Piss Poor Pre-hospital care in the juvenile justice system!

[Alcomedicism]

This article was published in the 6/15/2005 edition of the Arkansas Democrat-Gazette newspaper. This is the story of a teen that cried for help and got little in return.

LaKiesha Brown has slept throught the night but awoke on April 9th exhausted.

Instead of dressing for breakfast, "Keisha" remained in her small metal frame bed.

Her lips were pale and dry. She was thirsty.

For most of her 17 years, she felt abandoned and unwanted. In just over two hours, she was going to die. Employees at Alexander Youth Services Center, a state juvenile lock-up facility where she had lived for nearly two years, asked the nurse to check on Keisha.

Nurse Lynetta Buckley arrived about 6:20 a.am. Keisha's eyes were closed, and she responded only after Buckley called her name and shook her.

Her pulse and respiration levels were slightly high, but Buckley said they were normal.

"Client very weak" Buckley later wrote in a report about that visit. By the time the nurse left, she thought her patient appeared more alert.

A worrited employee has asked treatment supervisor Joy Cole if Kiesha whop had been placed on bed rest, could eat in her room. "Make Keisha put on her clothes and go to breakfast, because security was not going to bring her food to her," one employee wrote later that morning recording Cole's orders.

two month's later, an internal investigation by the state Youth Services would cite "credible evidence" that Cole's supervisor, program director Joann McCoy, violated policy by telling Cole to send Keisha to the cafeteria. The report also found nurses should have called a doctor about Keisha's condition and the Cole dismissed an employees request to call an ambulance for Keisha, and also found that several employees failed to document her failing condition.

An investigation by the Arkansas State Police into Keisha's death produced no evidence of criminal wrongdoing.

But state legislators want to know exactly how Keisha was treated in the final hours before her death. So far, Youth Services Division officials have declined to comment, citing federal patient privacy laws (HIPAA) and state youthful offender-laws. A joint meeting of legislative committees that deal with youth services is to discuss the case today at 1:30 pm.

Most of the adults who knew Keisha best - employees who saw her everyday - delined the Arkansas Democrat-Gazette's request for an interview, did not return messages, or could not be located.

Officials with the state Department of Human Services, the agency responsible for Alexander, declined to discuss Keisha's case, citing federal patient privacy laws (HIPAA)

But employees at Alexander are required to keep meticulous notes, and those notes, along with medical and phsyological records obtained by the Democrat-Gazette, tell the story of the end of Keisha's life.

When Keisha was born, her mother was a 17-y/o high school dropout with a toddler. The club life - with its late nights and fights - excited Michelle Brown more than full-time motherhood.

"I just didnt want to have another baby," Brown acknowledged

So she sent Keisha to live with her grandparents and father in Osceola.

Only after Keisha's death did Brown learn through psychological evaluations that Kiesha was devasted and had complained for years that her mother had abandoned her.

After giving birth to her third child, Brown brought 4 y/o Kiesha home to Blytheville, but Keisha's hurt remained. In later years she would complain that Brown beat her, Brown felt that she was simply disciplining a daughter that was out of control.

Brown was still staying out late she recalls now. She dated the wrong men and didnt have alot of money.

When Keisha's older brother was 10 she came home and the first question was "Who did you fight tonight?" Thats when Brown realized she needed to make some changes. But she couldnt change Keisha.

There is a Poloroid picture of Kiesha in elementary school. Her hair is neatly braided back and she is snuggling into her mothers arms on a sunny Easter. She is wearing a black dress with puffy sleeves and bright colored flowers holding a basked made by her beloved "Granny Pooh" before Granny Pooh was sent to prison for selling drugs.

Nothing in the photo gives away Keisha's secret - that she was being sexually abused. The abuse continued into her adolescence.

At age 12, she told her mother about one incident, her mother filed a report with the police but no charges were filed.

She also learned to play a game most children her age couldnt fathom, called "hide-and-go-get-it" One person closes their eyes and counts while everyone else hides. Who ever he finds one of the hiding, the two of them would have sex.

