My mother died on June 23rd, 2004.
She was 85 and lived in St. Petersburg Florida.
In August of last year she complained that she was spitting up blood
and her own primary care doctor just said she "looked fine" and showed
her the door!
My mother was mentally VERY sharp and she wrote this doctor a scathing
letter about how he had ignored her. (I have a copy of it) She then
went to another doctor who also didn't run any tests on her to find
out why she was spitting up blood, but at least he prescribed some
things for her and she was SLIGHTLY more satisfied with his response
to her concerns.

Two months ago she went into the ER and was hospitalized for breathing
trouble. They treated her with duiretics and sent her home. On June
6th she returned to a different hospital having trouble swallowing and
breathing. After some biopsies it was determined she had two cancers,
lung and esophegeal. When she was at the previous hospital only two
months before they hadn't found anything diagnostically.

I am aware that my mother was "elderly" (although really she had been
a "young" 85). But that she was elderly, does that make it excusable
for those doctors to ignore her the way they did? I understand that
she was too old for "treatment" but she obviously had cancer for quite
awhile while everyone was "missing it". Didn't she had a right to
some diagnostic tests prior to the "emergency" situation? Particularly
because she was specifically asking? She went to doctors for years
for her breathing, does a great big cancerous mass in the lung just
appear overnight? (seriously, does it? I don't know!)

My final question involves her death certificate that I recieved
today. The reason for her death is given as "multiple, due to advanced
aging" (??????) She had two cancers, could not swallow or keep
anything down. What is the story on a death certificate? Isn't it
supposed to list the reasons, instead of this vague nothing reason?
Anyone could have seen that she died from the cancer. I was there. She
died from cancer, (well actually she never recovered from the "feeding
tube" procedure). Why is the doctor apparently reluctant to indicate
conclusive reasons on the death certificate?

Thank you very much for reading my post and offering your views. At
the very least I may want to complain about her treatment to someone.
(The hospital? The first doctor? the State of Florida?) But I would
like to hear your views first, however. Thanks again.

patti wrote:[a bit of medical history ending in a finding of cancer] I am aware that my mother was "elderly" (although really she had been a "young" 85). But that she was elderly, does that make it excusable for those doctors to ignore her the way they did? I understand that she was too old for "treatment" but she obviously had cancer for quite awhile while everyone was "missing it". Didn't she had a right to some diagnostic tests prior to the "emergency" situation? Particularly because she was specifically asking? She went to doctors for years for her breathing, does a great big cancerous mass in the lung just appear overnight? (seriously, does it? I don't know!)

All the above, as far as I can tell, are medical questions and need to be
directed to medical experts. My expertise in cancers are only lay and come
from very personal experiences that are are anything but expert. I did lose
a close three friends to very fast growing cancers which came apparently
from nowhere to overwhelm them - two almost instantly. That does not mean
that such occured with your mom. My final question involves her death certificate that I recieved today. The reason for her death is given as "multiple, due to advanced aging" (??????) She had two cancers, could not swallow or keep anything down. What is the story on a death certificate? Isn't it supposed to list the reasons, instead of this vague nothing reason? Anyone could have seen that she died from the cancer. I was there. She died from cancer, (well actually she never recovered from the "feeding tube" procedure). Why is the doctor apparently reluctant to indicate conclusive reasons on the death certificate?

The filling out of a death certificate is partly a legal and partly a
medical issue so is somewhat a suitable question for this forum, but sadly I
lack the expertise to answer specifically your question for Florida. I am
tackling your question here because I see you're distraught and to advise
you to see a local legal practioner in Florida who specializes in medical
malpractice. He'll advise you if your mom was treated reasonably given her
condition and age. You do realize that an 85 year old and a 40 year old do
have differing expectations of treatment so that needs to be factored in.
The lawyer can also advise you as to if the death certificate was filled out
properly. I think you'll find it was, but he'll assure you one way or the
other.
What I suggest you do is seek some neutral advice first and then, armed with
knowledge, make those queries to the hospital or wherever. A medical
malpractice attorney isn't really neutral, but if something is awry here,
he'll sniff it out. If he sniffs nothing, then it's a good indication,
there's nothing to be sniffed.

-paul
ianal

-----BEGIN PGP SIGNED MESSAGE-----
Hash: SHA1

pattimbergin@aol.com (patti) wrote in
news:umfle01u1tm7qrta7h8hqqc9irmh8od759@4ax.com:
Thank you very much for reading my post and offering your views. At the very least I may want to complain about her treatment to someone. (The hospital? The first doctor? the State of Florida?) But I would like to hear your views first, however. Thanks again.

Check with a local attorney. There are probably a few that would be
willing to do a free consultation on this and give you a much better
idea of what action is available to you. Make sure you have every
bit of documentation you can get your hands on before you set up the
consultation, though, as the more you have, the better your chances
of a favorable decision.

