and a positive doll's eyes (negative oculocephalic reflex). The electroencephalogram pattern suggested bilateral cerebral dysfunction consistent with a toxic metabolic or hypoxic encephalopathy. The patient underwent HBO therapy at 2.4 ATA for 90 minutes twice a day for 3 consecutive days. On day 7, the patient began to awaken, was weaned from ventilatory support, and was not soon verbalizing appropriately. A Folstein mental status examination showed a score of 26 of 30. Neurological examination demonstrated mild residual left upper extremity weakness and a normal gait. There was no evidence of significant neurological sequelae at 1 month follow-up.(ABSTRACT TRUNCATED AT 250 WORDS) Comment in • The science (or lack thereof) in the treatment of carbon monoxide poisoning. [Am J Emerg Med. 1994] • Randomized clinical trial in carbon monoxide poisoning needed. [Am J Emerg Med. 1994] PMID: 804**** [PubMed – indexed for MEDLINE] The facts presented in my mother’s encounters with Mather Hospital exposes a weakness in Healthcare Proxy Law. With regards to “honoring a Healthcare Proxy Agents wishes” to not “examine, obtain vitals’, diagnose, treat, deny hydration and nutrition” must first follow at least a minimal Examination, Blood Panel and Toxicology Tests. Not performing toxicology tests and other diagnostics when Carbon Monoxide Poisoning had been identified and treated from her apartment is troubleing. Not examining the patients skin because the HCP Agent does not want the patient to get undressed is especially worrisome. If tests are not performed based upon reason, a Healthcare Proxy Agent with the wrong intentions for whatever reason, can easily poison the principal, and as my mother’s Carbon Monoxide event has proven, the Hospital will enable the death and dispose of the body. There is evidence that Mather Hospital had not obtained a copy of the Healthcare Proxy Document related to the Agent, who’s activities are in question. Normally documents containing directives on the patient’s healthcare wishes would be available for examination, authentification and guidance. Mather Hospital has transformed me from a victim of the consequences of Elder Abuse/ Neglect, Defamation and Humiliation to a committed Elder Advocate. Within the next several years I will be seeking to change the laws for the protection of the Elderly, with the laws deficiencies clearly demonstrated with mine and my mother's experience at Mather Hospital.

Mather Hospital, Failure to Report, Failure to Intervene, Fails the Patient. Confirming the Diagnosis of Elder Abuse can be made Exclusively by Documenting "Abruptly Discontinued Pain Medications" without Medical Supervision. "Under treatment of pain equals elder abuse." Chronic Neuroimmune Disease 1/13/13 "Under utilization of prescription drugs" is a sign of physical abuse. (National Centers on the Elder Abuse Administration on Aging). "Denial of Pain Medication is Elder Abuse", Elder Abuse, the Pharmacist’s Role, Center on Elder Abuse.org, "Denying Access to Pain Medication", Elder Abuse, Center on Excellence on Elder Abuse & Neglect, "Denying access to pain medication is physical abuse", Laura Mosqueda, M.D., Director of Geriatrics, University of California, Irvine School of Medicine.Mather Hospital Documenting the Knowledge of Pain Medications being "Abruptly Discontinued". "At home are vitamin D, Valium, Remeron, vitamin B12, Tylenol, and Keppra. The patient apparently was also on high dose of vicodin, which she has been abruptly discontinued for the last three days." (Mather Hospital, Consultation Report", dated 1/30/13, page 1, heading Medications.) Mather Hospital Documenting the Medically Unsupervised Discontinuation of Pain and other Medications. The patient has not recently seen a physician…" (Physician Documentation, 1/30/13, HPI, 15:35) AARP United healthcare Summary March 15, 2013, page 3 of 7, corroborates the accuracy of Mather Hospital’s knowledge that the "patient has not recently seen a physician" from the admission date 1/13/13, while taking all documented medications, till the admission date 