hospital/emergency department visits and sundowners (patient assault)

Posted by trishcnwma @trishcnwma, May 17 1:55pm

My LO (sister) has increasingly severe sundowners /agitation). It begins between 3-4PM and runs through the night into early morning. Boston and suburban MA hospitals know what sundowners is but are not knowledgeable or prepared to manage patients that present with it.
My sister had another UTI and kidney stone this past week that resulted in 2 ED visits.
• First visit
~ 8 hours long (arrived mid-afternoon and got a room with PureWick for extreme incontinence quickly). Results from the abdomen CT / bloodwork took long enough, but waiting for a plan took ~2.5 hours (Urology was considering admitting her for a stent). As time wore on, she became more agitated and was screaming and trying to get out of bed. Staff were pretty rough with her and I finally said I would disconnect her and "discharge" her myself if they didn't come with a resolution. Doctor came soon after, said the stone was not actually in the urethra, and discharged with a UTI prescription.

• 2nd visit – 2 days ago
Same ED, 2 days later, for the same extreme abdomen/back pain. She saw her urologist that morning, who said the stone had passed, but it was after hours and the x-ray he ordered indicated there may be another stone.

LO brought to a room quickly but the pain was bad and she was agitated. The bed did not have the front lift function to prevent her from moving forward off the bed. I told the nurse this was bad and that she'd try to move. Soon after, she was clearly agitated and they tried to give her Valium and she spit it on the floor. They said they’d give her a different medication and did not OK Valium with me first (I would not have approved due to her gait issues/leg weakness) Soon after the nurse left, my LO started screaming and moving forward and grabbed me when I tried to stop her. I screamed "HELP" loudly and nobody came. I got loose, walked out of the room, and headed to the main waiting area to get our other sister (who was not allowed back with us, saying there was a 1-person limit).

While I was gone, hospital staff (a big burly guy) repeatedly forced her down (her words; she remembered details after we returned home) and I don't know if they gave her medication (doctor told me they didn't but she was completely subdued when I returned to the room ~ 10 minutes after leaving). We can identify the staffer who abused her since he was in the main waiting area. My other sister and I talked to him about 2 of us being in our LO’s room. When he couldn’t get anyone on the phone, he went back into the ED rooms to find someone and confirm that it was okay for 2 family members to be present.

LO was injured badly injured by the staffer, with bruising on her chest, neck, and both arms. She cannot lift her left arm and cries and complains of pain when trying to get up (extreme incontinence requires frequent toilet visits). I’m taking her to urgent care for an x-ray.

My questions about this experience:
- Is this considered elderly abuse?
- Will this be considered she said/he said since I was not present to observe the abuse?
- I always discuss her dementia, sundowners, agitation during triage. Do I have any other responsibility related to this or for leaving briefly?
- This is by far the best hospital in the area (and generally our favorite; we avoid the closest one due to prior issues with medical care). If I report this, do I risk her not being allowed back?

Thanks for all feedback.

Interested in more discussions like this? Go to the Caregivers: Dementia Support Group.

Profile picture for tdrell @tdrell

@ocdogmom could you send me the form please!!
Thanks

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@tdrell Please send me your email address in a direct message. The file is too big to attach here.

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Profile picture for diverdown1 @diverdown1

I would call the HR department at the hospital and explain what occurred. Also, you can reach out to your state's Dept of Aging and Disability, inquire as to if this reaches the level of elder abuse. I am sorry you and OL had to go through that.

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@diverdown1 Thank you. I called Patient Relations a couple of times and followed up with a lengthy description of the incident. The first call was made from my local Council On Aging office where I’d gone to discuss the situation with the outreach coordinator. She was very helpful.
I believe the assault was an unusual experience- as I said in my letter to Patient Relations. I stressed that I was writing to make them aware of the situation and to ensure that it never happens to my LO or anyone else in the future.

My LO is once again at the same hospital and the experience has been excellent (though they’re still trying to find the source of her pain). The Patient Relations office is accessible and I plan to stop by to speak to them in person.

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Profile picture for jeanadair123 @jeanadair123

A few weeks ago my husband went to ER and had to spend the night, having dementia they said he would probably have sun downers which personally I had never noticed. During the afternoon he tried to take out his IV, he already took off his blood pressure and oxygen which was not a big deal. I left for an hour and when I came back he was restrained and had a camera in his room because he kept trying to take the IV out and he had a heart monitor on. I was horrified he kept saying to me please take it off, he finally got it off the nurses came running and put it back on with him fighting the whole way, he said to them don’t do that what did I ever do to you? I was heart broken and finally asked if they could give him some medication which they did. I then went home for a couple of hours and called the hospital every hour. The nurses said he had calmed down and was going to the bathroom every two hours I am sure he figured that out? When I arrived at 6am the restraints were off. I felt they were very aggressive and NEVER will I ever allow that to happen again. The thing was the next day the doctor felt it was not wise to give him the stress test so we didn’t even have to stay overnight. I am eternally thankful that he didn’t remember this. I forgot to mention the awful bruising on his wrists.

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@jeanadair123 I’m so sorry for your experience. The night my LO was assaulted, I had forgotten what medication had been used to calm her during prior ED visits and the staff apparently didn’t bother to check. The medicine that calms her is Ativan …now I’ll never forget it.

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Thank you, I will definitely write that down.

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Update: I heard back from the head of the hospital’s patient relations department. They’re doing a full investigation, which they said can take 30 days or more. At the end of the investigation, they’ll follow up with the results. I did not share pictures of the bruises with my letter but intend to do that so they can see the physical evidence of the assault.
I’m hoping for a good outcome.

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