I insisted that a doctor see her again: The effects of dehydration

Myra Fournier's story:

My mom went through a rather "interesting" few days.

She was in the hospital overnight on Thursday for transient ischemic attack (TIA) symptoms, discharged on Friday, and doing VERY well Saturday morning.

At 4:00 on Sat, Guy called me to say that he and the aide can't really rouse her. They were all set to go out after lunch, and then just got weak, couldn't walk, and had to be carried to bed. The nurse checked her out and vitals were fine. She slept all afternoon, but by 4:00 they got more concerned. By the time I got over there around 5 pm, she had a severe headache, slurred speech, and a weak left side.

We called an ambulance and when she got to the ER, I suggested they start an IV of fluids. They disagreed. Instead they did a CAT scan and an EKG. Both normal. They gave her a Tylenol for her headache, which did nothing. By 10 pm she was screaming in pain, confused, and agitated and they gave her a shot of morphine. By the time the needle left her arm, she was sound asleep and peaceful. She was admitted to a room after midnight and had a pretty good sleep. I once again suggested an IV of fluids, but the nurse did not think that mom was dehydrated.

On Sunday they did an MRA (as opposed to an MRI) and an EEG (I think) and both were negative for stroke and seizure. They did labs and ruled out infection. They decided to cut back on her blood pressure meds because her blood pressure was also low.

I went home on Sunday around noon while Guy stayed for the afternoon and we had a private aide for overnight. On Monday morning, the aide reported that mom had a terrible night, did not sleep, and the headache was back. When I got there around 10:30, her speech was slurred and she was listing over to the left. A hospitalist came and decided to order an IV of fluids. I waited with her all afternoon, and she fell sound asleep - so deeply that once again she could not be roused: not by yelling at her, rubbing her arm, or pounding on her chest. However, the IV never came and the nurses and PT just thought she was having a "sleepy" day. Ridiculous.

By 5:00 pm I INSISTED that a doctor see her again and that the IV be started immediately. They started the drip at 5:30 and at 5:40 her eyes fluttered open and she started to revive. They ran the drip all night long - I slept over again - and by this morning she was bright, perky, and not (TOO) confused. Speech and strength on both sides were normal. Headache gone. She walked with her walker and held court with the various staff members!

I took her home at 2:30 and when I left at 4:00, she was busy making dinner plans with friends for THIS EVENING and trying to decide on what kind of little celebration she should have for her upcoming birthday. I asked her if she wanted to nap and she was not a bit sleepy.

I was REALLY stunned that dehydration (plus, low blood pressure probably) could cause these kind of severe complications. I hope she was frightened enough to keep to a healthy eating and drinking regimen. I instituted around-the-clock care again until at least the weekend to get her back on her feet (literally).

Advice to patient advocates: Stay on guard about the indirect effects of dehydration on elderly patients.

Read another story about dehydration. Thanks to patient advocate Myra Fournier for the story.

Her nursing home wouldn't call an ambulance: Arbitration to pre-empt lawsuits

Mary Hight had moved into a nursing home when she reached her late 80s, in 2002. She was diagnosed in 2003 with congestive heart failure, though she was otherwise in good health and continued to vacation with her family, according to her son. "Mom, at 90, would be on the beach in sunglasses and a bathing suit," he says.

But in 2004, when the 92-year-old woman fell ill for days and became badly dehydrated, her nursing home in Kosciusko, Mississippi, wouldn't call an ambulance, despite her daughter's urging. Instead of seriously assessing the situation, nursing home staff engaged in a diatribe with Mary's daughter Janice about the costs of an ambulance. Her daughter, Janice Cowart, pushed her mother uphill in a wheelchair to a nearby emergency room. But her mother died from heart failure the next day.

The family was surprised to realize that when her mother had entered the nursing home, Janice had accepted a nursing home contract requiring binding arbitration to resolve disputes. The arbitrator found the home was negligent both in allowing Mary to become dehydrated and failing to get her to an emergency room. But he awarded only $90,000 to the family, saying an underlying condition could have caused Mary's death. He chose not to award punitive damages. After paying the lawyers, "we didn't get one cent," said Mary's son. The nursing home has denied wrongdoing, and has declined to comment.

The nursing home industry's arbitration strategy is part of a much broader response by U.S. companies to consumer lawsuits. Nursing homes have been among the biggest converts to the practice since a wave of big jury awards in the late 1990s.

The American Arbitration Association – the biggest arbitrator – frowns on agreements requiring arbitration in disputes over nursing home care and generally refuses such cases. The American Health Lawyers Association also avoids them.

Advice to adult children looking for a nursing home for frail parents: Question admissions personnel closely. If an arbitration agreement is mandatory, write on the contract that you're being given no choice. Write, "I'm signing this because I was told I have to."

Browse for related stories in the index at the very bottom of this page, or read a nursing home story.

Thanks to Nathan Koppel for the source article in the April 11 issue of the Wall Street Journal.