Cause(s) of Death: Myocardial Infarction; Ischemic Cardiomyopathy
Location: Holy Spirit Hospital, Camp Hill, PA
Location: Holy Spirit Hospital, Camp Hill, PA
Date of Death: July 30, 2014
Timeline of Events
Note: Prior to this incident, a variety of state and county agencies were contacted. Applications for and inquiries to nursing homes were largely ignored. There were multiple doctor's visits, including specialists. Note that at an appointment at Hamilton Health Center, Harrisburg, PA, a Podiatrist specifically mentioned that Mr. Malehorn had a strong heart beat.
Recommendations: Maintain a timeline of contact with all care giving, agencies, etc; include the names of people contacted..
July 29th, 2014: Concentra Urgent Care, 4200 Union Deposit Road, Harrisburg, PA 17111
Recommendations: Maintain a timeline of contact with all care giving, agencies, etc; include the names of people contacted..
July 29th, 2014: Concentra Urgent Care, 4200 Union Deposit Road, Harrisburg, PA 17111
On July 29th, Mr. Malehorn was taken to Concentra Urgent Care. Reason: shortness of breath
Because Mr. Malehorn was disabled, I requested a wheelchair. His disability, Charcot-Marie-Tooth disease, made walking difficult.
After getting Mr. Malehorn into the waiting room, the nurse asked me if he was experiencing problems breathing. I told them that, since I am not a medical professional, I wasn’t sure. He had been experiencing anxiety attacks, had been prescribed medication; however, had discontinued taking it some months before.
I was given paperwork to complete (about ½ hour). At this point, Mr. Malehorn’s discomfort became obvious. We waited approximately another 15 minutes before being taken into an examination room. At that point, we waited another 15 or 20 minutes for a doctor. (I question their lack of urgency; their perception of the situation appeared to be that Mr. Malehorn did need immediate care.)
The doctor did not examine Mr. Malehorn and, in fact, hardly looked at him. However, she did speak to me at length. I finally interrupted her to ask what she would or could do for Mr. Malehorn. She stated that the facility did not have the diagnostic tools that would be needed and that he would need to be taken to a hospital. I asked who would call for an ambulance. She replied that Concentra Urgent Care staff called for the ambulance. At this point, I was given an envelope with the paperwork that I had completed. That paperwork, which contained all of his information along with my contact information, was to go with Mr. Malehorn to the hospital.
During this time, I mentioned to the doctor that he was hungry. He had eaten at lunch time; however, it was well past dinner time. The Doctor gave him a bottle of water, a bottle of orange juice, and a pack of peanut butter crackers. The Doctor said that it was alright to feed him.
Ambulance: South Central Emergency Medical Services Inc., 8065 Allentown Blvd., Harrisburg, PA 17112
Two EMTs arrived. The female EMT connected Mr. Malehorn to a monitor and asked if he had ever been diagnosed with AFIB. I told her that I had never been told that he had any heart condition and that, at a doctor’s visit to Hamilton Health Center, I was told that he had a very strong heart beat.
The female EMT said that they should start a procedure (I do not recall the exact name of the procedure). The male EMT said no that he preferred if they would wait until Mr. Malehorn was in the ambulance. Though the female EMT questioned this, the male EMT held to his decision.
Now, instead of rushing Mr. Malehorn into the ambulance, the male EMT proceeded to ask me questions regarding my address, phone number, and my relationship to the patient. Although I mentioned that the information was in the paperwork, he told me that he needed to ask the questions too. (The paperwork was not reviewed by hospital personnel until the next morning. Apparently, no one 'knew' about the paperwork that was sent with Mr. Malehorn.)
The male EMT also told me to stop feeding Mr. Malehorn the juice, water, and crackers. When I explained that we had the Doctor’s permission to feed Mr. Malehorn, the male EMT became somewhat agitated and told me to stop. At this point, Mr. Malehorn was obviously distressed and could not breathe.
After the male EMT was satisfied with my answers, they proceeded to move Mr. Malehorn out into the hallway to the stretcher. Unfortunately, when they lifted him from the wheelchair to the stretcher, the stretcher wheels were not locked in place. As a result, the stretcher moved. Rather than drop him onto the floor, they quickly ‘flopped’ him onto the stretcher. Whether because of pain or fear, Mr. Malehorn began to cry. I kissed him and told him that all would be alright. I asked the medical personnel to make sure that the hospital received my contact information. (I question their lack of urgency and their lack of care in placing Mr. Malehorn on the stretcher.)