In those days Borwn worked 12-hour shifts and often left the kids unsupervised. Keisha was smoking marijuana and defying her mother. She ran away from home several times.

she called bomb threats to school and school officials complained she broke every rule she knew about.

Once when police hauled her to jail for disorderly conduct, she snorted coke in her cell in hopes she wouldnt get caught.

As her life spiraled out of control over the next three years, she became suicidal and went in and out of psychiatric and juvenile detention facilities.

One day when she was 15, Keisha failed to show up for cometology class, and Brown tracked her to a crack house. shje waited outside all day, yealling at approaching customers and screaming at dealers that they wouldnt make money as long as Keisha remained inside.

When Keisha finally came out, Brown called police.

"I cant stand you, I cant stand you," shouted Keisha at her mother, "Why did you call police?"

The answer though clouded by anger at that moment, was clear to Brown.

"It just got to the point that every time I turned around, I had to go track her down, I had to go look for her." Brown recalled. She could no longer handle Keisha, who was by then 200 pounds and taller than her mother. "I always said I didnt ever want to find her in a ditch."

After bouncing from from a juvenile center to home and back again, Keisha landed at Alexander in April 2003.

Like Kiesha, Alexander also has a troubled past.

It is the states largest juvenile lockup facility. and workers there deal with 140 of the worst offenders at the time.

Over the years, inmates have complained of workers kicking, slapping, even threatening them with death. Others have killed themselves there.

One boy, known for days to be suicidal was able to hang himself because the guard didnt check on him. A few months later another committed suicide in the same cell - just as the state hired Cornell to sort out all of the problems.

In 2002, the U.S. Department of Justice found that dozens of problems were terminated but many reamained. The state said it would be six months or more before all problems could be resolved.

In September 2003, Keisha was transfered to Aleaxnader but then was transferred back out after another inmate accused her of rape, she later pleaded guilty to the charges and was placed back at Alexander for the final time in November of 2003.

Eventually Keisha's behavior began to change. By late 2004, written complaints about her agressive behavior stopped. Her suicide attempts stopped too.

she earned her GED and send black-and-white copies to her relatives.

She finally began to think about her future, beyond her May 1,2005 release date and hoped to someday help other girls in her situation, and idea she put into a poem in November:

The revelation of Gods plan is so near

Its come to me, but not in a dream

Im suppose to help others as part of a team

We will start up a home for other lost souls

To teach them Gods word, and help them reach their goals

So when someone else finds their self in my place,

They can turn to the Lord and seek His face

No matter how bad you situation may be,

Remember Jesus saved a hopeless case like me.

Brown, who lived about three hours away visted Kiesha for the first time in two years just a few weeks before Keisha died. She hadnt visited sooner because she didnt want Keisha to think she approved of her bad past behavior.

But now she felt Keisha had found some answers and moight someday lead a normal life. Just when they had begun mending their relationshipm Brown would later say, Keisha died becuase the medical staff brushed aside her complaints.

(More in next post)

[THE_DITCH_DOCTOR]

She screwed up and she paid with her life. If she hadn't have been a crack addict she wouldn't have wound up in the situation she was in. Her prior abuse is no excuse. She's is the one solely and totally responsible for her situation, in fact she probably received more medical attention inside the detention center than she would have as a roving crack addict.

[Ridryder 911]

You have to own up for yourself... take responsibility, good or bad. That is called maturity. Everybody has problems, to what degree they are interpreted & how a persons react & decide how to handle, is another thing. We can also show articles of success, of post incest, rape, warfare trauma. It is how you handle, what you what to do, with your scars, that makes the difference.

Be safe,

Ridryder 911

[Alcomedicism]

(Continued from last post)

The medical staff at Alexander had a forced familiarity with Keisha.

In late 2004 and into 2005, Kiesha routinely asked for medical attention.

But the nurses who staffed the facility until 20 everynight and on-call doctors didnt believe she was sick, according to their notes. Psychiatrist Richard Livingstong described Keisha as 'hysterical'.

