Head injury, Haldol, catheter, restraints?

[DeeTribeste]

Hi All Nurses, I am not a nurse but I was a patient for a year and a half and got to know a lot of very fine nurses. This is about my mother, who was an RN in NYC a long time ago. (She even worked in the psych ward at Bellvue, but doesn't talk about it except to say it was dangerous.) My early career was in academia, teaching psychology with a specialty in social aspects of old age (which is relevant here). This is very long, so proceed at your own risk.

So, my mother is over 80, and she fell and hit her head one morning recently. She seemed out of it, and had a cut in her scalp. A neurotic sibling called paramedics from another state without asking if my dad thought it was necessary. He let them take her, and followed. They have to take everyone to the emergency room at a well-regarded university's hospital, where she had never been, so that's where she went.

At the hospital, they did xrays, and her skull was fine, and they closed a small laceration (that wasn't bleeding) with a few dissolving sutures. She couldn't state her birthday or what city she was in, so they admitted her for observation. I can't help but think the hospital did everything wrong from then on, but I can't square that with the university's reputation. I also think she would have known the city if asked at home, and wish they'd known that she normally can't remember her birthday. She doesn't have dementia, but she hates birthdays (except Chistmas). It's a running joke. We don't celebrate them. She can talk about Obama, Putin, Bush, the drug war, GMOS and animal welfare. Just don't ask her her birthday.

First, they tried to make her eat, but she wasn't hungry. Somehow that turned into her getting incredibly agitated and them injecting haloperidol. From what I can tell on pubmed, that's a really bad idea after a head injury, and in general. One dose might be okay, but basically it prevents the brain from healing. I asked her why they did that, and she said "They do it to punish us." My mom was a very self-possesed, intelligent, funny person. To hear her say that was very difficult. Despite my thoughts on the usefulness of the orientation questions, the agitation means something WAS wrong with her brain. She's so well-mannered that I have never seen her annoyed with anyone other than me and my dad. One possibility is that she had been given a benzo or painkiller and had an adverse reaction, but she doesn't think so.

The news of the haloperidol was relayed to me by my sister, who got it from my dad, around noon. I was THAT FAMILY MEMBER who phoned the nursing station and told them NOT to do it again. I knew personally of an adverse reaction in a young person who killed himself a few months after some injections. I think it was unrelenting akathisia. It can cause delirium, too, as you all know. I knew also about the FDA box warning for the elderly with dementia and psychosis. It's not that she was demented or psychotic, but all bets are off at her age, and she was acting sort of demented and psychotic, so the wise thing would have been to back off. (She's all of 5'2" and 110 pounds.) On a hunch, I looked it up later and found out about its harmful effects after head injury. Just wrong. But why would they want someone with a fresh concussion and disorientation to eat right away?

She let out more of the story every few days. Of course, because she was drugged up, things didn't go well. Had she not been, she might have had the sense to get out of there. For some reason, they held her down and inserted a bladder catheter against her will. She says she was yelling and screaming for help, believing that it was just a rogue crew of psychos doing it, and decent nurses would rescue her. No one did. How could there possibly be a need for that? Before the ordeal, she walked a mile a day -really- and was on no medications whatsover.

Then, they put restraint mitts on her at night. This was incredibly upsetting to her. She said she tried to get them off. The thought of my mother in that position puts me in rage or grief everytime it comes to mind. Recall that she was there for no reason. Her husband is alive and well, so she could have been at home being observed by him, right? They live two miles from the hospital.

She got no further testing. No one was interested in why she fell. No neurologist visited her. From what I have since read, Amantadine, Ritalin, and a few other drugs are sometimes given short-term after head injuries to aid in recovery. Nothing was done diagnostically or therapeutically, but I think she has PTSD from what WAS done. 48 hours of feeling like you're in Guantanamo is a long time. I'm not doing too well, either.

When she got home, her ankles were swollen, and her big toe on one foot was inflamed and itchy. She has never had either of those before.

Come to find out the hospital has an appalling safety record. The worst in the county for immediate jeopardy, with twice as many penalties as the second worst, which has more beds. Second highest for administrative penalties. The first highest got theirs in three different years, with one very bad year, and hasn't had any since 2011. This place has had them in five years and got one in 2012 and one in 2015. They have the highest rate of UTIs and second highest for the other kind of infection (main line?). Dinged in 2011 for use of restraints, but the Chief Nursing Officer still likes them better than room sitters, according to a union newsletter. The news letter quoted a nurse who said the CNO doesn't think room sitters do any good. Patients hate the place on Yelp.

Mom mom is a shell. She can't carry in a conversation for long. She loses the thread. She no longer wants to do her daily routine, which was a full day of normal activities for someone age 60, not 80+. It could be the head injury, but Haldol can change people permanently, and there's no reason to think they stopped giving it just because I called. There is also the emotional trauma. She is not a complainer and never shows vulnerability, but she is shell-shocked, or broken. It was too much, for too long, for no reason.

I just can't believe staff would be so callous and frankly, stupid. Should I be asking about the MD in charge, or would this be nursing management, in terms of who sets the tone in an ED and the intermediate care ward? I mean, why were there three harmful, risky, and unnecessary interventions inflicted on someone who could have been with her husband and pets anyway? I already reported it to the Department of Health, but some of it seems criminal in nature. Assuming what she told me is all accurate, was it all legal (in California)? What about consent? Is that waived in some cases?

Thanks for any insights.

[JustBeachyNurse, LPN]

You came to the wrong place. We cannot offer medical advice as per the site terms of service we agreed to neither ask for nor offer medical advice.

Call the patient relations department.

Call your mother's physician

Call your state's ombudsman for the elderly

Call the department of health.

Call a legal nurse consultant if you have access to the full records.

Any of the above can help you. It's impossible to Monday morning quarterback without knowing/seeing your mother, knowing her history or seeing the medical record.

Good luck