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Impressum

Cause of Pearl’s Death

The cause of death is listed on the death certificate and the hospital doctor’s report. I disagree with both and provide my own conclusions based on the analysis reported above.

Florida Certificate of Death: Septic shock, multiple organ failure

Hospital ER Physician’s Report: Septic shock of unclear etiology, Shock liver, Acute renal failure, History of Giant Cell Arteritis, Polymyalgia rheumatica, Hypertriglyceridemia, Hypertension, Spastic colon, Pancreatitis, Gastroesophageal reflux disease, History of cerebrovascular accident related to Giant Cell Arteritis.

James’ Conclusions: The death certificate and physician’s report list septic shock. There are many types of shock – septic reflects systemic disease which is speculative. Lack of fever upon admittance makes systemic disease unlikely. GCA and PMR, while historical, aren’t life-threatening illnesses when properly managed by prednisone. Hypertriglyceridemia leads to liver degradation but isn’t life-threatening in a traumatic manner. Pancreatitis was speculative and unlikely because she had no fever. Spastic colon and GERD without ulceration can cause pain but not death. Pearl’s blindness in one eye, the cerebrovascular accident nine years before, is referred to but has no significance relating to distress in the ER.

After consideration of the information available regarding management of her distress I believe her demise was due to a combination of:

• Anaphylactic or Endocrine shock or both. Anaphylactic shock was brought on by hypersensitivity to or the compounding effect of the five sedatives administered by the paramedics and the ER staff. Endocrine shock resulted from lack of administration of corticosteroids in a timely manner by the ER staff for a patient with adrenocortical insufficiency. Either or both contributed to multiple organ failure.
• Secondary issues: Effects of severe dehydration and debilitation. Dehydration resulted from the immediate distress that led to the ER visit. Debilitation reflected the nine year long illnesses of GCA and PMR and the use of prednisone and other medications needed to sustain reasonable health.