Twenty-seven year old Heather Spriggs had a complete body when she arrived at Grays Harbor Community Hospital on October 27, 2011. A day and one-half later, she was flown out almost dead. Surgeons at the UW Hospital had to cut off her cadaverous legs to save her life.
Before then, Heather had been paying the price for the curing of her childhood cancer – Non-Hodgkins Lymphoma. Aggressive treatment had cured the disease. She was on the swim team in high school. And later Heather worked as a school bus driver. But eventually she was diagnosed with chronic heart failure and renal failure.
At 5:00 AM on October 27, 2011, Heather Spriggs, arrived at the emergency room with pain and tingling from the waist down both her legs. The pain was so bad that she didn’t want to walk. The ER doctor felt ankle pulses but didn’t chart them. Instead of trying to figure out a cause, he administered pain medication, did not make a differential diagnosis and punted Heather over to admitting.
Over the next two hours, nurses note that her legs are cool and becoming mottled in appearance.
At 10:00 AM, Heather was next seen by a newly certified physician’s assistant, who had worked at the hospital for one year. He was nice but inexperienced. He didn’t even have his college degree yet. He observed that her legs were cold to touch, mottled and he could not detect pulses in them by palpation. He didn’t use the hand held Doppler in the cupboard to double check if there were pulses. He diagnosed pneumonia, chronic heart failure and neuralgia. The ER doctor had already decided she did not have pneumonia. There was no known type of neuralgia condition that wiould spontaneously result in the bilateral leg symptoms with which she was she presented. The physician’s assistant shared his (wrong) diagnosis with the hospitalist, Hany Bashandy, who was his supervisor.
It was around 11:00 AM, the hospitalist worked until 7:00 PM in the evening and not once did he check on her.
Heather was left to lie in her bed through the morning and afternoon. No registered nurse was in charge of Heather. She was cared for by a licensed practice nurse in violation of WAC 246-840-700. This nurse did not have the ability to assess or direct Heather’s care.
At 3:00 PM a physical therapist arrived. Heather was given a walker and directed to walk, which she did. She walked at least one hundred steps. The physical therapist didn’t examine Heather’s legs and made no note about whether they were cold, mottled or had pulses. The therapist completed her evaluation at 4:15 PM. Heather was sent back to bed.
Meanwhile a registered nurse who received her degree two months before, arrived on the floor. She noted at 5:00 PM, that Heather’s legs were cool, mottled, the nail beds dusky, and she could barely hear faint and thready pedal pulses. She also observed Heather get up out of bed, walk to the bathroom, do her business, then return to bed. She did not report the condition of Heather’s legs to physicians because she believed that report had already occurred.
Four hours later Heather underwent full cardiac arrest. A different ER doctor attended. Heather survived 30 minutes of resuscitation arrest and was stabilized.
Staff did not figure out the cause of the arrest. They assumed it was from her heart failure. If they had studied the matter a bit, they would have realized that something else was going on. Her potassium levels had quickly and dramatically increased since admission. This was evidence of rhabdomyolisis – a critical chemical imbalance resulting from substantial tissue death. In this case, her leg ischemia.
The ER doctor returned to the emergency department. And once again, Heather was left to lie in her bed under the care of the nurses.
At 10 PM the night shift RN noted that Heather’s legs were mottled.both tibial and pedal pulses were absent, and nail beds dusky. At 11 PM the RN called the Dr. Bashandy who was at home but on call. He lived a few minutes away. He did not come to the hospital. An hour later, she called him back to report abnormal blood chemistry results. She said that she told him of the significant findings involving Heather’s legs. Dr. Bashandy, the hospitalist, denied this.
Over the next seven hours, the doctor never came in. The hospital had a policy that a doctor didn’t have to see a patient admitted to the hospital for 24 hours. He was going to hold out to the last possible hour to see her.
At 7 PM the very experienced day shift nurse took over. She was immediately horrified. There were no pulses in Heather’s legs. They were cold, mottled, pale and waxy. She was unable to Doppler any pulses; the soles of the feet are dusky, and the last three toes of the right foot and little toe of the left foot are dusky. Clearly the legs had changed since she had been admitted.
By that point, the hospitalist had arrived to begin his regular day shift. At 7:00 AM he was called in urgently to see Heather. He could see instantly, that she was in grave danger.
There was a vascular surgeon in the hospital doing rounds. He was a real gem of a doctor who lived five minutes away and would come to see any hospital patient if needed for a consult. No one had called him about Heather. Simply by chance he was in the hospital. When he glanced in to Heather’s room, he immediately saw that her legs were cadaveric. He then told the hospitalist to get her on Heparin. He urged the staff to get her out of the hospital to a place that could do the amputations. He rushed off to surgery where his patient was probably asleep on the table waiting for him. After finishing that surgery, he returned four hours later and Heather still had not been transported.GHCH took a total of nine hours to get Heather to the University of Washington Medical Center.
Before losing her legs, Heather did well in high school, was a champion swimmer, and appeared to be for the most part healthy following her bone-marrow transplant and total body irradiation treatment for her Non-Hodgkins Lymphoma.
Heather has always put a positive happy face on despite her many medical issues. She had less stamina to work full time and eventually needed to go on social security disability in order to make ends meet.
According to one of her treating physicians, Heather used up another of her nine lives in surviving her hospitalization at Grays Harbor.