Replies to This Discussion

Permalink Reply by Tamara Myers on March 6, 2012 at 3:33pm

This has struck a chord with me because I am a proud  mother of a mentally handicapped son with OSA and a Registered Respiratory Therapist that has chosen to focus my career in Sleep Disorders. I would like to weigh in on this tragic situation.  First of all, without seeing the full video AS WELL as the correlating information that the study was collecting, all the facts can not be known.  We are recording brain waves, heart rate and rhythm, respiratory rate and effort, and oxygen levels.  This information is analyzed by the Sleep Technician and helps determine whether the patient is in distress vs having some anxiety.  I ask ALL patients to begin on their back IF POSSIBLE.  It is absolutely true that OSA is usually worse when positioned on your back. However, if the patient is uncomfortable or unable to fall asleep, we aren't doing anyone any good, in addition to increasing patient anxiety because they worry that they won't/can't sleep, as they become more tired.  It is better for the patient to fall asleep in whatever position is comfortable for them.  Most of the time, one of two things will happen:  the patient will roll onto their back at some point during the study, or if they are unable to sleep on their backs, they usually have SA significant enough that it will be present in all other positions as well.

I do not believe that the parents should be blamed.   It is very difficult to raise any child, but a child with a mental disability is a unique challenge.  Depending on the disability, the ability to reason, sometimes even comprehend,  a situation is impaired, therefore consequences are misunderstood, if understood at all.  Parents of any child, can not be present 24 hours a day and control every aspect of that child's life.  If he required 24 hour care, his caregiver or parent should have been present with him throughout the study.  A sleep technician usually has more than one patient, and ANY patient that requires any kind of care requiring extended or frequent periods of time if taking that tech away from the monitors.  Many labs have multiple beds and multiple sleep technicians on duty, and therefore, monitoring of all the patients is done by another technician.  

In this particular case, I have to question why his team of physicians ( I assume from his multiple medical conditions he had several specialists treating him) hadn't sent him for a sleep study a long time ago?  I would be willing to bet that he presented with multiple risk factors and symptoms of OSA long before he completed this study.

I believe that every sleep technician, any caregiver, should be trained in CPR.  An defibrillator should be present in all sleep lab areas, not necessarily in every room. A policy should be in place for emergency situations that clearly communicates the step by step procedures per protocol.  

It is a tragedy that this happened.  It is also a tragedy that the family is pursuing civil action.  This will not bring him back, nor will it heal their pain.  Nor will blame.  This is a situation in which technicians, sleep lab directors, and patients can learn from.

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Permalink Reply by Rita Butler on March 6, 2012 at 3:44pm

I was never told to sleep on my back but told I could sleep on either side...to do what I did at home.  I feel this young man's doctor should be investigated also.  Before I had my study done I had to see a sleep specialist and was given a thorough examination.  He wanted to know what meds I was on and when was the last time I had an EKG done.  With this young man's medical history, someone dropped the ball big time and I'd start with his doctor.
 
ZolliStar said:

     Thanks for finding this Fox video, Mike.

     What was interesting is the fact that the patient was asked to sleep on his back. It seems to me that I was asked to lie on my back, at least in the beginning. I think we all know that's a problem for those of us with OSA, one reason so many of us (my hand is raised) are side sleepers.

     Also, I'm gratified to know that the tech did notice the distress and did go in to help the man. Alas, his overall health condition, including his heart condition, might have been just too serious for him to be able to survive the stress of the sleep study.

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Permalink Reply by ZolliStar on March 6, 2012 at 3:55pm

      Thank you for your experienced, thoughtful weigh-in, Tamara.

      You're right about how difficult/challenging it is to monitor a person's eating, something that's true even when the individual isn't mentally handicapped. I'm afraid I came down a little hard on the parents on this issue.

       I suspect that the thousands upon thousands of sleep studies performed every week with no untoward incident has caused us all to forget that things can go wrong particularly if an individual has multiple, unresolved health problems.

       Your last paragraph was particularly thoughtful and intelligent.