Not a lawyer
Joe Bramblett

-----BEGIN PGP SIGNATURE-----
Version: PGPfreeware 6.5.8 for non-commercial use <http://www.pgp.com>

iQA/AwUBQO5ji6auO3Snl+t6EQKSsgCgkqsxNy6KHTqmCWqNFV4uH+ pEljwAoPa8
asz8VE8NygIDO90poNwec1AQ
=Vlt+
-----END PGP SIGNATURE-----

patti <pattimbergin@aol.com> wrote:My mother died on June 23rd, 2004.She was 85 and lived in St. Petersburg Florida.In August of last year she complained that she was spitting up bloodand her own primary care doctor just said she "looked fine" and showedher the door!
[snip]I am aware that my mother was "elderly" (although really she had beena "young" 85). But that she was elderly, does that make it excusablefor those doctors to ignore her the way they did? I understand thatshe was too old for "treatment" but she obviously had cancer for quiteawhile while everyone was "missing it".

I sympathize with you (and your mother) over her PCP saying she
"looked fine" when she was "spitting up" (coughing? vomiting?) blood.
But the open question is whether your mother was damaged by the
doctor's failure to do anything about her undiagnosed cancer.

There's a big difference in treatment options for someone who is 85
vs. someone who is 40. A 40-year-old can usually tolerate extensive
surgery. So it makes sense to do diagnostic tests, and if the tests
indicate a problem, to go to exploratory surgery and, if necessary,
removal of any cancers found, and/or chemo- or radiation therapy.

Most 85-year-olds cannot tolerate that kind of regimen. Subjecting
your mother to such surgery would likely have made her die _sooner_.
Or she might have survived the surgery but died a few days or weeks
later from whatever treatment she was given. I think most ethical
doctors would not subject an 85-year-old woman to such a regimen of
treatment, because it would either hasten her death or cause her
unnecessary pain without providing her with significantly improved
lifespan or quality of life.

One of life's rules is never ask a question if you don't want to know
the answer. It applies to trial lawyers, but it also applies to doctors.
Why run diagnostic tests if you're not going to anything regardless of
what the tests show? If nothing else, the tests cost money that could
be used to pay for _useful_ treatments for somebody else and/or
palliative treatments for your mother. And most of the tests will be
painful, uncomfortable, and/or embarrassing or degrading.

Even something as simple as X-rays often require the patient to assume
an uncomfortable position and hold it for several minutes. And I
can't imagine anyone wanting to be subjected to, e.g., having a camera
threaded down their throat to look for stomach cancer, or up from the
other end to look for intestinal cancer. Mind you, I would do it if I
had indicative symptoms, but I'm 57 and in pretty good shape.

But I would _never_ subject my mother (82 years old) to such a test,
especially in view of her expressed desire to not be subjected to
surgical procedures unless they are necessary to relieve pain or
otherwise improve her quality of life.
--
I pledge allegiance to the Constitution of the United States of America, and
to the republic which it established, one nation from many peoples, promising
liberty and justice for all.
Feel free to use the above variant pledge in your own postings.

pattimbergin@aol.com (patti) wrote in message
news:<umfle01u1tm7qrta7h8hqqc9irmh8od759@4ax.com>... My mother died on June 23rd, 2004. She was 85 and lived in St. Petersburg Florida. In August of last year she complained that she was spitting up blood and her own primary care doctor just said she "looked fine" and showed her the door!... After some biopsies it was determined she had two cancers, lung and esophegeal. When she was at the previous hospital only two months before they hadn't found anything diagnostically.
[snip] My final question involves her death certificate that I recieved today. The reason for her death is given as "multiple, due to advanced aging" (??????) She had two cancers, could not swallow or keep anything down. What is the story on a death certificate?

Death certificates, at least the standard ones CDC recommends all
states use, have two parts: Part I describes the chain of causation
leading to death; Part II lists conditions found to be contributing
but not causal. There is a CDC handbook describing in great detail how
cause of death is to be listed; see
http://www.cdc.gov/nchs/data/misc/hb_cod.pdf if you're really
interested.

Part I entries are supposed to be quite specific: "multiple, due to
advanced aging" is far from specific, especially when there is much
that should have been on the record for her.

Whether cancer is a Part I or Part II entry would be a judgment call.
If the doctor believed that the cancer was not in the direct chain of
causes leading to her death, it would be in his discretion not to list
it in Part I, but it would be extraordinary not to list an advanced
cancer in Part II.
Isn't it supposed to list the reasons, instead of this vague nothing reason? Anyone could have seen that she died from the cancer. I was there. She died from cancer, (well actually she never recovered from the "feeding tube" procedure). Why is the doctor apparently reluctant to indicate conclusive reasons on the death certificate?

