Florida woman goes into hospital to have baby, leaves as a double amputee

[UM Review RN]

How tragic! How frightening! This could happen to ANY of our patients! The rest of the story here:

http://www.wftv.com/news/6253589/detail.html

Woman Becomes Quadruple Amputee After Giving Birth

POSTED: 5:59 pm EST January 19, 2006

UPDATED: 4:06 pm EST January 20, 2006

ORLANDO, Fla. -- A Sanford mother says she will never be able to hold her newborn because an Orlando hospital performed a life-altering surgery and, she claims, the hospital refuses to explain why they left her as a multiple amputee.

The woman filed a complaint against Orlando Regional Healthcare Systems, she said, because they won't tell her exactly what happened. The hospital maintains the woman wants to know information that would violate other patients' rights.

Claudia Mejia gave birth eight and a half months ago at Orlando Regional South Seminole. She was transported to Orlando Regional Medical Center in Orlando where her arms and legs were amputated. She was told she had streptococcus, a flesh eating bacteria, and toxic shock syndrome, but no further explanation was given.

The hospital, in a letter, wrote that if she wanted to find out exactly what happened, she would have to sue them.

"I want to know what happened. I went to deliver my baby and I came out like this," Mejia said.

Mejia said after she gave birth to Mathew last spring, she was kept in the hospital with complications. Twelve days after giving birth at Orlando Regional South Seminole hospital, she was transported to Orlando Regional Medical Center where she became a quadruple amputee. Now she can not care for or hold her baby.

[SharonH, RN]

This is tragic. A woman goes into the hospital to have a baby and comes out with no arms or legs. THAT is the only thing that is fishy or suspicious here. Someone earlier commented that this woman may just be looking for someone to blame. Well......yeah. I don't know of anyone who leaves a hospital without any limbs and who doesn't want answers. I think she deserves them. If it were me, I would demand answers and then we would have to go over it again and again and again. "Now how did this happen again?" "How?" "HOW?"

I wish this woman the best of luck.

[rach_nc_03]

When I first saw this story on CNN, I immediately thought about DIC from septic shock. I've seen patients in septic shock, and if I recall, they have compromised circulation to the extremities.

Could this possibly be the cause in this case, or am i totally off the mark?

[snowfreeze, BSN, RN]

racn nc 03,

I agree with you on the shock. I read a couple of articles on this woman. She gave birth then later, a day or so, had another surgery for hysterectomy. That could have been the flesh eating bacterial infection. Then the staff noted that she had a rash, then she was transferred to another facility and had the amputations. Possibly became septic after the surgery and was put on vasopressors which will clamp down peripheral circulation. Black hands and black fingers along with 3rd spacing from the rest of the treatment for shock..fluid recusitation. Then the gangrene developed in her extremities and she and her husband chose for the amputation vs death. She wants to know HOW she got the initial infection. This is partly critical thinking and partly what I have read in articles. Makes sense to me when the blanks are filled in like this though.

[SharonH, RN]

racn nc 03,

I agree with you on the shock. I read a couple of articles on this woman. She gave birth then later, a day or so, had another surgery for hysterectomy. That could have been the flesh eating bacterial infection. Then the staff noted that she had a rash, then she was transferred to another facility and had the amputations. Possibly became septic after the surgery and was put on vasopressors which will clamp down peripheral circulation. Black hands and black fingers along with 3rd spacing from the rest of the treatment for shock..fluid recusitation. Then the gangrene developed in her extremities and she and her husband chose for the amputation vs death. She wants to know HOW she got the initial infection. This is partly critical thinking and partly what I have read in articles. Makes sense to me when the blanks are filled in like this though.

This makes a LOT of sense.

[wooh, BSN, RN]

Her husband or other family member could have visited her with a sore throat or she could have had it on her when she came in. Sure, someone else on the floor could have had it. Strep isn't necessarily a nosocomial infection. I don't blame her for wanting someone to blame, but I don't necessarily think there is someone to blame here. (There could be, but without further information, we don't know. And you can't prove a negative. They could give her blood cultures on every other patient in the hospital, it's not going to prove where the infection came from.)

[zacarias, ASN, RN]

but why all limbs? I'm don't know that much about flesh eating bacteria but wouldn't you just have to amputate one limb, why all four??

[caroladybelle, BSN, RN]

Is this story the beginning of an urban legend?

