What was the medical cause of Jesus's death?

Petitioning secondary cause of death on certificate

• My mother was diagnosed with Non-Hodgkins Lymphoma in August, 2004. She underwent a bone marrow test to see if the cancer had spread to her marrow. It hadn't, but after the test, she complained of extreme pain where they had drawn the sample. I later read persistent pain at the test site was not normal and a sign of infection. I'm not sure if she only complained to my dad and me, or also to her doctor. A week after her first and only round of chemo, her neck tumours had visibly shrunk to almost nothing, but she was not able to eat and, thinking her too lethargic, her GP had her check into the hospital for observation. After a night's sleep in a regular room, she had a kind of seizure due to a massive infection with a hospital superbug, resistent pseudomonas aeruginosa, and was taken to ICU. The infection started around her lower organs, where they had done the bone marrow test, and she went into septic shock. (For her chemo, they didn't give her any kind of medicine to up her WBCs. Her WBCs had gone down to 0.) They put her on a ton of sedatives, and other medicines, of course. I kept telling them she was extremely sensitive to medicine and that in Illinois, her doctor had always given her tiny doses. They didn't listen to me. After shutting down, her organs amazingly started working again and she came out of a week long coma (I'm not sure how much of it was because of the sedation), and things were looking up, but she couldn't regain her strength enough for the doctors to feel comfortable removing the ventilator. One reason she didn't get stronger was that each time she started getting stronger, some doctor, who'd never seen her before, would say he needed to perform some diagnostic test to see why she was so weak. These tests always wiped her out, and always came back negative. I was with her all the time, while the doctors and nurses came and went, and I saw this happening. I really think if they had just let her alone for at least one week, she would have recovered enough to at least leave the ICU. Anyway, after 29 days, she was still on the ventilator, though her breathing had been at times strong enough to go without it. She was breathing strongly at the end. Physically, they said she was doing great -- her edema was gone, her jaundice gone. But, she'd been lying on that cot for 29 days. (Near the beginning, during a BP drop, one night nurse had told me I should think about my mother and let her die, but then when I asked her GP, he said that was nonsense, and my mother did come back from the BP drop and her BP eventually stabilized. Then another doctor in passing in the lobby brusquely told my dad and me we should consider end of life issues before he said he had to go. We'd only seen him once before. Then the cancer doctor said my mom was making a miraculous recovery.) Psychologically, I think she decided to die when she heard they were moving her to the telemetry room for more tests. She had a massive brain hemmorhage the morning of the scheduled move and they told us we should pull life support so we did, and she died. The death certificate lists brain hemmorhage as primary cause of death, and cancer as secondary cause of death. No one talked to us about this -- once she died, I never heard a word from the doctors as to what happened. I left messages, and no one called me back. To me, it's clear that the bacterial infection killed her -- it should at least be listed as the secondary cause. Sorry for going on so long, but my friend said one can petition to have the certificate changed to reflect reality. Does anyone here know what that involves? Who do I petition and what sort of process is it? I'm not going to sue anyone, but I've found that I can't let this go. I feel like I'm letting them get away with a lie. (If they don't list pseudomonas aeruginosa as a cause, then how many other cases do they mislabel and then what are their statistics worth?) Thanks very much.