Holy Spirit Hospital, Camp Hill, PA
Upon his arrival at Holy Spirit Hospital, I was told that he ‘coded’ and that they worked on him for one half hour. They were able to ‘bring him back’. At that point, from what I understand, he was put on life support; I do not know if other treatment was given. I was not notified until 11 a.m. the next morning that there was any cause for concern. (The paperwork that was sent with Mr. Malehorn included his brother's name, address, and phone number.) I had been under the impression that he was being cared for. (I question why someone in his family was not contacted for 12 to 15 hours regarding his condition.)
Before proceeding to the next series of events at Holy Spirit Hospital, the relationships need to be known.
Supporting Information: Relationships
Bobby Pressel: Mr. Malehorn was married twice. He had a child, Bobby, with his first wife Sue. After they divorced, Sue remarried and requested that Mr. Malehorn relinquish all rights to his son. He agreed and signed the papers that allowed Sue’s husband, Paul, to adopt Bobby. Although there was no legal connection, I made sure that, after meeting Mr. Malehorn approximately 8 years ago, he saw Bobby approximately twice a year. Bobby is engaged to Trisha E. Calp. She has three children; two from two other men and one son with Bobby. All three children were removed from her care via social services. Trisha E. Calp is listed on the Pennsylvania State Police Megan’s Law Website as a Type 3 offender.
Daughter, Bobbi Phillips: Mr. Malehorn was married twice. He had a daughter, Bobbi, with his second wife Lil. After they divorced, Lil remarried and requested that Mr. Malehorn relinquish all rights to his daughter. He agreed and signed the papers that allowed Lil’s husband to adopt Bobbi. Although there was no legal connection, I made sure that, after meeting Mr. Malehorn approximately 8 years ago, he saw his daughter and her family approximately twice a year. His daughter, Bobbi, is married to Shawn. They have one daughter.
Brother, Richard (Rick) Malehorn: When I met Mr. Malehorn, he had not seen or heard from his brother, Rick, in many years. I made it a point to take Mr. Malehorn to visit his brother at least twice a year. His brother never made any effort to visit Mr. Malehorn. In addition, when I asked Rick for his phone number, he said that he didn’t know it. I gave him my cell phone number. That number was the same for the entire period of time that Mr. Malehorn was in my care. His brother, Rick, never called. Rick has a life partner, Cindy. From what I understand, Rick and Cindy have been together for 20 years. Cindy also showed no interest in Mr. Malehorn.
Friend, Steve: Mr. Malehorn’s friend, Steve, can substantiate my claims regarding the general lack of concern.
Note that court documents can substantiate that there was no legal connection between Mr. Malehorn, Bobby Pressel and Bobbi Phillips.
Holy Spirit Hospital, Camp Hill, PA
After Mr. Malehorn was transported to Holy Spirit, I contacted his ex-wife, Sue. She affirmed that she, along with Trish, would be going to Holy Spirit early the next morning to check on Bobby Pressel and that they would check on Mr. Malehorn.
At around 11 a.m. on July 30th, more than 12 hours after Mr. Malehorn was transported to the hospital, I received a call from the ICU. (Heidi: 7632514) She told me that someone would have to come into make a decision about Mr. Malehorn’s care. I asked her to please clarify her statement. At about the same time that Heidi called from ICU, I received a call from Sue stating that I should come to the hospital immediately.
Upon my arrival, I was told that I a doctor would be in to speak to me shortly. Though I was concerned about Mr. Malehorn’s status, I remained calm and in control. (My emotional state can be confirmed by a friend, Brian W. He was in the ICU to visit his Mother who was a patient.)
Before the doctor arrived, I asked if Bobby Pressel could be brought down to the ICU from his room on another floor. Bobby Pressel, with several IVs and monitors attached, arrived shortly thereafter.
The doctor, claiming to be a cardiologist, subsequently arrived. He quickly explained that they would have to start dialysis immediately; however, given that the heart was only functioning at about 10%, he was suggesting disconnecting life support with no further treatment. At this point, I introduced myself and said that I would like to have dialysis started immediately.
The doctor overrode my decision, stating that Bobby Pressel would have the right to the decision. (Bear in mind that there was no legal connection between Bobby Pressel and Mr. Malehorn.) In addition, the doctor included Bobby Pressel’s fiancée, Trish, in the decision-making process.
I steadfastly and calmly disagreed with Bobby Pressel’s rights. The doctor became adamant that I was not the decision-maker. Given that Bobby Pressel was clearly not feeling well and appeared to be ‘out of it’, I requested that we also wait for Bobbi Phillips. My line of reasoning was based on Bobby Pressel’s health as well as on the fact that I didn’t want him to have to bear the brunt of the decision.