1/30/13, when Vicodin, Levothyroxine, Lopressor, Lovanox and Prednisone was discontinued. (Mather Hospital Nurse’s Notes, 1/13/13, page 1, Home Meds, Mather Hospital Physician Documentation, 1/30/13, page 1, Home Meds) United Healthcare reports in it’s summary only 2 physician claims for this time period. Mather Hospital "ER Visit", 1/13/13, #30572-8****4-1, Doctor Services $2,532.19, and a Mather Hospital "Doctor Care in Hospital", 2/1/13, #30582-4****6-1, $199.00 Mather Hospital "Confirming the Diagnosis" by Utilizing the "Direct Questioning" Method. (Elder Abuse an Introduction for the Clinicians, Dr. Ronald A. Chez, Center on Elder Abuse . org)"Are you or have you been threatened or abused?" The patient replied YES! (Mather Hospital Admission Profile, 1/30/13, page 6 under Self-Perception.) Mather Hospital’s Policy Regarding Mandatory Reporting in Conduct and Compliance Manual In Overview, Introduction, Page 2, B. "The importance of the compliance program moreover, compliance with state and federal rules and regulations is essential because of our potential civil or even criminal liability if we were found to have violated the applicable standards." Page 6, III section ,"Standards Related to Quality of Care", DMandatory Reporting. "The hospital will ensure that all incidents and events that are required to be reported under federal and state mandatory reporting laws, rules and regulations are reported in a timely manner". Section D continued, Page 7, "The compliance officer or his designee will validate that appropriate systems are in place for identifying and reporting incidents that require reporting. "The compliance officer will conduct periodic reviews to monitor the hospital’s compliance with such requirements in connection with, but not limited to, the following": #3, "Elder Abuse". WHY DISCONTINUING PAIN MEDICATION WHILE MEDICALLY UNSUPERVISED, IS ABUSE! Patient’s Pain, Suspected Multiple Myeloma Mather Hospital Not Addressing Pain, Withdrawal and Rebound Effects."Complaint: Your Mother’s medications were not appropriately adjusted, causing her condition to be effected"."Response: Your mother’s medications were in fact appropriately adjusted in accordance with laboratory results." (Letter, Maryanne B. Gordon, MA, RHIA, CHCQM, Administrative Director, Mather Hospital.) Which of the following "Laboratory Test Results" done at Mather Hospital, (CMP, APTT, BNP, CBC W/DIFF, Magnesium, Prothrombin Time, Troponin, TSH, Urine Admission, Troponin, Basic Metabolic Panel, CBC, Phosphorus, John T. Mather Encounter Summary, 1/30/13, page 1, Orders:) based upon Medical Science, justifies the "Abrupt Discontinuance" of Vicodin and Prednisone for Cancer Pain, without a substitute, while not being Medically Supervised? Looking specifically at pain medications for cancer, due to it’s debilitating effects.Mather Hospital Establishes Timeline of Discontinued Pain Medication. "At home are vitamin D, Valium, Remeron, vitamin B12, Tylenol, and Keppra. The patient apparently was also on high dose of vicodin, which she has been abruptly discontinued for the last three days." (Mather Hospital, Consultation Report", dated 1/30/13, page 1, heading Medications.) Withdrawal Symptoms Appear Exactly 2 Days As Would Be Expected."Withdrawal symptoms typically begin within a day or two of stopping the medicine" "I urge anyone in this situation to stop their narcotic medication under their doctor’s supervision". (Living Well Expert, Dr. Jennifer Shu)"15:35 The patient reports chest pain that is located primarily in the substernal area. Onset Yesterday", John T. Mather Hospital Physician Documentation, 1/30/13, page 1,)Abruptly Discontinued 3/27/13, Symptoms 2 Days Later, 3/29/13.Mather Hospital’s Knowledge of Vicodin Usage Confirmed."Apparently was on high dose of Vicodin" (Mather Hospital, Consultation Report", dated 1/30/13, page 1, heading Medications.) Prescription given at discharge of Mather Hospital ER, Discharge Instructions, 1/13/13, Vicodin 5-500 mg. Oral Tablet, take 1 tablet(s) by ORAL route every 6 hours as needed; Quantity: 20 tablet(s).Vicodin 5 mg. 