What’s her life worth?

Hearing begins Monday in case of woman overdosed with blood thinner at Enloe Medical Center

TOO MUCH MEDICINE <br> Francine Shaw, 83, was a vigorous woman before being overdosed with the blood thinner Heparin at Enloe Medical Center. Now she needs around-the-clock care from her daughters, including Kim Shaw, shown here.

Francine Shaw, 83, was a vigorous woman before being overdosed with the blood thinner Heparin at Enloe Medical Center. Now she needs around-the-clock care from her daughters, including Kim Shaw, shown here.

Photo By Ginger McGuire

Heparin in the news:
Heparin is one of the oldest and best anticoagulants, but it can be dangerous. In 2007, actor Dennis Quaid’s newborn twins were accidentally given an adult dosage 1,000 times stronger than recommended, but they survived. And in 2008 contaminated Heparin from China killed 81 people in the United States.

Shopping used to be one of Francine Shaw’s favored pastimes—that and attending New Hope Fellowship in Chico every weekend with her oldest daughter.

The 83-year-old Paradise woman also took pleasure in traveling to Marysville to visit some of her grandchildren, as well as taking walks and spending time in her garden.

Now “she has lost a lot of her ability to recognize her surroundings, she doesn’t recognize Paradise anymore, and she has lost interest in things she used to enjoy,” daughter Kim Shaw said.

Roughly a year ago, on July 31, 2008, Shaw was inadvertently infused with 50 times the appropriate dose of Heparin, a blood thinner, at Enloe Medical Center after a procedure intended to improve the circulation in her right foot. After the overdose she experienced a right-sided stroke that caused permanent major physical and neurological injuries, including left-sided paralysis/neglect, general lethargy and loss of memory and cognitive function.

A medical-malpractice action suit, Shaw vs. Enloe, is scheduled for hearing Monday (July 13) at the Butte County Courthouse in Chico. The plaintiff contends “Enloe and its nurses were negligent and acted below the standard of care,” according to a legal brief.

Today Shaw is a “safety risk,” her Sacramento-based attorney, Steven Schultz, said. She requires 24-hour supervised care, and her three daughters are taking the brunt of the responsibility. Kim Shaw was forced to move in with her mother, and all three daughters have had to rearrange their personal and work schedules—not to mention deal with their own pain resulting from the ordeal.

“This is a woman who was independent before all this happened,” Schultz continued. “She lived alone and took care of herself.”

Enloe officials and the hospital’s attorney, Sacramento-based Barry Vogel, declined to comment on this case because it is in litigation.

The incident couldn’t have come at a worse time for Enloe. The hospital was just coming out of a difficult period during which the state Department of Health Services had repeatedly deemed it noncompliant with certain federal Medicare standards. No sooner had the hospital tightened its practices sufficiently to regain full accreditation, in January 2008, than three medical-malpractice/wrongful-death lawsuits were filed against it. All three cases involved anesthesia-related hospital deaths that occurred before Enloe’s then-CEO, Debi Yancer, was hired.

Now Yancer’s successor, Mike Wiltermood, has inherited not only those cases, but also Shaw’s.

Schultz said Enloe does not dispute that the overdose occurred, but is challenging the plaintiff’s estimation of the cost of the damages, both past and future. While he would not discuss details, he said Enloe had offered Shaw a settlement that was not nearly sufficient.

As part of the evidence in the case, a life-care planner says Shaw can have a normal life expectancy of 7.6 years based on CACI tables if she receives certain caregiver assistance, medications, therapies and treatment. The gross total cost through 2016 equals $1,231,830.04, according to the brief.

Moreover, “the case also represents a failure in the health-care delivery system at Enloe” because this is not the first time Enloe has overdosed its patients with medications and/or failed to follow drug warnings designed to protect patients,” the brief reports. It states Shaw was the fourth known overdose in one year.