When the cardiologist asked where Bobbi Phillips was, I stated that she was on her way back from the shore and that she would arrive within the hour. The cardiologist asked me which shore. I answered that I didn’t know but that she was somewhere around Lancaster, PA at that point. The cardiologist responded that, since I didn’t know where she was coming from, I was clearly not in a position to make a decision. I calmly pointed out that the relevant information was with regards to when she would arrive; not where she was coming from. The cardiologist then left the room.
At this point, I tried to contact Mr. Malehorn’s brother, Rick. Though I did not have a phone number for him, I knew that his life partner, Cindy, worked at Weiss Markets. I called Weiss Markets, they tried the phone numbers that they had on file; however, all had been disconnected. I also tried to contact Mr. Malehorn’s friend, Steve. Though he responded via text message, he could not make it into the hospital.
Bobbi Phillips did arrive in about an hour. When I invited her to hold Mr. Malehorn’s hand, she declined stating that she couldn’t do that. I told her not to worry that I would make sure that Mr. Malehorn was aware that she was there.
At this time, another doctor came into the room. This doctor made it a point to totally exclude me as well as Sue in the conversation. He directed his remarks to Bobby Pressel, Trish, and Bobbi Phillips, stating that the best decision would probably be to disconnect life support. Though I disagreed, I told the children that I would support their decision.
They subsequently, within 5 minutes, agreed to disconnect life support. Mr. Malehorn died shortly thereafter. However, during the entire time that he was on life support and up until a short time before his death, he responded to comments with facial expression and with squeezing my hand as well as Sue’s hand. (Note that shortly afterwards, I was approached by a team requesting permission to remove Mr. Malehorn's organs. I explained that I did not have legal rights to make that decision; the decision was up to his children. After the children declined to allow the organs to be removed, the team once again requested my permission. I explained that the doctor had already made the decision that I had no legal right or responsibility to any decisions. In addition, I would not go against the wishes of the family.)
Post Note
The next morning, I drove to Mr. Malehorn’s brother, Rick’s house. Given the distance from my home in Middletown, I took Trish with me as a navigator. (Sue was supposed to go along; however, due to her own health issues, she was in the Emergency Room.) We told Rick that his brother had passed away the previous evening. Except to answer Rick’s questions, exact details were withheld. I did tell him that I had tried to contact him; however, was unable to get a phone number. (Note to Hospitals: Much later in the week, someone mentioned that I could have requested police assistance. That in an emergency, they will go to a house to deliver a message.)
***** ***** *****
Follow-Up Response to My Complaint from Department of Health / Acute Care, Harrisburg, PA 1/26/15 (My comments are italicized, in parenthesis, at the end of each paragraph)
The investigation into the concerns you expressed about the care Robert Malehorn received as a patient in Holy Spirit Hospital has been completed.
On behalf of the Department, please accept our sincere condolence on the loss of Mr. Malehorn.
An unannounced investigation was conducted on January 16, 2015. The investigation included interviews with staff, review of policy and review of medical record documentation. We were able to determine the care and services provided were appropriate and the hospital followed their policy in determining next of kin. (No the hospital did not notify next of kin. Robert’s only legal next of kin was his brother, Richard. Richard could not be contacted).
As the result of this investigation, no violations of applicable State regulations and Federal Conditions of Participation were identified. Even though no violations were identified, the facility has taken our investigation seriously and cooperated fully with the investigation. (They are overlooking the fact that one of the people who was allowed to participate in the decision to end care is on Megan’s List. She did not have appropriate permission to travel to Holy Spirit Hospital. I would suggest that is a violation; particularly as her presence on the property may have compromised the safety of the children in the hospital.)
The Division must have evidence to substantiate an allegation. In order for a citation to be written, the surveyor must observe the practice or be able to prove from the documentation in the record, or from interviews with staff and others that deficient practice had existed. This does not mean your concerns are not valid, it only means that during the investigation, evidence could not be identified to substantiate the issue or experience you described.
Due to laws governing patient confidentiality, the Department is unable to provide specific patient related information directly to you unless we receive permission from the patient; a copy of durable power of attorney for medical care from the person who holds it; or from the person who has been named the executor of the estate. To date, this office has not received the required documents. (I can pursue two options here: Have Robert’s brother Richard agree to become an executor of the estate. If he fails to agree, I can forward all hospital and doctor bills to his address, making him responsible. Or, I can use the Internet to make sure that all caregivers are aware of this Catch-22. In other words, while a caregiver might be responsible for the patient in many respects; they essentially have no rights. Since then, I have been advised not to care for anyone...That is, we should allow the county and state services, charged with the duties of caring for the disabled, to 'step up to the plate' and do their jobs!)
Thank you for bringing your concerns to our attention and giving us the opportunity to look into them on your behalf. (Really...Was the situation truly assessed? There are numerous issues regarding lack of care and communication...)