Tamara Myers said:

This has struck a chord with me because I am a proud  mother of a mentally handicapped son with OSA and a Registered Respiratory Therapist that has chosen to focus my career in Sleep Disorders. I would like to weigh in on this tragic situation.  First of all, without seeing the full video AS WELL as the correlating information that the study was collecting, all the facts can not be known.  We are recording brain waves, heart rate and rhythm, respiratory rate and effort, and oxygen levels.  This information is analyzed by the Sleep Technician and helps determine whether the patient is in distress vs having some anxiety.  I ask ALL patients to begin on their back IF POSSIBLE.  It is absolutely true that OSA is usually worse when positioned on your back. However, if the patient is uncomfortable or unable to fall asleep, we aren't doing anyone any good, in addition to increasing patient anxiety because they worry that they won't/can't sleep, as they become more tired.  It is better for the patient to fall asleep in whatever position is comfortable for them.  Most of the time, one of two things will happen:  the patient will roll onto their back at some point during the study, or if they are unable to sleep on their backs, they usually have SA significant enough that it will be present in all other positions as well.

I do not believe that the parents should be blamed.   It is very difficult to raise any child, but a child with a mental disability is a unique challenge.  Depending on the disability, the ability to reason, sometimes even comprehend,  a situation is impaired, therefore consequences are misunderstood, if understood at all.  Parents of any child, can not be present 24 hours a day and control every aspect of that child's life.  If he required 24 hour care, his caregiver or parent should have been present with him throughout the study.  A sleep technician usually has more than one patient, and ANY patient that requires any kind of care requiring extended or frequent periods of time if taking that tech away from the monitors.  Many labs have multiple beds and multiple sleep technicians on duty, and therefore, monitoring of all the patients is done by another technician.  

In this particular case, I have to question why his team of physicians ( I assume from his multiple medical conditions he had several specialists treating him) hadn't sent him for a sleep study a long time ago?  I would be willing to bet that he presented with multiple risk factors and symptoms of OSA long before he completed this study.

I believe that every sleep technician, any caregiver, should be trained in CPR.  An defibrillator should be present in all sleep lab areas, not necessarily in every room. A policy should be in place for emergency situations that clearly communicates the step by step procedures per protocol.  

It is a tragedy that this happened.  It is also a tragedy that the family is pursuing civil action.  This will not bring him back, nor will it heal their pain.  Nor will blame.  This is a situation in which technicians, sleep lab directors, and patients can learn from.

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Permalink Reply by Bob Plugh on March 6, 2012 at 6:55pm

A 25 year old, mentally limited patient's primary medical team is THEIR PARENTS.  And YES, HIS PARENTS failed him miserably.  There is absolutely NO indication that he was on any medication for ANY of those other symptoms - and from the looks of him, there is simply NO WAY he would be free of meds.

Matt said:

Let's see, the article says he was mentally-handicapped, and that his family says he was very overweight, and suffered from congestive heart failure, cardiomyopathy, diabetes and high blood pressure. That's serious stuff.

One could get into that condition, regardless of family. See it all the time at the VA hospital, with older patients.

So, I guess it could be said that his medical team failed him; that they shouldn't have risked the sleep study, or that the lab should have been better equipped to handle such a situation.

I didn't see where it said he was required to sleep on his back?

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Permalink Reply by B Robles MD on March 7, 2012 at 12:41am

Clearly there is a lot of emotion here that can be justified if in fact what is said is true.  Unfortunately the truth will likely not come out and we will only hear what lawyers want us to hear. If a patient falls out of bed and people just walk around him and look at him, that is unacceptable. At the very least they need to check on him and make sure he is ok.  This is basic for BLS (Basic Life Support) training.  There is no doubt that the individual pictured in the video is trying to get someone's attention, though I am not convinced he was in distress.  There was no audio that I could hear and to me it looked like he was waiving to get the staff's attention.  However, as I understand it, patients are not tied down and thus if he needed to get up, he certainly could have.  But consider what little we know.  This is a 25yo morbidly obese young man that had congestive heart failure and cardiomyopathy.  Just the stress of the night and the exam can certainly cause his heart to decompensate and spiral down and lead to death.  I do not believe it was the study that led to his death but rather it was a complication of his poor health.  More regulation will not change outcomes unless one is referring to incompetence or frank negligence.  Still there are licensing bodies that allow these centers to provide the services they provide and thus if the center fell short of what is necessary to provide safe care, then maybe the regulating body is at fault for failure to weed out poor care providers.  If the licensing bodies cannot weed out bad behavior, more rules will not either.  If rules and laws did anything, we would have empty prisons.  You cannot change bad behavior with more rules but you can certainly increase cost.