1q6h prn since 6/30/11, Prednisone 5 mg., 1 in AM and 2 at PM, since 5/31/11, (Primary Care Physician Face Sheet for patient, printed April 16, 2013.) "Vicodin daily for 3 years", (John T. Mather Memorial Hospital Admission Profile, 1/30/13, page 4, Street Drug/Medication/Inhalent Use, Frequency of Street Drug/Medication/Inhalent.) Cancer Pain Established, "Symptoms and Laboratory Results" indicative of Multiple Myeloma. "Generalized Bone Pain", (John T. Mather Memorial Hospital Admission Profile, 1/30/13, page 2, Medical Surgical History.) Mather Hospital Reference Lab Testing, 2/2/2013, 07:00, "Serum IFE reveals the presence of monoclonal free lamba light chains". Mather Hospital Affiliated Physician. "Recommendation/Plan: An 85-yar-old lady with past medical history of seizures and anemia secondary to chronic kidney disease who presents with an acute DVT. I will perform a hypercoagulable workup, as she does have a family history of DVT’S "however, she has Bence Jones protein suspicious for multiple myeloma."( David Chu, Northshore Hematology/ Oncology Associates, Recommendation/ Plan, 1/23/12, page 3.) Mather Hospital Physician. "Immunofixation, urine. Bence Jones Protein Positive Lamba Type." (Joseph P. Boglia, M.D., P.C.) Patient’s Pain was from Suspected Multiple MyelomaMemorial Sloan Kettering Cancer CenterMultiple Myeloma:Pain Management"A majority of patients with multiple myeloma report that they experience some pain related to the disease. The pain may be a result of a bone fracture or of a tumor pressing against a nerve."Universally Accepted Treatment of Multiple Myeloma PainMemorial Sloan Kettering Cancer CenterMultiple Myeloma:Pain Management"Analgesics, or pain relievers, remain the mainstay of bone pain treatment. The strongest analgesics, called opioids or narcotics, are often prescribed to control pain in myeloma patients. The most commonly prescribed drugs are codeine, morphine, and morphine-like synthetic compounds." Medically Supervised Tapering; Universally Recognized Protocol for Discontinuing Vicodin not Established at Mather Hospital. "You should never try to quit taking Vicodin on your own; reduction of the medication and detoxification must be supervised by a doctor. Addiction experts and clinicians recommend a gradual reduction of the medication, as sudden cessation can trigger severe withdrawal symptoms.""Withdrawal symptoms usually start within a day or two of stopping the medication".© 2014 Addiction Vicodin. All Rights Reserved. Home | XML Site Map | RSS Get Off Hydrocodone (Not Cold Turkey)"Clinical experts prefer it that you don’t get off hydrocodone cold turkey. They feel that withdrawal doesn’t have to be a painful and debilitating process. Instead, you can slowly lower hydrocodone doses over time to lower risk of severe symptoms of withdrawal. Always check with your prescribing doctor and ask for a hydrocodone tapering schedule when coming off hydrocodone. Tapered hydrocodone doses should be medically supervised in the case that tweaking and adjustments are required. In general, some guidelines for getting off hydrocodone include":1. A 2 to 3 week hydrocodone tapering regimen should be adequate in most cases2. Reduce the hydrocodone dose by 10% at each interval3. Reduce the hydrocodone dose by 20% every 3-5 days4. Reduce the hydrocodone dose by 25% per week5. Avoid reducing the daily dose by > 50% at any given interval Painful Symptoms of Unsupervised Vicodin Withdrawal. Stopping Hydrocodone Cold Turkey Risks"Stopping hydrocodone cold turkey can be a unpredictable process. While opiates are known to provoke general symptoms during withdrawal, the fact remains that everybody is different. And depending on your current mental and physical health, stopping hydrocodone cold turkey can be more or less successful. The possible ricks you run quitting hydrocodone suddenly includes the following:"• coma• confusion• erratic and uncontrollable moods• hallucinations• increased heart rate/blood pressure• relapse do to inability to handle pain• seizurestremorsMayo Clinic ProceedingsVolume 81, Issue 6 , Pages 