• Answer:

  Hello again, Kella, Your mother's case is one I have seen several times before. It should not be difficult to get the death certificate changed, if the doctor is willing to do so. If not, you have further recourses. I called Vital Records for Los Angeles County, at 213-240-8374, and briefly relayed your story. The person I spoke with was surprised that the sepsis was not mentioned at least as an underlying cause. The very nice woman I spoke to (Whose name I did not get)said that you need to start with your mother?s primary physician first. S/he is the one to amend the death certificate. If the doctor refuses, your next step is to call the pathologist who performed an autopsy, if one was performed. If no autopsy was performed, and the primary care physician will not amend the certificate, call the medical examiner?s office. I have also posted other offices who deal with death certificates, further down in the answer, who may be helpful. I could do no more, as the office wanted your mother?s information, and that I could not supply. County of Los Angeles-Department of Coroner Program Office of Chief Medical Examiner-Coroner 1104 North Mission Road Los Angeles, CA 90033-1578 If you find no satisfaction there, the office of Vital Records told me your next step is to find a lawyer who will help you get the certificate changed. Sometimes a simple call from a lawyer to an unwilling doctor will do the trick! About Death Certificates: ========================= On Page 17, of this CDC document on preparing death certificates, you will read that infection (sepsis) may be too vague to post on a certificate. ?The cause-of-death section is designed to elicit the opinion of the medical certifier. Causes of death on the death certificate represent a medical opinion that might vary among individual physicians. A properly completed cause-of-death section provides an etiologic explanation of the order, type, and association of events resulting in death. The initial condition that starts the etiologic sequence is specific if it does not leave any doubt as to why it developed. For example, sepsis is not specific because a number of different conditions may have resulted in sepsis, whereas human immunodeficiency virus syndrome is specific.? ?When a number of conditions resulted in death, the physician should choose the single sequence that, in his or her opinion, best describes the process leading to death, and place any other pertinent conditions in Part II. ??Multiple system failure?? could be included in Part II, but the systems need to be specified to ensure that the information is captured.? However, on Page 39, you will notice that ?sepsis? and ?septic shock? are listed as terms used on death certificates. This may help you in at least getting the sepsis (infection) listed on the certificates as to what started the chain of events. http://www.cdc.gov/nchs/data/misc/hb_cod.pdf On Pages 28 and 29, you will see a case history of a woman who died of Pseudomona aeurginosa infection (sepsis), and which IS listed on the death certificate. http://www.cdc.gov/nchs/data/misc/hb_cod.pdf From the CDC, here is a standard US death certificate. Notice that there are spaces to enter the underlying cause of death, as well as the actual cause of death. ?The cause-of-death section consists of two parts. Part I is for reporting a chain of events leading directly to death, with the immediate cause of death (the final disease, injury, or complication directly causing death) on line a and the underlying cause of death (the disease or injury that initiated the chain of events that led directly and inevitably to death) on the lowest used line. Part II is for reporting all other significant diseases, conditions, or injuries that contributed to death but which did not result in the underlying cause of death given in Part I. The cause-of-death information should be YOUR best medical OPINION. A condition can be listed as ?probable? even if it has not been definitively diagnosed.? http://www.cdc.gov/nchs/data/dvs/DEATH11-03final-ACC.pdf The National Association for Public Health Statistics and Information Systems (NAPHSIS) ?The National Association for Public Health Statistics and Information Systems (NAPHSIS) is a national association of state vital records and public health statistics offices which is based in the Washington, DC area. The association was formed in 1933 to provide a forum for the study, discussion, and solution of problems related to these programs in the respective members' health departments.? http://www.naphsis.org/about/index.asp According to NAPHSIS: ?The causal chain should begin with the cause that was closest to the time of death and work backwards to the initiating condition which is called the underlying cause of death. For example, the physician might report a death for which staphylococcus pneumonia occurs closest to the time of death; however the physician also reports that the pneumonia is due to carcinoma metastatic to both lungs, which in turn, is due to poorly differentiated adenocarcinoma, unknown primary site.? http://www.naphsis.org/projects/index.asp?bid=409 The following statement came