Nurse charged with Assisting Father's Sucide... - page 4

....or that is what the allegations are. We were at a hospice meeting today and it was bought up; thoughts??? There are more links per google...I choose the most current one...... Read More

  1. by   MunoRN
    Quote from Spidey's mom
    Hospice is a different world than med-surg or the ER. Patients can tolerate a high dose of medication without dying from it.
    I'm assuming I am reading this portion incorrectly since I don't know any sort of magical protections given to hospice patients from the effects of opiates, I'm pretty sure the morphine doesn't know why the person is taking it and therefore effects the patient differently.
  2. by   MunoRN
    If a hospice patient is going to the hospital to get Narcan only to be then put on a morphine drip and allowed to die, there is obviously a fatal flaw somewhere in our thought process.

    There is a reason the Supreme Court felt it worthy to rule on whether or not it was legal to adequately control pain even when it will likely hasten death (they said it was OK), that reason is that it does happen. We allow patients to stop eating and drinking, which can make the dying process more comfortable, although in many cases it hastens death.

    We give hospice patient bottles of morphine, I hope nobody actually believes that this sort of thing doesn't happen on a relatively regular basis. In ICU, I see certain subset of end-of-life patients that are probably more prone to looking to speed the process up, but even if the views and wishes of only a small portion of ICU comfort care patients translate into settings outside of the ICU, there's still a relatively large number of home hospice patients who are prone to this sort of thing, the only difference is that a Nurse happened to walk in (supposedly) catching the culprits red handed.
  3. by   Carrie RN
    When I see inadequate pain control I call the doctor until pain is under control. Sometimes especially with a terminally ill patient staying on top of the pain becomes the priority above respiration per minute.
  4. by   DedHedRN
    I can see this situation in a totally different light. The person took the entire bottle of morphine. Its possible, many pts get prescribed 20-30-40 mg per hour, and at 20mg per ml, can easily run though a entire 30ml bottle in one day, without ever exceeding the dose. Now you throw a new hospice nurse into the situation...freaked out, "why did the pt take the whole bottle in one day?" thinking the pt is trying to kill themselves. Maybe they really were not. Now pt out of morphine, daughter nurse upset, "get him more morphine! Hes not dead yet!" trying to help him out of his terrible pain. New hospice nurse totally takes it out of context, calls the police, and daughter nurse gets ****** off wants to kick hospice nurses booty and throws her phone. Now things get really ugly, they drag the dying man to the ER, give him huge shot of Narcan, throw him back into 100/10 pain, and then have to put him in ICU with morphine drip till he dies a few days later.
  5. by   Spidey's mom
    Quote from MunoRN
    I'm assuming I am reading this portion incorrectly since I don't know any sort of magical protections given to hospice patients from the effects of opiates, I'm pretty sure the morphine doesn't know why the person is taking it and therefore effects the patient differently.
    Patients with a terminal illness don't start out at diagnosis with high doses of medications. They start at smaller doses that handle the pain. We do not worry about addiction with terminally ill or hospice patients. So, if their pain goes up, we increase the dosages in small increments. We can reach very large doses and the patient has gotten acclimated to each dose. All the hospice conferences on pain that I've ever gone to say we don't worry about addiction, that the initial risk of respiratory depression is when opioids are first started, that large doses of these opioids are ok to work up to starting at smaller doses. It is a different way of thinking than for a patient in the ER or on med-surg who are going to get better, their pain gets better, they don't need to increase their pain meds.

    Medicating for pain with hospice patients is different than medicating patients who are going to get better. It's part of the hospice nurse certification test to realize this.


    An excessive dose can, of course, cause respiratory depression. The dose should be titrated to give the minimum dose necessary to achieve pain control. The risk of respiratory depression is greatest when opioids are first begun.14 Tolerance to the respiratory side effects develops rapidly, allowing "aggressive upward dose titration."15 Patients in pain also respond differently to opioids than do persons without pain. Pain acts as a natural antagonist to the respiratory depressant effect of opioids. As pain increases, the level of opioid necessary for relief goes up, but so does the tolerance to respiratory side effects.14 If tolerance to the analgesic effect of an opioid occurs, analgesia may be safely obtained by upward titration of the dose because there are "parallel curves for the development of tolerance to the analgesia and to respiratory depression."16 With careful titration, even very large doses may be safely administered."
    International Association for Hospice & Palliative Care - IAHPC
  6. by   Spidey's mom
    Quote from IsisC
    I can see this situation in a totally different light. The person took the entire bottle of morphine. Its possible, many pts get prescribed 20-30-40 mg per hour, and at 20mg per ml, can easily run though a entire 30ml bottle in one day, without ever exceeding the dose. Now you throw a new hospice nurse into the situation...freaked out, "why did the pt take the whole bottle in one day?" thinking the pt is trying to kill themselves. Maybe they really were not. Now pt out of morphine, daughter nurse upset, "get him more morphine! Hes not dead yet!" trying to help him out of his terrible pain. New hospice nurse totally takes it out of context, calls the police, and daughter nurse gets ****** off wants to kick hospice nurses booty and throws her phone. Now things get really ugly, they drag the dying man to the ER, give him huge shot of Narcan, throw him back into 100/10 pain, and then have to put him in ICU with morphine drip till he dies a few days later.
    Yeah, I don't think the whole story is in the article linked in this thread. And "revived" is all it says in this article which might have meant IV fluids and time - I'm not sure they gave Narcan and if they did, it wouldn't be a "huge" dose nor is there 100/10 pain.

