Oregon's dying have few rights... Oregon's dead have few voices!

Evelyn L. Moreno was diagnosed with abdominal cancer at Kaiser Permanente Sunnyside Hospital; the late part of November 2002.

Evelyn wanted to have as much time possible with her grandchildren and family.She exercised her right, requesting that she be "full code" status. The term "full code" means that the patient wishes full resuscitation. This story is about Evelyn's fight to go home to die, and her abandonment. Evelyn was on IV pain medication while in Kaiser Permanente Sunnyside Hospital. Evelyn was released to go home by ambulance. The home care Nurse was afraid of jeopardizing her Nursing License - ignored the Doctors written orders for Morphine to be given at specified times. The Nurse refused to treat Evelyn or instruct family in medications as it had been arranged before they left the hospital. Evelyn made her decision about going home, based on the help and care that Salem Hospital - Regional Home Care Services was to provide. During the last five years, Evelyn was hospitalized several times with serious COPD exacerbations. This breathing disease was life threatening. When the outlook did not look good, Evelyn always chose life. Evelyn fought her way back many times to self sufficiency, driving a car, shopping, and a meaningful life with her family.

This time it was different. Evelyn wanted to go home; to her own apartment. Evelyn knew she was dying. Kaiser Doctors and local hospice would not allow this because of her wanting to be a "full code". In December, she was told more than three times by Kaiser Doctors that she could go home. Then was told at the last moment that she could not go unless she changed her mind regarding her "no code" directive. Evelyn cried after each disappointment. Evelyn wanted help breathing from a ventilator when that time came. Evelyn was not afraid of that breathing aid, having been on it several times. Evelyn was trying to exercise rights that was being taken from her.


Trying desperately to hang on to life as long as possible. Evelyn carefully, and lovingly placed her fallen grey hair from the chemotherapy, into three separate envelopes for her grandchildren, and her son.

Her son Patrick, took issue with the Kaiser Doctors, about not granting his mothers wishes. He said, "She has a right to "full code" status, if that is what she wants. Do you want her to change her religion too; to be aloud to go home?".

• Dr. Sean Jones, Evelyn's primary Kaiser care physician agreed to take over her care, and granted her wishes. Along with Dr. Wendy Meyers they made plans through Kaiser's Health coordinator, Sheila Mackey, RN and Salem Hospital - Regional Home Care Services to send Evelyn home.



• Salem Hospital - Regional Home Care Services is under contract with Kaiser Permanente offering service to Kaiser patients. Contacts were made by telephone, and Kaiser sent Salem Hospital - Regional Home Care Services all Doctor's orders by fax. They agree to take Evelyn as a patient in their Home Health Program.



• Evelyn Moreno had a continuing relationship with Salem Hospital - Regional Home Care Services; with the same level of expectation regarding her care. On more than three occasions during the last five years Kaiser had used them when Evelyn was released from the hospital with COPD that had been in the end terminal stages.



• Evelyn's most recent care from Salem Hospital - Regional Home Care Services, before December 30, 2002 was June 2002. They assisted with the administration of her IV Push medication while at home; the drug Cofazolin, 1 line per 15 sec. in a PICC line. Salem Home Hospital Regional Home Care Services was caring for her while on IV therapy.



• On December 30, 2002 - The unimaginable happened. Evelyn Moreno was sent home at her request from Kaiser Permanente Sunnyside. Evelyn was going home to die. Her "full code" wishes still intact. Arrangements had been made for Angella Estrada, RN from Salem Hospital - Regional Home Care Services to be there at 3:30PM when Evelyn's ambulance arrived from the hospital. Angella was to instruct Patrick Hobbs in the administration of medications, and care for his mother. Angella did not show up until late in the evening, and refused all instruction and care for Evelyn Moreno. Angella did not do anything that was written in the Doctor's orders for the care of Evelyn Moreno. Did Angella "do" anything?
  
  This is a question that needs to be answered.
  
  Angella did not check Evelyn's blood sugar. Evelyn was an insulin-dependent diabetic. Evelyn's nutritional TPN cad pump went unchecked, N/G gastro intestinal tubing and pump had to be set up by Patrick Hobbs. The Nurse did not check the connections, to make sure everything that was put together in her absence was put done correctly. Patrick had no choice, gastric juices were building up from the bowel obstruction. When the nurse did not show up, he figured out how to assemble that piece of equipment.
  
  The only thing Angella Estrada, RN did for Evelyn, was to get a catheter size. Evelyn was using IV push pain medication because her bowel obstruction made oral medications useless, and her COPD made a Morphine pump difficult.