What you may think "anyone could have seen" may not be what the doctor
finds to be conclusive. While I don't like second-guessing doctors, it
would seem that if the cancer is nowhere mentioned, it does look like
he is concealing his (or his colleagues') previous failure to
diagnose. If you see a lawyer about pursuing a medical malpractice
case, this would certainly be one of the points to bring up.

--
Not a lawyer,

Chris Green

barry gold you wrote: One of life's rules is never ask a question if you don't want to know the answer. It applies to trial lawyers, but it also applies to doctors. Why run diagnostic tests if you're not going to anything regardless of what the tests show? If nothing else, the tests cost money that could be used to pay for _useful_ treatments for somebody else and/or palliative treatments for your mother. And most of the tests will be painful, uncomfortable, and/or embarrassing or degrading.


Well shoot Barry, if this is how it is, if a person is not "allowed"
tests due to advanced age shouldn't the doctors just flat out lean
over the desk and say something like "Bernice, your spitting up blood,
but you are 85 and therefore ready for the glue factory. I refuse to
run tests on you. The tests are uncomfortable and I am not even going
to ask you whether or not you want to opt for them."<---THAT would
have been "honest" (according to you) and then my mother would have
had some of the truth which she asked for and was denied. (She would
have then realized she was not even "worth" diagnosing!)

Your mother and my mother have differing views. My mother definately
would have gone for the tests. She asked for them. You wrote "never
ask a question if you don't want the answer". That's rich, because
it's what I am complaining about, my mother did ask the questions
because she did want the answers.

patti <pattimbergin@aol.com> wrote:Well shoot Barry, if this is how it is, if a person is not "allowed"tests due to advanced age shouldn't the doctors just flat out leanover the desk and say something like "Bernice, your spitting up blood,but you are 85 and therefore ready for the glue factory. I refuse torun tests on you. The tests are uncomfortable and I am not even goingto ask you whether or not you want to opt for them."<---THAT wouldhave been "honest" (according to you) and then my mother would havehad some of the truth which she asked for and was denied. (She wouldhave then realized she was not even "worth" diagnosing!)

Yes, it _would_ have been more honest. And the right thing to do.
Of course, it could have been phrased a _little_ more tactfully:

"Bernice, I could run tests and find out that you have cancer. But if
you do, the proper treatment would be extensive surgery lasting about
12 hours. I don't think your body can tolerate 12 hours of surgery,
so I don't see the point you going throught the test. At 85, your
affairs should already be in order. If they aren't, _put_ them in
order. I'll prescribe a course of antibiotics just in case you have
penumonia, but aside from that I don't see anything to be gained from
tests.
Your mother and my mother have differing views. My mother definatelywould have gone for the tests. She asked for them. You wrote "neverask a question if you don't want the answer". That's rich, becauseit's what I am complaining about, my mother did ask the questionsbecause she did want the answers.

Yes, but would the answer have done her any good?

Remember, this is misc._legal_.moderated. In order for you to
have a "case" against the doctor, you would have to show that the
failure to run the tests deprived your mother of something -- some
years (or perhaps even months) of life that she could have enjoyed.

If the answer is that any possible treatment would have made her
remaining life shorter and worse, she didn't have any "loss" to be
compensated for. And aren't we all better off if a doctor doesn't
order a sequence of expensive tests when all you're going to find out
is "I'm going to die of lung cancer" vs. "I'm going to die of viral
pneumonia"?

What is gained by running the tests, aside from satisfying her
curiosity?

Now, if she were paying for the tests herself, I'd say she was quite
within her rights to have them for that reason. But I don't see why a
third-party payor should cover them if they aren't going to do her any
"good" (from a legal point of view).
--
I pledge allegiance to the Constitution of the United States of America, and
to the republic which it established, one nation from many peoples, promising
liberty and justice for all.
Feel free to use the above variant pledge in your own postings.

On Thu, 15 Jul 2004 12:48:52 -0400, bgold@nyx.net (Barry Gold) wrote:
. . . .
Yes, but would the answer have done her any good?
Remember, this is misc._legal_.moderated. In order for you tohave a "case" against the doctor, you would have to show that thefailure to run the tests deprived your mother of something -- someyears (or perhaps even months) of life that she could have enjoyed.
. . . .

Along those lines, I refer OP to an Oregon Court of Appeals case from
a couple of years ago, Chouinard v. Health Ventures. The defendant
misread an MRI (IIRC) and missed the plaintiff's tumor. It was
discovered about 100 days later as a result of another exam. The
court affirmed a directed verdict for defendant, on the ground that
there was no evidence the tumor had appreciably grown.

Daniel Reitman