Response to Treatment - August 24, 1993

     Seth's delirium was not ended by deeply sedating him
(either with phenobarbital or high doses of benzodiazepines)
as called for in the humane Standard of Care   ___bookmark.
The predictable result followed.  Around 1:30am his agitation
increased uncontrollably and he was given a shot of Haldol. 
Rather than sedating Seth, the medication reacted paradoxically
and he attempted to jump out of the window. The Least 
Restrictive form of care, i.e, deep sedation, was not used to 
alleviate Seth's suffering. Instead, guards were called and Seth
was tied down to the bed in restraints.

     In spite of the fact that Seth had been in restraints for over 
7 hours, when Dr. Collins visited him in the morning he still did
not increase the Ativan order to a point that would cause sedation
and an alleviation of suffering.  He also recommended continuing
the restraints in spite of the fact that there was a simple alternative,
i.e, deep sedation. Seth's pressure and pulse were abnormal, he
was restrained and struggling, yet nothing was done.  I was not
called and there was no senior staff supervisor who knew how 
Seth should have been treated.  Dr. Berkowitz, the intern
responsible for his care, and the one who failed to transfer Seth the  
previous afternoon to a "special unit where he would be withdrawn"
(in Dr. Sagman's words to me),  watched Seth's agony worsen.
This was a callous, wanton, and reckless disregard of our son's life.

     The treatment perception of this unsupervised staff seems to have
been that effective treatment was needed only at the point that death
was approaching.  By 12:40pm, this was clearly the case, 
Seth was eventually transferred to the ICU.

     The Senior trainee in the ICU, Dr. Birch, did know that Seth
had to be sedated. However, the intern Dr. Mayer, who was 
obviously unsupervised and unmonitored in her actions, did not
follow his recommendation. 

     A review of the doses of 2mg Ativan intravenously given over the
initial hours in the ICU by Dr. Mayer  (click on Order Sheet in
Doctor's Orders for August 24, 1993), reveal that while the doses were
sufficient to at least prevent his heart from stopping, they were not 
sufficient in stopping his agitation and delirium. Seth was cruelly tied
up in 5 point restraints,  continuously.

     Finally, at 10:45pm, around 9 hours after he first arrived in the ICU,
a dose of 6mg Ativan IV was given which did sedate Seth. He was
reported to be asleep at midnight. 

Click here for graph of Heart Rate
Click here for graph of Blood Pressure
Click here to return to Doctors Orders for August 24, 1993