In 2007 a patient at Enloe was overdosed with the drug Cardene for hypertension and another was overdosed with 10 times the dose of Dilaudid, the brief states, citing a September 2007 Department of Public Health Survey. The report concluded that in each case the hospital either did not have appropriate policies and procedures in place or failed to follow existing policies and general safety practices.

Just five months prior to these incidents a DPH survey indicated the hospital had failed to properly monitor patients on the drug Droperidol, failed to follow drug manufacturers’ warnings for use of the drug and failed to pay attention to a 2001 FDA warning about the drug.

The brief alleges the nurses who overdosed Shaw claim to have no knowledge of the previous 2007 incidents, even though in both cases DPH cited Enloe for creating an “immediate jeopardy” and called for new policies regarding medication administration.

“Enloe was so concerned about these earlier incidents that its nurses (the actual individuals who give the medications) have no awareness that anything happened,” the trial brief concludes sarcastically. “All of these individual and system failures resulted in Ms. Shaw getting overdosed with Heparin, and losing the enjoyment of the last years of her life in the process.”

Shaw was admitted to Enloe to have a procedure done that would eliminate clots in the smaller arteries of her lower foot. As part of the process, a small dose of Heparin was supposed to be injected to prevent new blood clots from forming at the infusion site. High-risk drugs such as Heparin are administered through an Alaris Infusion Pump, which includes a guardrail system as a means to cross-check to prevent overdoses. The brief states nurses attempted to calibrate the guardrail system possibly four times or more, according to nurses’ testimony, and were not able to get the system to accept their input.

“Incredibly, the nurses decided to continue exiting and restarting the program rather than seeking help from someone who knew how to correctly set the system,” according to the brief. “This mistake resulted in the nurses essentially overriding the Guardrail safety function to give Ms. Shaw the dosage of Heparin they thought was 500 units per hour.”

Rather, she was infused with 25,000 units of the drug in a half-hour. About three hours later “there was oozing blood noted from the sheath,” followed by a drop in Shaw’s blood pressure, low hemoglobin and abdominal distension suggesting a bleed, as well as right-sided intra-cerebral bleeds.

“Caregivers and the medical chart have universally agreed the brain hemorrhage was caused by the Heparin overdose,” the brief reports.

The Shaw family filled the waiting room at Enloe that day, trying to make sense of the situation.

Kim Shaw said it was traumatic. “When I first saw her [in the hospital] I thought she was on death’s door. But little by little, she started getting a little better.” But her mother will never again be the woman she was when she entered the hospital.

Just a few months prior to the incident Shaw had enough energy to do her own yard work, Kim Shaw said. Now she has trouble walking around her home, and she can’t see anything to her left since the stroke and is prone to walk into the wall.

She can’t feed herself and needs full assistance with normal activities of daily living such as general hygiene. She also must wear diapers.

Every once in a while Shaw will say something, but her speech is slurred and difficult to understand. She remembers bits about her past, yet most of her short-term memory is diminished since the stroke.

She’s glad to be alive, however. Sitting in her living room decorated in mostly pink pastels, she said quietly, “I thank the good Lord I came out of it.”

Shaw knows she isn’t the same, Kim said, which is frustrating for her and everyone who loves her, especially since she was never the type of person who waited around for someone to help her.

Shaw, who was born in Oklahoma, grew up in Chico since she was about 12 years old. She had a total of five children (her two sons have died). Her family still has a newspaper article about her when she was a Rosie the Riveter during WWII, working at the Chico airport as a sheet-metal-shop employee. “Vital war work doesn’t keep the present day miss from being attractive,” the article states.

She also worked as a security guard at one of the high schools in Chico and ran a day-care center out of her home in Paradise for nearly 10 years. At one point Shaw was president of a former family business, Norcal Integrated Ceilings.

“We really didn’t expect anything like that to happen, and it shouldn’t have,” Kim Shaw said. “I just feel that the whole thing is really unfair to her—to the person she was and the person she is now because of what happened at Enloe.

“They took away her livelihood, her dignity, her independence, and it can’t be fixed,” she continued. “It’s upsetting to watch.”