On Dec. 30th, 2004, Keisha spent most of the day at school screaming and crying that her back hurt. The same day she wrote a 3-page-letter begging for help.

...My medical conditions are being ignored and neglected. I have taken proper commands for attention. I've been complaining for exactly one week about my back being hurt.

Nurse Kimberly Colcough received the hand written greivance and typed a response.

The nurses, Colcough wrote, found nothing wrong with Keisha.

about a week later, Dr. Robert Choate, a North Little Rock Pediatrician on contract with Alexander, examined Kiesha. choate ordered her to see a psychologist in hopes of curbing her complaints.

"She was counseled that her chart had more complaints than anyother and that could negatively affect her Mey 1 release date." and that she had lost all credibility with the Alexander staff.

The medical staff tested her for a possbile urinary tract infection, her redords show, but ordered no other tests.

For four weeks, Keisha quit asking for help. But by February, she renwed her medical complaints

BACK PAINS

Having asthma attack

chest and back pains, been coughing & wheezing alot today.

I early February, Chaote refused to see Keisha. HJe later wrote that her request for attention appear to be manipulative and not valid.

On Feb. 6 she again filed a grievance.

I've been writing sick calls about my chest and breathing. [A]ll the nurses here have been telling me they cannot do anything. Ive been hurting like this since Wednesday and the doctor refused to see me.

I feel my medical concerns are being ignored.

"That was Keisha's standard response with every complaint that she brought to us, whether it was a stubbed toe or shortness of breath," Choate said in a phone conversation on Monday.

Three days after Keisha filed the grievance, Colcough wrote Choates:

"This is becoming a problem becuase she is crying in tears everymorning that she cant get out of bed or walk to the kitchen. She is also missin groups and gym... I have multiple staff approaching me daily on her situation. I have been instructing staff that she is to continue to participate in everything and to be held accountable for her behavior if she doesnt.... it is becoming very time consuming for me."

But Keisha kept on.

I am short of breath at all times even worst when I lay down.

Chest is tight. Having difficulty breathing.

Chest and back aches when I breathe.

Eventually Keisha's therapist confronted her, warning that her behavior could 'negatively affect her release date.'

Within days, Keisha stopped asking to see the nurses.

From Feb. 17 until her death she only requested medical attention twice, once for dry skin and another for a broken tooth.

But she told her family she was still ill.

On Feb. 19, three days after her last written complaint about her back and breathing, Keisha wrote her Granny Pooh.

Things are getting a little shaky for me. I plan on hanging on though.... I been sick alot lately. These nurses here suck. My back hurts alot. When I breathe a certain way it hurts in my left rib.

They tell me I am not hurting but I stay strong anyhow.

In the end, when Keisha lay dying no one with authority to get medical help believed her.

But other employees at Alexander becema more concerned with her health.

The night of April 7 on the walk back from a softball game, she stumbled and fell. Although she didnt lose consciousness she did appear sleepy.

Nurse Colcough found Kiesha lying on the ground, face up and unable to move.

"I found nothing out of the ordinary" Colcoulgh wrote in an email to her bosses.

When Keisha nearly fell again, employess drove her to the infirmary.

Colcough told employess everything seemed fine.

"I was unable to find any physical findings of a serisous medical problem that would render Kiesha motionless,unconscious, or unresponsive." Colcough wrote.

Employees took Keisha to her dorm. She did not come out to take showers or write letters as she usually did.

Cole, the medical supervisor, and Colcough believed Keisha was doing it to attract attention.

Keisha spent most of the next day on bench at school next to the office. Employees described her as very sick. To librarian Tressa Matthews, she seemed "pale and unable to move." Cole again instructed no special treatment.

The administrative assistant to the medical staff would later tell investigators that Matthews called and asked that Kiesha receive medical attention. But the assistant, said, that the medical staff thought it was another complaint from client Brown.

That evening, Keisha collapsed in the cafeteria. Case mamanger Mary Taylor repoarted Keisha's worsening condition, but Cole told her not to, according to the internal investigation.