825-828, June 2006"Broken Heart Syndrome" After Separation (From OxyContin)"People who abruptly discontinue opiods may experience "Broken Heart Syndrome" increasing their risk of cardiac event. "Though most Broken Heart Syndrome patients regain full cardiac function some die and others suffer life-threatening complications." (Mayo Clinics June issue of the Mayo Clinic Proceedings) "Broken Heart Syndrome" Can Result From Opioid Withdrawal, Cocaine Use• Heart Disease news • Jun 22, 2006 "People who experience abrupt withdrawal from high-dose opioids or use cocaine increase their risk of cardiac event, according to two new studies published in the June issue of Mayo Clinic Proceedings"."Patients may experience shortness of breath and chest pain and, upon hospital admission, go through extensive tests to determine a diagnosis and rule out heart attack." Mather Hospital Documentation of Sudden Onset of Cardiac Event Associated with Vicodin, Metroprolol and Prednisone Withdrawal and Rebound Effects and Characteristics of "Broken Heart Syndrome". "The patient was admitted for possible" acute coronary syndrome."(John T. Mather Hospital Discharge Summary, 1/30/13, page 1, Hospital Course.) "SAO2 41% @15%" (Terryville Fire Department, Hospital Patient Record Copy, 1/30/13) "Chest Pain" …" (John T. Mather Hospital Discharge Summary, 1/30/13, page 1, Chief Complaint.) "Chest pain… the pain radiates down left arm…" "Pertinant positives:shortness of breath". "Modifying factors: The Symptoms are alleviated by nothing. The symptoms are aggravated by nothing." "The patient has not experienced similar symptoms in the past". The patient has not recently seen a physician…" (John T. Mather Hospital Physician Documentation, 1/30/13, HPI, 15:35) "S1 and S2 Positive". …" (John T. Mather Hospital Discharge Summary, 1/30/13, page 1, Heart.) "Abnormal ECG" (John T. Mather Hospital Nurse’s Notes, 1/30/13, page 1, Diagnosis:) "Rythym is atrial fibrillation With PVC’s" (John T. Mather Hospital Nurse’s Notes Cont, 1/30/13, page 2, Assessment:, Cardiovascular:) "17:18 Notified ED physician of critical lab value positive troponin reported to dr. morgan 0.07. (John T. Mather Hospital Nurse’s Notes, 1/30/13, page 2, ED Course:) "CARDIAC MARKERS, Troponin 1, 0.06 H, 1/31/13 11:27, BNP 260 H, 1/31/13 09:01". (John T. Mather Hospital Chemistry, Cardiac Markers, 1/31/13, page 2.) 15:39 "abnormal EKG, acute myocardial infarction, acute pericarditis, anxiety, atypical chest pain, coronary artery disease chest wall pain. (John T. Mather Hospital Physician Documentation Con’t., 1/30/13, page 2, Differential diagnosis:) Mather Hospital Confirming "Acute Coronary Syndrome" Associated with Withdrawal and Rebound Symptoms. "1/30/13 17:38 Admit ordered for Kanakoudas, Dimos. Preliminary diagnosis are Chest Pain, Abnormal ECG. Problem is new." (John T. Mather Hospital Physician Documentation Con’t., 1/30/13, page 4, Disposition:). Mather Hospital Confirming "Acute Coronary Syndrome" as Withdrawal and Rebound Symptoms by Restoring Opiates and Relieving Symptoms. "16:49, Morphine 2 mg., Sub-Q, upper left arm" (John T. Mather Hospital Nurse’s Notes Cont., 1/30/13, page 2, Administered Medications:) "17:35, The Patients symptoms have improved, morphine markedly releived the patient’s pain. Symptoms have improved. Pain Meds Pain medication ordered, see orders" (John T. Mather Hospital Physician Documentation Con’t., 1/30/13, page 2, Medication Response.) "17:35 Moderately improved", John T. Mather Hospital Physician Documentation Con’t., 1/30/13, page 2, Response to treatment:) Mather Hospital Not Addressing the "Abrupt Discontinuation" of Pain Medications for Cancer and the need for Immediate Medical Supervision for the Continuation of Pain and Withdrawal. "16:49, Morphine 2 mg., Sub-Q, upper left arm" (John T. Mather Hospital Nurse’s Notes Cont., 1/30/13, page 2, Administered Medications:) "16:49, Morphine 2 mg., Sub-Q, ONCE" (John T. Mather Hospital Nurse’s Notes Cont., 1/30/13, page 2, Order Name.) "The Patient was Discharged", 2/2/13. (John T. Mather Hospital Discharge Summary, 1/30/13, page 