• Angella Estrada said that she would not teach Patrick how to administer his mother's pain medication, the IV Push Morphine, and IV Push injection of Ativan. Stating that if something went wrong, her nursing license could be in jeopardy. It was explained to Angella that Evelyn had been on 2 MG Morphine for several weeks, and had not received her medication since 1:45PM. It was late in the evening, Angella was asked by Patrick to give the Doctor ordered medications herself, or call Kaiser get help. Angella was told that Evelyn Moreno was in pain now. Angella Estrada, RN patted Evelyn's leg and said, "Sorry sweetie, I wish I could help you - but I can't". Angella went to her car to call her Supervisor. Before she left, she told Evelyn and Patrick to call "911" if you have too.
  
  Angella should have made arrangements for the care of her patient, if she was unwilling to do the job. Not just walk out. She should have called "911" herself, or made sure someone was going to give the care and instruction that she was refusing to give. This was abandonment!



• Evelyn became scared and asked Patrick to help her. Evelyn was having a fear induced anxiety attack, Evelyn knew she was all alone without help. This further compromised her condition. Evelyn had placed all of her trust in her son, Patrick and Salem Hospital - Regional Home Care Services.



• Patrick called all over trying to get help. April Petz, RN from Kaiser was reached by telephone. Patrick received telephone instructions and tried to fill a carpujet morphine cartridge unit. It started leaking all over, then decided to try ativan. He was told how to push air into the vial, draw out .25 cc of Ativan and mix it with .25 cc of Saline; together with a 5cc Saline flush for the PICC line. The cell phone dropped out; but the Patrick continued and finished the injection. He called the nurse back right away. Evelyn seemed to relax slightly.



• Patrick talked to the Charge Nurse at Kaiser Permanente, to see if anyone would come out and finish the medication instructions. No one was able or willing. Evelyn's Oxygen stats started dropping. Her Bi-pap breathing mask was placed on her by the son. Evelyn's was breathing fast. He called "991".


This is Patrick Hobbs, Evelyn Moreno is my mother. I was there in that apartment with my two children, doing all of the above, to the best of my abilities.

My mom was afraid, and she saw the fear in my face. I was prepared to learn what needed to be done, to take care of my mother to the end. We were both told the "Home health Care" was in place before we ever left the hospital.

My mother trusted me to take care of her. When her oxygen levels started dropping before I called "911" - I saw through the clear Bi-pap mask my mom was saying to me , "help me, help me, help me". We were abandon by the health professionals that we trusted. I should not feel any guilt. However, I certainly do feel that weight, and perhaps I will for a long time. Her rights were violated! She had the right to go home to die; and to do so with no pain.

The paramedics arrived. I told them about the pain and anxiety medication being overdue and the refusal of the Nurse to follow the Doctors instructions. The paramedic picked up and read the same Doctors orders. He called McMinnville Hospital, and Kaiser Sunnyside. My mother was not conscious. The paramedic gave my mother 2 MG Morphine IV carpujet injection in her PICC line. They tried to make her stable, they could not. She was retaining Co2. Her levels were 120 by the time she reached McMinnville Hospital.
My mom died at 5:11AM

Please help us: Oregon's dying have rights too. The State of Oregon Department of Human Services - Health Care Licensure and Certification Section, has complete an investigation. Kaiser Permanente was cited by the State of Oregon. Salem Hospital - Regional Home Care Services has a fiduciary responsibility to it's patients. We must look at their records - and conclude that nothing was done to care for Evelyn Moreno.



Kaiser Permanente (audio)


Evelyn's Last Phone Call (audio)
Salem Hospital - Regional Home Care Services
Doctor's Orders
Medication Requests
Video

Please help us, write:
Gov. Ted Kulongoski, Office of the Governor State Capitol, Room 160 900 Court Street NE Salem, OR 97301-4047
Regarding: Evelyn L. Moreno - Rights Issue.


This is not a story from of a grieving son, as some would say. It is a story of professionals outside of their comfort zone; a story of one lady's rights that were taken away... when she was most defenseless.

You have heard about Oregon's assisted suicide law. What about the rights of those who choose to hang on to life as long as they can; with dignity and choice. This is Evelyn L. Moreno's story. Please be her voice.


News media release - Media use rights are granted.
Proctected by Copyright, First Amendment, and Fair Use Laws.
Copyright (c) 2003, Patrick Hobbs.



Contact us at patrickhobbs@hotmail.com