    We can give a patient Morphine Sulfate Oral Solution (20 mg/ml) for respiratory distress and for pain. The patient can have 20 mg every 15 minutes . . .. we give big doses so you might have a point but the article intimates that the patient drank the entire bottle at once. Every one of my patients complains about the taste though - it is syrupy sweet sticky stuff.

    Too many holes in this story.
  7. by   LadyFree28
    Quote from IsisC
    I can see this situation in a totally different light. The person took the entire bottle of morphine. Its possible, many pts get prescribed 20-30-40 mg per hour, and at 20mg per ml, can easily run though a entire 30ml bottle in one day, without ever exceeding the dose. Now you throw a new hospice nurse into the situation...freaked out, "why did the pt take the whole bottle in one day?" thinking the pt is trying to kill themselves. Maybe they really were not. Now pt out of morphine, daughter nurse upset, "get him more morphine! Hes not dead yet!" trying to help him out of his terrible pain. New hospice nurse totally takes it out of context, calls the police, and daughter nurse gets ****** off wants to kick hospice nurses booty and throws her phone. Now things get really ugly, they drag the dying man to the ER, give him huge shot of Narcan, throw him back into 100/10 pain, and then have to put him in ICU with morphine drip till he dies a few days later.
    I actually see this as being a possible scenario-I only say possible because, unfortunately, we were not there.

    If he was getting morphine close to ATC, he needed more morphine.

    I still wonder if the situation involved the wife, would the hospice nurse treated the situation differently than the father's daughter-which happens to be a nurse situation...

    As I stated before, I think there was a communication breakdown, and ultimately, the patient suffered.
  8. by   LadyFree28
    Quote from Spidey's mom
    Yeah, I don't think the whole story is in the article linked in this thread. And "revived" is all it says in this article which might have meant IV fluids and time - I'm not sure they gave Narcan and if they did, it wouldn't be a "huge" dose nor is there 100/10 pain. We can give a patient Morphine Sulfate Oral Solution (20 mg/ml) for respiratory distress and for pain. The patient can have 20 mg every 15 minutes . . .. we give big doses so you might have a point but the article intimates that the patient drank the entire bottle at once. Every one of my patients complains about the taste though - it is syrupy sweet sticky stuff. Too many holes in this story.
    The article I posted is the most recent development; it only included that she had a preliminary hearing, and a summary.

    I can try to find a record of the primary hearing; to my knowledge, PA has yet to enforce their open records law; the only open access I remove reading about was the Penn State case.


    I was able to find a article on a NPR blog about the case over two months ago:

    http://www.npr.org/blogs/health/2013...-fathers-death
  9. by   MomaNurse
    I think everyone can agree on one thing no matter where they stand on this issue- The patient had a horrible death. It will be very interesting to see how this case is tried in court. Again, thank you for bringing it up. I would really appreciate it if you would keep us updated.
  10. by   Spidey's mom
    I did a google search too. It would be interesting to be a juror if this goes to trial.

    Here's one short update from Oct. 11 . . .. she pressured the hospital to give an extra dose????

    A Philadelphia nurse is charged with assisted homicide in the death of her 93 year old father. Yesterday at a hearing in Schuylkill County, Barbara Mancini was accused of pressuring the hospital to give her dad, Joseph Yourshaw an extra dose of morphine. Yourshaw was suffering from kidney failure, end-stage diabetes, heart disease and the effects of a stroke. He died four days after he drank the extra morphine.
  11. by   LadyFree28
    I was able to find the court document; it was from an organization named Compassionate Choices, who supports the Nurse; it's the nurse's habeas corpus:

    http://community.compassionandchoice...nt.doc?id=1324

    I tried to find a conclusive state motion instead; maybe it's too early.
    Last edit by LadyFree28 on Oct 13, '13
  12. by   Spidey's mom
    Thanks - that was fascinating. A few thoughts . . ..

    We leave medication in the home for family members or for the patient to administer. Yes, bottles of Morphine Sulfate Oral Solution. Yes, syringes already filled with same for P.O. use.

    Many of our patients are on CADD Pump which is a subcutaneous method of delivering continuous Morphine or Dilaudid and then the possibility of a bolus. We up both as needed.

    Seems like he had bottles of liquid morphine in the house for a long time. Seems like no one knows how much morphine was in the bottle although we do keep track of how much the patient is using.

    I think I'll bring this case up to our hospice team as well.
  13. by   Spidey's mom
    I just read the NPR story linked earlier . . I'd missed it the first time through. The story says the daughter gave her father a vial of morphine - not a bottle. Just interesting . . .

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