My father died in the ICU on Levophed, ventilator, and tracheostomy. Was it medical negligence?

My name is Patrik Hutzel from intensivecarehotline.com,  and this is another quick tip for families in intensive care. Here at intensivecarehotline.com, we instantly improve the lives for families of critically ill patients in intensive care, so that you can make informed decisions, have peace of mind, control, power, and influence, making sure your loved one always gets the best care and treatment, even if you’re not a doctor or a nurse in intensive care.

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So, today I have an email from Leo, who says,

“Hi Patrik, 

My father started dialysis last night around 10:30 p.m. At that time, he was on 18 mcg of Levophed, which is also known as norepinephrine or noradrenaline. About 25 minutes into dialysis, my father’s oxygen began to drop. After a few minutes, the therapist walked into the room, observed the ventilator and tracheostomy, murmured 100 to the dialysis nurse, and left the room. My father’s oxygen at the time was about 83%. My father’s blood pressure was below its target of 55. The Levophed was increased to the maximum of 22 mcg and put on ventilator settings at the maximum level. Around 11:40 p.m. the doctor came to the bedside and said that my father is dying. The doctor ordered a blood gas. And I was told that my father was becoming acidotic. Around 5:13 a.m. the ICU team is performing CPR on my father. At that moment I saw one of the ICU doctors coming and told me that my father was already dead. Aren’t they doing CPR? Can’t he be saved? I repeatedly called my dad’s name. There might be life or something, but the doctor walked over to the crash cart and signed the death certificate. I feel that the doctor didn’t do enough to save my father. I need help finding answers about medical negligence. I want a thorough medical review of my dad’s records. Can you help me, please?” 

From Leo.

Leo, first and foremost, I’m so deeply sorry for the loss of your father. Losing a parent in the ICU is devastating under any circumstances but witnessing CPR (Cardiopulmonary Resuscitation) being performed on your father, calling his name, and then being told he was already gone, that is a profoundly traumatic experience. Your need for answers is completely understandable. I want to help you work through this as clearly and honestly as I can.

Let me break this down the way I always do, honestly, directly and in a way that actually makes sense.

What was your father’s condition in ICU? Understanding the full clinical picture, your father was clearly extremely critically ill, Leo, before dialysis was even started. But let me explain each element so you understand what was happening.

Levophed, which is also known as norepinephrine or noradrenaline, at 18 mcg and then 22 mcg, so-called maximum, I will come to that. Levophed, which is also known as norepinephrine, is one of the most powerful vasopressor or inotropic medications used in intensive care. It is used when a patient’s blood pressure is dangerously low and cannot be maintained on its own, which needs to be compatible with life, typically in conditions like severe septic shock, cardiogenic shock, or multi-organ failure. Being on 18 micrograms is already an extremely high dose. Reaching the so-called maximum of 22 mcg tells us that your father’s cardiovascular system was in profound crisis and distress, that his body was fighting to maintain any meaningful blood pressure at all.

It might have been 22 mcg maximum, but they could have started other vasopressors, such as epinephrine or vasopressin. It might have been maxed out on the Levophed level, but what other inotropes or vasopressors did they use?

Your father had a tracheostomy, which means he had to be on a ventilator for a significant period of time, long enough that the ICU team had made a decision to place a surgical airway in his neck rather than keeping a breathing tube through his mouth. A tracheostomy is typically performed when a patient is expected to need prolonged mechanical ventilation. This tells us your father had been critically ill for some time before this particular night.

The fact that the respiratory therapist came into the room, observed the ventilator and the tracheostomy, murmured 100 to the dialysis nurse, and then left. Leo, I understand why that would have been alarming and confusing to you as a family member standing in that room. That kind of communication, or lack thereof, directed at you is something that should have never happened. Families deserve to be spoken to directly and clearly, especially in moments like that.

Next, oxygen dropping to 83 percent, why this is so serious. Normal oxygen saturation should be above 94 to 95 percent. When your father’s oxygen dropped to 83 percent, his vital organs, including his heart, his brain and his kidneys were being deprived of adequate oxygen. In a patient who is already hemodynamically unstable and on maximum vasopressor support, a drop in oxygen like this can rapidly accelerate a downward spiral that becomes extremely difficult to reverse.