2, DISPOSITION:) FOLLOWUP: "Followup in one or two weeks with primary care physician". (John T. Mather Hospital Discharge Summary, 1/30/13, page 2,) MEDICATION: "As per medical reconciliation list." (John T. Mather Hospital Discharge Summary, 1/30/13, page 2,) Only 3 Medications on Reconciliation List Given In Hospital, Pain Medications Neglected for Cancer Pain at Home. "Verified Keppra 500mg. orally 2 times a day, 1/30/13, continued as the inpatient order levetiracetam." (John T. Mather Memorial Hospital Admission Reconcilliation, 1/30/13, Admit Date: 1/30/2013, Discharge Date: 2/2/2013, Att: Kanakoudas, Dimos). "Verified Remeron 15mg. orally 2 times a day, 1/30/13, Remeron continued as the inpatient order mirtazapine." (John T. Mather Memorial Hospital Admission Reconcilliation, 1/30/13, Admit Date: 1/30/2013, Discharge Date: 2/2/2013, Att: Kanakoudas, Dimos). "Verified Valium 2.5 mg. tablet bid prn anxiety, 1/30/13, Valium continued as the inpatient order diazepam. (John T. Mather Memorial Hospital Admission Reconcilliation, 1/30/13, Admit Date: 1/30/2013, Discharge Date: 2/2/2013, Att: Kanakoudas, Dimos). "diazepam (dispense as Valium) Give 5 milliGRAM(S) Oral 2 times per day for Moderate Pain PRN Special Instructions: HOLD FOR SEDATION Date Due to Review:01-Feb-2013 00:00 **Discontinued**(John T. Mather Memorial Hospital Admission Reconciliation, 1/30/13, Admit Date: 1/30/2013, Discharge Date: 2/2/2013, Additional Current Orders, Att: Kanakoudas, Dimos). "levetiracetam (Dispense as Keppra) Give 500mgs. Oral 2 times per day Priority- Time:Routine Rx Date Due to review:01-Mar-2013 00:00 (John T. Mather Memorial Hospital Admission Reconciliation, 1/30/13, Admit Date: 1/30/2013, Discharge Date: 2/2/2013, Additional Current Orders, Att: Kanakoudas, Dimos). Mirtazapine (Dispense as Remoron) Give 15 mgs. Oral 2 times per day Priority- Time:Routine Rx Date Due to review:01-Mar-2013 00:00 (John T. Mather Memorial Hospital Admission Reconciliation, 1/30/13, Admit Date: 1/30/2013, Discharge Date: 2/2/2013, Additional Current Orders, Att: Kanakoudas, Dimos). Mather Hospital Documents the Knowledge of Discontinued Medications on Admission Dates 1/30/13 and 2/9/13. Mather Hospital, "Nurses Notes", 1/13/13, page 1, under "Home Meds" hospital staff document the patient as taking; Keppra, Vicodin, Lopressor, Remeron, Valium, Amitiza, Prednisone and Levothyroxine. Mather Hospital "Physicians Documentation", 1/30/13, under "Home Meds", Hospital staff documented; Valium, Remeron, Keppra. Mather Hospital "Admission Reconciliation", dated 1/30/13 at 18:15, under "Home Medications", again confirmed reduction to Keppra, Remeron and Valium. Hospital "Admission Reconciliation", 2/9/13, 5:15:46 AM hospital staff document just Valium. "At home are vitamin D, Valium, Remeron, vitamin B12, Tylenol, and Keppra. The patient apparently was also on high dose of vicodin, which she has been abruptly discontinued for the last three days." (Mather Hospital, Consultation Report", dated 1/30/13, page 1, heading Medications.) Hospital "Admission Reconciliation", 2/9/13, 5:15:46 AM hospital staff document just Valium. "Patient was not given aspirin… states patient no longer takes medications". (Mather Hospital, Physician Documentation, 2/9/13, 21:08, page 2). No Longer Taking, Home Medications:acetaminophen HYDROcodone 325 mg. 5 mg. oral tablet 1 tab orally every 4 hours, as needed. (John T. Mather Memorial Hospital Admission Reconciliation, 2/9/13, Admit Date: 2/9/2013, Discharge Date: 2/12/2013, Additional Current Orders, Att: Kanakoudas, Dimos). No Longer Taking, Home Medications:prednisone 5 mg. oral tablet 1 tab orally once a day.(John T. Mather Memorial Hospital Admission Reconciliation, 2/9/13, Admit Date: 2/9/2013, Discharge Date: 2/12/2013, Additional Current Orders, Att: Kanakoudas, Dimos). No Longer Taking, Home Medications:metoprolol succinate 25 mg. oral tablet, extended release 1 tab orally once a day.(John T. Mather Memorial Hospital Admission Reconciliation, 2/9/13, Admit Date: 2/9/2013, Discharge Date: 2/12/2013, Additional Current Orders, Att: Kanakoudas, Dimos). No Longer Taking, Home Medications:levothyroxine 25 mcg (0.025 mg.) oral tablet 1 tablet orally once a day.