No, it is in several of the local papers.

I know that the form of bacteria can go from mere pain to lifethreatening ill, quite rapidly. But how long is the incubation period before initial pain is noted? It would seem to be that the patient would have had it before coming....unless she had been in the hospital for several days to weeks.

And, yes, revealing whether another patient had the disease would violate HIPAA.

Anyone know whether she was in a semi-private or private room?

I always love it when Admitting insists on placing a "clean" patient in with someone that has an unknown illness. Cases like these make a case for all private rooms.

[caroladybelle, BSN, RN]

but why all limbs? I'm don't know that much about flesh eating bacteria but wouldn't you just have to amputate one limb, why all four??

You amputate the limbs that have lifethreatening infection. If all of the limbs were affected, then they all would be removed.

There are a number of cases of multiple amputations from this illness.

[UM Review RN, ASN, RN]

here's another website for those of you who had questions:

http://www.peacehealth.org/kbase/topic/mini/hw140405/symptoms.htm

here's an excerpt:

necrotizing fasciitis (flesh-eating bacteria)

symptoms

symptoms of

necrotizing fasciitis

may develop quickly, often as soon as 24 hours after a minor skin injury. the

rapid onset of symptoms

is one of the most important clues that you may need immediate medical care. another common characteristic of this disease is that the pain is greater than you would expect from the appearance of the wound.

necrotizing fasciitis most commonly affects extremities, particularly the legs, but can affect

any

part of the body.

[HappyNurse2005, RN]

But if it was necrotizing fasciitis, in theory, wouldn't that affect just one area, like one limb? I didn't know it could skip around and do hands/feet, but nothing in between?

Doesn't it also originiate in a wound?

Makes me think about bacterial meningitis. That can cause quad amputations.

Maybe she's diabetic-that could cause wound healing issues

There's got to be more to this. Articles like that are just misleading, imho. Especially to non medical types who can't speculate like we can.

[DutchgirlRN, ASN, RN]

The article in the Tampa Bay paper says the amputations took place 12 days after the delivery. She developed a rash and severe stomach pains, two days later she was sent to ICU and then later transferred to another hospital where she when into kidney failure and gangrene set in and 12 days after she gave birth, the doctors amputated her arms and legs.

This sheds a little more light on the situation but I still don't get it. Where were the surgical permits? Informed consent? Did the surgeon not see her in her room to explain what surgery she needed? Where was her husband before she went to surgery? It seems to me they may have operated on the wrong person. Has anyone ever heard of a quadruple amputation all done during one surgery? Really really bizaare and really really sad.

I have a young patient who had a BKA 2 days following a common surgical procedure. No TEDS, No SCDS, No Louvenox, and the day of surgery the pt. told the primary nurse that the foot hurt really bad, the nurse pulled the covers back, said yeah it's a little blue and a little cold but it's nothing to worry about. This young pt's hx is significant for clotting disorder. Somebody is in trouble. Can you imagine telling a patient it's ok if your foot is blue and cold? Didn't even check the pedal pulses. And what about in PACU and after the surgery, some people were not doing their jobs. Pitiful!

[pugmum]

One short story ... young lady, early 20s goes to a walk-in one morning because of severe lower leg pain. No known injury. Examined by physician, prescribed anti-inflammatories, goes home.

Goes to ER 2 hours later because pain is increasing. Examined by ERP - no sign of injury, no redness, swelling, no break in the skin, VS including T all normal. Blood work and radiology neg. Given pain medication and discharged home.

Returns to ER late afternoon/early evening because pain is increasing, uncontrollable. Examined again, lab/xray all normal, VS fine, no circulatory problems....major complaint excruciating pain in lower leg...consults with a couple of specialists, no definitive diagnosis. Decided to keep in ER for observation and pain control.

Repeat blood work throughout night - normal. VS and T stable throughout night. Pain continued. Nurse checks VS at 0700, fine. At 0800 goes back to check before she leaves for her shift, BP bottoming out, pt.cyanotic, no periph pulses.

Subsequently transferred to ICU but died shortly after admission. Autopsy showed she died of shock due to flesh eating disease.

Yes, it can happen that fast. What was so tragic in this case was there was no indication other that the pain of what was going on. Parents sued hospital, physicians and nurses, but no one was found liable...it was one of those unfortunate things. Very tragic.