Dialysis in a hemodynamically unstable patient is a known risk. And this is an important point, Leo. Starting dialysis, whether it was CRRT, which stands for continuous renal replacement therapy, or intermittent haemodialysis in a patient who is already on near maximum doses of Levophed and other vasopressors and on a ventilator, is a high-risk clinical decision. It is well recognized in intensive care medicine that dialysis or hemofiltration can cause significant hemodynamic instability, meaning it can cause blood pressure to drop further and oxygen levels to fall.  The question of whether it was appropriate to start dialysis at that point in time, given your father’s level of instability is one of the key questions that needs to be answered through a review of his medical records.

You talked about metabolic acidosis, what does that mean? When the doctors ordered a blood gas and was told your father was becoming acidotic, this is a critical finding. Metabolic acidosis means the body is producing more acid than it can clear. In intensive care, this typically happens when circulation is so severely compromised that the tissues and organs are not receiving adequate blood flow and oxygen. It is a sign of profound physiological deterioration and is associated with very high mortality. When a patient on maximum vasopressors is becoming acidotic, the options available to the ICU team become very limited, very quickly.

CPR in ICU, understanding what it means and what it can realistically achieve. Leo, when CPR was started at 5:13 a.m., I want you to understand the clinical reality of what CPR can and cannot do in these circumstances. When a patient is already on maximum doses of vasopressors, is on a ventilator at maximum settings, has a dropping oxygen saturation, and has a blood gas showing worsening acidosis, CPR is rarely able to reverse the underlying cause of the cardiac arrest. The heart has stopped because the body systems have failed at a fundamental level, and CPR alone cannot fix that underlying cause.

That doesn’t mean that nothing wrong occurred. It does not mean that medical negligence did or didn’t happen. Those are entirely separate questions, and they cannot be answered without a thorough evidence-based review of your father’s complete medical records, which is where me and my team comes in.

Did the doctor do enough to save your father, and here’s the answer. Leo, you have said clearly that you feel the doctors didn’t do enough. I hear that and I want to give you an answer. From what you have described, I cannot tell you whether medical negligence occurred without looking at the medical records, and I want to be clear about this, nobody can tell you that without reviewing the full medical records. Anyone who gives you a definite answer without doing the medical record review is not being truthful with you.

What I can tell you is that there are legitimate clinical questions raised by what you have described. Was it appropriate to start dialysis when your father was already on near maximum Levophed and clearly hemodynamically unstable? Was the drop in oxygen and blood pressure during dialysis responded to quickly enough and in the right way? Was the respiratory therapist’s assessment communicated and acted upon appropriately? Were the blood gas results acted upon in a timely and clinically appropriate manner? Was the CPR performed correctly and in accordance with established resuscitation guidelines? Were there any delays in escalating care, treatment, any failures in communication, or any departures from accepted standards of care? Did they try to correct the acidosis with medications?

These questions can only be answered with access to the complete medical records, and also, was he having a DNR (do not resuscitate)  that you didn’t know of, because unfortunately, this happens in hospitals that patients are being issued a DNR, a do not resuscitate order without families consenting to it or even knowing about it. I’ve seen it over and over and over again, because if that was the case, that might be the reason why they didn’t go in full throttle with CPR.

But Leo, I can’t stress this enough, access to the full medical records is absolutely critical, and it’s also absolutely critical for anyone watching this who has a loved one in ICU right now, so you’re not getting into those situations in the first place. The medical records are everything in a situation like yours, but they’re also everything when you have a loved one critically ill in intensive care, because without access to the medical records, you’re flying blind.

They are the complete documented account of every decision that was made, every medication that was given, every ventilator setting that was used, every nursing observation and doctor observation that was recorded, every blood result that came back. The medical records will include nursing notes, doctor’s notes, which document observations, vital signs, nursing, medical interventions, almost hour by hour, that document doctors’ assessments, nursing assessments, and clinical decision making. Medication administration records documenting every dose of Levophed and every other medication given and when. Ventilator charts documenting the exact settings used and any changes made. Dialysis records documenting when dialysis was started, what mode was used, and what happened during it. Blood gas results documenting the exact values and when they were obtained. Resuscitation records documenting exactly what happened during the CPR and who was present. Death certificate and related documentation.

Without these records, you are working in the dark. With these records, you can get real evidence-based answers about what happened to your father.

And here’s how we can help you at Intensive Care Hotline, Leo. Because at Intensive Care Hotline, this is exactly the work we do. We help families who are looking for clarity and answers after a loved one has died in intensive care, or when a loved one is currently critically ill in intensive care, and the family needs support and advocacy.

