Response to Treatment - August 23, 1993

     As occurred both in the Emergency Room and with
Dr. Sagman, Dr. Collins also doubted the information I
gave him regarding Seth's misuse of the Xanax. His response
was to hold even the insufficient dose Dr. Sagman had
initiated. When Seth was found wandering deliriously in the
hallways, Dr. Collins was  finally aware that he was in 
benzodiazepine withdrawal.  Once again, the orders for
medication - Ativan 2mg q4hours - were totally inadequate
and therefore wrong. Also wrong was the accompanying order
to hold for sedation. In fact, deep sedation was exactly the
treatment desperately needed.

     I had been told by Dr. Sagman by phone that Seth was
to be transferred to a "special unit where he would be 
withdrawn."  There is an order from Dr. Berkowitz stating
that Seth was to be transferred.  Dr. Berkowitz left the 
hospital for the day without transferring Seth.  Dr. Berkowitz
was aware that Seth was delirious and therefore not responding
to the medication. He left no note for the night staff.

     Wrongly treated and monitored, Seth became increasingly
agitated over the course of the evening. It was in the early morning
hours of the next day that he was placed in restraints.

Click here for graph of Heart Rate
Click here for graph of Blood Pressure
Click here to return to Doctors Orders for August 23, 1993