When two nurses arrived, tey found Keisha sitting on the sidewalk, breating fast. As she had more than a month before, Keisha said her chest felt tight, that she was short of breath and felt dizzy.

The nursr recorded her vital signs, including her pulse at 100 and her respiration at 30. A normal pulse in a resting adolescent is between 60 and 90 and respirations between 12 and 16.

Nurses did not notify Choate on April 7 or 8, he said.

"I would have liked it if they had, but then I have to rely on their judgement." Choate said.

He believes he and the nurses provided Kiesha with good medical care.. They ahd no idea, heasid, that she might be suffering from blood clots in her lungs.

A preliminart autotopsy report shows that those blood clots likely traveled to her lungs and killed her.

"Even with good care people get sick," Choate said. "Her nurses and me cared for her more than her family did."

Dr. Barry Brenner, who heads the emergency department at the University of Arkansas for Medical Sciences, said in an interview with Kiesha's respiration and oxygen level at wich was 95 percent, were alarming.

Vital signs exceeding normal levels combined with complaints of shortness of breath and chest pains often signal heart problems or pnuemonia, said Brenner, he never treated Kiesha but discussed the aspects of her condition with Democrat-Gazette.

"Because the pulse ox and respiratory rate, you get an evaluation in the emergency room, which includes a chest x-ray, and EKG, and a blood gas," Brenner said. "I bet something would have been wrong on those things."

"But you dont know unless you look."

The night before Keisha died, no one looked.

Instead, the nurse gave Kiesha two puffs from her asthma inhaler, put her on bed rest and left.

7:20 am: Shift supervisor Eva Davis walked with Keisha as she shuffled the 350 feet to the cafeteria, stopping twice to allow Keisha to rest.

Daivs urged Kiesha to eat at least a little food and to at least drink her orange juice. Eventually, Keisha ate a few bites, her ehad resting on the table the whole time.

Arkansas State Police special agent Mike Dawson would later note that McCoy, the program director and second in command at Alexander, told him Kiesha "ate good" that morning.

Just before 8, Davis and Keisha left the cafeteria.

Keisha was too weak to make it back to her dorm, so employee Fannie Holt directed her to the gym, 50 feet closer.

As they walked, Keisha could barely breathe. Once in the gym, she crawled onto a greene and white gymastics mat while other girls played basketball.

"Keisha-baby, are you OK?" a 16-y/o friend asked.

"Im cold, Im cold" Keisha responded in a faint whisper.

Kiesha was covered in chill bumps, and her teeth chattered. Friends covered her with jackets.

Keisha's lips were white and cracked just as the ywere the day before. the skin around her eyes was pale. Her dark hands looked purplish blue.

At an employees request, nurse Buckley brought Keisha's asthma inhaler and again checked her vital signs, though no one recorded them.

Buckely gave Keisha 400mg of ibuprofen equivalent of 2 tablets. In Kiesha's chart the nurse noted that the medication was for "minor pain/toothache/fever."

About 20 mins later, Davis asked Holt to take Keisha back to the dorm.

9:15 am: Three employees and an inmate carried Keisha to the infrimary.

At first some staff were un-concerned. A video srveillance tape shows three employees near ner feet, laughing and talking for several minutes.

But her condition quickly deteriorated.

As she lay on the couch, she tugged at her clothed, moaning and gasping for air.

Her pulse and blood pressure dropped.

Ger breathing became labored.

Her lips and fingernail beds were white.

She lost consciousness

"Kiesha" employees called.

nothing.

One of the nurses called Choate at 9:22 am

As they discussed Keisha's vital signs, the nurse suddenly said,"Doctor, I think she's gone."

"Have you called 911?" Choate asked.

9:28 am: Nurse Buckley called 911.

Though standing orders from a doctor and the facility's written nursing protocols require staff to give a patient oxygen and an adrenaline shote during a respiratory emergency, the medical records show they did neither.

Keisha had no pulse.

she wasnt breathing.

Her eyes rolled back, her face was cold.

One employee suggested the nurse try CPR.