Here is specifically how we can help you. Number one, thorough medical record review.  Our team will conduct a thorough, detailed review of your father’s complete medical records. We will go through the nursing notes, physician notes, medication charts, ventilator records, dialysis records, blood gas results, and resuscitation documentation. We will identify what happened in what sequence and whether the care your father received met the accepted standards. This is evidence-based, detailed, and honest. We will tell you what the records show, not what you want to hear. We will leave no stone unturned, and we have a team of legal nurse consultants here at Intensive Care Hotline.

Next, a consulting call with myself, or with one of my Intensive Care Hotline team will help you in multiple ways. We help you understand what happened to your father in plain and simple language. We help you formulate the right questions to ask. We speak directly with the ICU team on your behalf or with you, ask the hard questions, push for clear answers, and advocate for you and your family. Having someone in your corner who genuinely understands intensive care medicine, the medications, the ventilator, the dialysis, the physiology makes an enormous difference when you are trying to get to the truth.

Next, guidance on next steps, we can guide you on how to obtain the complete medical records, what to look for, and how to proceed if the review of the records raises concerns about the standard of care your father received.

So, what should you do right now, Leo? Number one, request the complete medical records immediately. Contact the hospital’s medical records department and request a complete copy of your father’s medical records without any delay. You are legally entitled to these records. Make absolutely sure you request everything: nursing notes, physician notes, medication administration records, ventilator charts, tracheostomy records, dialysis records, blood gas results, imaging, lab results, and all resuscitation documentation. Do not accept a partial set of records, and we can help you, even making sure the records are complete. We know what full complete medical records look like, because hospitals are often trying to shortcut releasing of medical records, and we often see that they’re not complete.

Next, do not sign anything from the hospital. If the hospital contacts you and asks you to sign any forms or documents, do not sign anything without fully understanding what you are signing; seek advice first.

Of course, contact us next at intensivecarehotline.com. We can schedule a consulting call with you as a first step, review your dad’s complete medical records, and help you get the answers you and your family deserve. You do not have to navigate this alone because your father’s life mattered, Leo. What happened to him matters, and you deserve an honest, clear, evidence-based answer, not dismissal, not vague explanations, and not silence. Whether the care for your father was appropriate or whether there were failures that contributed to his death, you deserve to know the full truth, and the truth is in those medical records.

Please reach out to us at intensivecarehotline.com today. Call us on one of the numbers on the top of our website or send us an email to [email protected]. And if your loved one is currently critically ill in intensive care and you’re watching this, get access to medical records now and contact us now, so that you’re not in a situation like Leo’s. We have saved hundreds of lives in intensive care with our consulting and advocacy, with our insights. And we bring in the leverage you so desperately need when you have a loved one critically ill in intensive care.

I have worked in critical care nursing for 25 years in three different countries where I worked as a nurse manager for over five years in intensive care. And I’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com. And I can very confidently say that we have saved many lives with our consulting and advocacy, because of our insights, and you can verify that on our testimonial section  at intensivecarehotline.com and you can verify it on our intensivecarehotline.com podcast section, where we have done client interviews.

And because our advice is absolutely life-changing, right? The biggest challenge for families in intensive care is simply that they don’t know what they don’t know. They don’t know what to look for, they don’t know what questions to ask, they don’t know their rights, and they don’t know how to manage doctors and nurses in intensive care. And that’s why we help you to improve your life instantly, making sure you make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets the best care and treatment always. And that’s why you can join a growing number of members and clients that we have helped over the years, saving their loved ones’ lives.

And that’s why I do one on one consulting and advocacy over the phone, Zoom, WhatsApp, whichever medium works best for you. And I talk to you and your families directly. I handhold you through this once-in-a-lifetime situation that you simply cannot afford to get wrong. And when I talk to families directly, I also talk to doctors and nurses directly, asking all the questions that you haven’t even considered asking but must be asked when you have a loved one critically ill in intensive care.  I also represent you in family meetings with intensive care teams.

We also do medical record reviews in real time so that you can get a second opinion in real time. We also do medical record reviews after intensive care, so, if, in case you have unanswered questions, if you need closure or if you are suspecting medical negligence.

We also have a membership for families of critically ill patients in intensive care, and you can become a member if you go to intensivecarehotline.com. If you click on the membership link or if you go to intensivecaresupport.org directly. In the membership, you have access to me and my team 24 hours a day in the membership area and via email, and we answer all questions intensive care-related. In the membership, you also have exclusive access to 21 e-books and 21 videos that I’ve personally written and recorded. And all of that will help you to improve your life instantly, make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets the best care and treatment always.

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Thank you so much for watching.

This is Patrik Hutzel from intensivecarehotline.com, and I will talk to you in a few days.

Take care for now.