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Permalink Reply by Norm Bellas on March 7, 2012 at 3:54am

Astute observations. Thousands of studies, no problem. Poor guy had a slew of health problems.

Eventually, something had to go wrong through the law of averages. 

Especially astute: 

1) Can't legislate away all risk

2) Could result in studies denied for people with too many health problems, the people who perhaps most need it. 

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Permalink Reply by RockRpsgt on March 7, 2012 at 6:55pm

I have thought about this situation much since first hearing of it a year ago. While my wife has to deal with death quite a bit this is my biggest fear. I personally don't now how I would handle it.

 

In my time as a tech my biggest arguments have been over my refusal to run studies at certain locations. In my short time in sleep I have seen every type of pt from simple apnea to transplant pts. The lab has to fit the pt. If you have serious needs or concerns you may want to rule out free standing labs that do not have the means to take care of every possibility. Go to a hospital lab. These labs may cost a little more in the long run but are worth it.

 

For the record I work at a free standing private lab.

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Permalink Reply by Beverly Carter on March 8, 2012 at 1:13pm

This would be interesting to see if what the father said is true. How would he know his son was seen waving his hands? I would think "that" would not be shown to the parents until the legal department let it be seen or the police. I did not hear anything about the police in that video. But anyway, if what was going on was what the father said, I would not go to THAT medical facility at all for "anything". JMO

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Permalink Reply by Judy on March 8, 2012 at 6:28pm

His mother is quoted as saying that he was a medical assistant so one would assume if this were true then he was more likely mentally "slow" rather than actually mentally handicapped.

 

First reports mentioned cardiomyopathy but not congestive heart failure. My understanding is that anyone w/congestive heart failure is a walking time bomb. And thus any sleep study ffor this young man should have been done in a sleep lab w/full hospital and ER type of assistance immediately accessable.

I haven't seen the video simply because I have slow speed dial up and it takes FOREVER for videos to be viewable for me. However, the still pictures from the video I've seen, while he was definitely overweight he did NOT appear to be morbidly obese.

 

He looks like a very sweet young man and this was certainly a tragedy for him, for his family, and for Emory as well as the public's perception of sleep studies and sleep labs.

 

 

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Permalink Reply by Clare on March 13, 2012 at 8:33pm

Hope some good comes out of a very sad situation. the Sleep Labs in South Florida have very different levels of Quality from Top Notch- too very poor. Some higher standards are long over due. My heart goes out to the family.

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Permalink Reply by jeremy gober on March 20, 2012 at 1:21am

When this originally came out in the news the family was trying to push the race issue and even went as far as to say that he was a perfectly healthy normal 25 year old. Even though he was 350 lbs, type 2 diabetes and the long list of other heart and health problems. They want to blame the people that were trying to help him because he happened to die in the sleep center, rather than blame themselves for the previous 25 years of horrible parenting and watching over their sons health. It is just a super rare coincidence that he died the night of his study. In some labs the pt waves to the camera to get ahold of the tech when they need to use the restroom. He was waving awfully calm to have been worried he was dying. Reports when this first hit the news said that after waving and the tech came in he went to the restroom and when he came back he was not put back on for monitoring and later collapsed while not being monitored. There is a chance that there was some signs of impending cardiac failure but that has not been disclosed, might not ever be. It is sad that he died from this, he is not the first and most certainly wont be the last. More training is necessary to adequately screen for osa. There is also some studies that should be coming out in regards to SID's and OSA correlation. I have 3 sleep labs and am not worried about my pts dying from cardiac failure in spite of this one incident.

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Permalink Reply by Bill Walton on April 4, 2012 at 12:19pm

What the video showed was not "waving his hands in a plea for help" and no reasonable person would interpret it that way.  Since FOX tends to exagerate and plays up the worst in order to sensationalize, the fact that they didn't show any footage of the patient being "ignored there on the floor" and people "walking around him like a dog" would indicate that it didn't happen.

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