But nothing brought Keisha back.

In written reports about that morning, some employees would remember the last moment of Keisha's life in the infirmary.

As she lay dying, Keisha thrust herself into a near sitting position, grabbed an employee Kenneth Copperwood's pants leg, gasped loudly and collapsed - the last time she ever reached out for help.

[Alcomedicism]

Hey I was only taking this stright out of the newspaper, thought it was interesting to see what the overall EMT City opinion was of it. Now that I finally finished posting the whole story. I agree everyone is responsible for their own action (or inactions), IE - if Keisha has stayed off of drugs and out of trouble she never would have ended her life at Alexander, but then again its clear the medical staff did not want to take proper pt care. Crack addict or not, as healthcare providers are number one goal is to strive for quality pt. care. Not substandard care like this where the nurses dont even consider CPR until too late. Why was the hurse conferring with the doctor instead of calling 911??? The nurse knew the pt. condition was bad and she needed a doctor right away. The Alexander doctor who was in North Little Rock - 3 hrs away - at the time had to specifically tell the nurse to call 911. Either nurses dont know their sh-t or they simply did not care. The girl should have been sent to the doctor the first time she collapsed and V/S were out of normal parameters. That is my 2 cents for what it is worth.

-Alcomedicism

[Summit]

You can say she got herself into trouble all you want.

That is irrelevant.

What is relevant is did the medical personell act professionally and responsibly. Did they do their damned jobs?

That newspaper makes it look like the answer to that question is NO.

[THE_DITCH_DOCTOR]

She's combative and being belligerent. Sounds like they did everything that could be reasonably expected. PE is notoriously hard to diagnose even in a perfectly well behaved patient, let alone one who is uncooperative and would to even a well seasoned observer appear to just be malingering. That would have been my assessment of this patient. Like I said, I don't see anything wrong with the actions of the staff given what we know about the manipulative type of person the patient was. Her lying and deceitful ways cost her her life. I almost hate to say it but: Oh well, one less psychotic trouble making junkie.

[chipmunkemt_98]

I don't care what she did or how she acted in the past! This child had a legitimate health complaint, and as a mother of three children and a Paramedic, I know EVERY complaint made should be acknowledged not ignored. I have NEVER treated a frequent flyer on the ambulance any different than a new patient I have just met. EVERYBODY, NO MATTER WHAT THE COMPLAINT, SHOULD BE EVALUATED TO DETERMINE THE CAUSE! This is what lawsuits are made of!!!

[THE_DITCH_DOCTOR]

Stop and look at it from a logical standpoint- she was known to lie and was an uncooperative patient, with a condition that is largely diagnosed based on presentation. PE is difficult to catch even in the best of circumstances and this was far from that given the patient in this cases. She had a known condition which would have seemed to account for her SOB and chest pain, as well as her known propensity to lie to gain her way. There was no indication, until her collapse, that was some wrong more than perhaps her asthma being uncontrolled through poor compliance upon the part of the patient or a patient who was simply malingering to get out of work details.

Inmates are notorious for faking illness in order to get their way, so Chipmunk does that mean that everyone of them should get a V/Q scan to rule out PE? Who's going to pay for that in the patients with a low risk presentation, such as this one? Can we bill you for the $6000-7000 for each of those procedures? I'm sorry but there are just better things to spend my tax dollars on than on what would be in 98% of cases nothing more than a wild goose chase. But then I guess I'm not a good person because I don't feel all weepy over the death of this obviously shining member of society. Like I said, maybe if she hadn't been such a dirt bag, maybe she would have been a believable patient.

[Chris1066]

One line sums all of this up. The nurse called her "client" in the report. Who calls their patient a "client"?

Whatever she did before she was there, doesn't matter. I personally don't really give a rat's ass about her... personally. BUT, she was a patient / "client", and judging from what the report says, the staff there was either inept or just didn't give a crap. Or a combination of both.

While these types of people often do make up complaints and what not to get attention, there's several signs she started to exhibit that should have told SOMEONE that something was seriously wrong.