from a Vanderbilt University, in Tennessee, but it should apply to California as well.:? Death certificates are legal documents. Do not attempt to change a death certificate, especially if there are questionable circumstances, without notification and discussion with the medical examiner's office. If a change is requested (for example, by the family), the attending physician should be notified immediately? Amending a death certificate: ============================= You may get some help from Alan Oppenheim (916-324-1100) or Jessica McCarroll (916-322-5179), who work for the automated vital statistics system. http://www.avss.ucsb.edu/tag/tag0601.htm Michael Rodrian State Registrar and Chief Center for Health Statistics [email protected] http://www.drbecky.com/birthcert.html Here is the contact information for the death records section, of L.A. County, CA. Branch addresses are also on this site for in-person visits. Birth, Death and Marriage Records Section P.O. Box 53120 Los Angeles, CA 90053-0120 Certificate Information.....................(562) 462-2137 http://lavote.net/recorder/birth_death.htm Request for certificates http://lavote.net/recorder/infoSheet.htm The county health officer may be able to assist you as well: Jonathan Fielding, M.D. 313 North Figueroa Street Los Angeles, CA 90012 [email protected] Office (213) 240-8117 FAX (213) 975-1273 Belinda Towns (Acting) Medical Director, Public Health 313 N. Figueroa St., Room 806 Los Angeles, CA 90012 [email protected] Office (213) 250-8685 FAX (213) 481-9853 http://www.dhs.ca.gov/hisp/chs/OVR/LocalRegistrar/CountyReg2.htm#Los%20Angeles Bone Marrow Biopsy ================== While complications from bone marrow biopsies do occur, they are rare. A bone infection is called osteomyelitis. Hopsital acquired infections are far more common in cancer patients, as the have such lowered immunity. You mentioned your mother?s white blood cell count (WBC) had gone down to zero! This made her highly susceptible to infections that lurk in the hospital, especially an opportunistic organism as P. aeruginosa. I can?t say with certitude, but your mom?s infection likely came from another source, and not the bone marrow biopsy. You can see the procedure outlined on this page. (You may have to sign up for free registration to view this page.) http://www.emedicine.com/med/topic2971.htm According to Textbook of Bacteriology, P. aeruginosa is an evil attacker of cancer patients: ?It causes urinary tract infections, respiratory system infections, dermatitis, soft tissue infections, bacteremia, bone and joint infections, gastrointestinal infections and a variety of systemic infections, particularly in patients with severe burns and in cancer and AIDS patients who are immunosuppressed. Pseudomonas aeruginosa infection is a serious problem in patients hospitalized with cancer, cystic fibrosis, and burns. The case fatality rate in these patients is 50 percent.? http://textbookofbacteriology.net/pseudomonas.html Osteomyelitis: Symptoms: · A general feeling of illness (malaise). · Fever, chills, and sweating. · Deep bone pain. · Pain that is worse when pressing on the infected area or when standing. · Swollen and red skin (sometimes) over the affected bone. · Drainage of pus from the wound. ?Antibiotic treatment is necessary to prevent destruction of bone tissue. If the osteomyelitis is severe, surgery may be required.? http://my.webmd.com/hw/health_guide_atoz/sto167507.asp?navbar=hw200221 Good luck in your quest to change the certificate. Your mother?s experience is not untypical of managed health care in the US. Stand though, that even if tests came back negative, tests have to be run on very ill patients, to assess their condition. A negative test can help doctor?s rule out something, allowing them to focus on the real problem. Tests such as blood cultures, that are drawn often on septic patients, need to be drawn frequently. Some will come back negative, and some can reveal a bacteria that is causing a fever. Most tests ordered are very useful, and serve a purpose. I truly understand your feeling that many tests seem unnecessary and may have caused pain and anxiety in your mother. The fact that the doctors did not call you back is inexcusable though. You have a right to lodge a complaint, if you like. (You might want to wait until after the death certificate is amended!) You can also call the hospital patient advocate services and tell them about your experience at the hospital, along with the doctor's names. SOmeone will then look into it. Contact for information about filing a complaint: Jonathan Fielding, M.D. 313 North Figueroa Street Los Angeles, CA 90012 [email protected] Office (213) 240-8117 FAX (213) 975-1273 I?m sorry you and your mother had to endure such an illness and the subsequent treatment. Wishing you the best! If any part of my answer is unclear, please request an Answer Clarification, before rating, and I will be happy to respond. Sincerely, Crabcakes Search Terms ============= Los Angeles + death certificates + changing cause of death Los Angeles + amending death certificates LA county medical examiner Pseudomonas aeruginosa + nosocomial infections