(John T. Mather Memorial Hospital Admission Reconciliation, 2/9/13, Admit Date: 2/9/2013, Discharge Date: 2/12/2013, Additional Current Orders, Att: Kanakoudas, Dimos). No Longer Taking, Home Medications:citalopram 20 mg. oral tablet 1 tab orally once a day.(John T. Mather Memorial Hospital Admission Reconciliation, 2/9/13, Admit Date: 2/9/2013, Discharge Date: 2/12/2013, Additional Current Orders, Att: Kanakoudas, Dimos). Verified, Valium 2.5 mg tablet bid prn anxiety (John T. Mather Memorial Hospital Admission Reconciliation, 2/9/13, Admit Date: 2/9/2013, Discharge Date: 2/12/2013, Additional Current Orders, Att: Kanakoudas, Dimos). The Results. 1/14/13: While Patient was taking All Prescribed Medications: Vicodin, Prednisone, Levothyroxine, Lopressor, Keppra, Remeron and Valium Under my Care. "Negative for Body Aches", "Negative for Pain", "Negative for Pain with Movement", "Negative for Chest Pain", "Negative for Shortness of Breath", "Negative for Headache", "Negative for Anxiety, Depression" ( John T. Mather Hospital Physician Documentation, 1/13/13, page 1, ROS:, 32:31, Constitutional:) "The patient appears in no acute distress, alert, awake, (John T. Mather Hospital Physician Documentation, Constitutional Con’t., page 2) "The patient does not display signs of respiratory distress, Respirations: normal, Breath sounds: are normal, clear throughout, no rales, rhonchi, no wheezing." (John T. Mather Hospital Physician Documentation, Constitutional Con’t., 1/13/13, page 2, Respiratory:) "Rate: normal, Rythym: regular, Heart Sounds: normal, normal S1 and S2." John T. Mather Hospital Physician Documentation Physician Documentation, Constitutional Con’t., 1/13/13, page 2, Cardiovascular:) "Pain, that is mild of the thoracic area, ROM normal"(John T. Mather Hospital Physician Documentation Con’t., 1/13/13, page 2, Back:) "Orientation is normal, Cerebellar function: normal finger to nose testing, able to perform alternating rapid hand movements, Motor: is normal, moves all fours, strength is normal, Sensation is normal, Deep tendon reflexes are normal"(John T. Mather Hospital Physician Documentation, Constitution Con’t., 1/13/13, page 2, Neuro:) "ROM : Intact in all extremities, Circulation: Circulation is intact in all extremities, Joints: All joints appear normal with full range of motion, neurovascular is intact distal to injury" (John T. Mather Hospital Physician Documentation, Constitution Con’t., 1/13/13, page 2, Musculoskeletal/extremity:)"Behavior: appropriate for age, cooperative" (John T. Mather Hospital Physician Documentation, Constitution Con’t., 1/13/13, page 2, Psych:) "Negative for Chest Pain, Palpatations", (John T. Mather Hospital Physician Documentation, Constitution Con’t., 1/14/13, page 1, Cardiovascular) "This is a well developed, well nourished patient who is awake, alert, and in no acute distress", " (John T. Mather Hospital Physician Documentation, Constitution Con’t., 1/14/13, page 2, Constitutional:) While Patient was Known to be off Prescribed Medications: Vicodin, Prednisone, Levothyroxine and Lopressor, Not Under my Care. "Unresponsive", (Mather Hospital Nursing Assessment, 2/9/13, page , under Coping,/Observed Emotional State. 2/10/13 09:00), "Non Verbal", (Mather Hospital Nursing Assessment, page 3 & 4, under Coping/ Verbalized Emotional State), "Semi Comatose" (Mather Hospital Nursing Assessment, page 7, Cognitive/Perceptual/Neuro under level of consciousness, 2/12/13) "Disoriented x 4" (Mather Hospital Nursing Assessment, page 7, Cognitive/Perception/Neuro under Orientation). "Deceased" within a month, ( Death Certificate 2/12/13). Remember it is the "End Which Unjustified the Means". The Center for Advocacy for the Rights and Interests of the Elderly (CARE), in solidarity, conferred the following statement to me, "We wish you luck and fortitude in advocating for the rights of older adults". "Those who fail to learn the lessons of history are doomed to repeat them". George Santayana