Mental Hospital

      An elderly gentleman was placed in a mental hospital when the family decided they were no longer able to care for him properly at home.  The man was diagnosed with "primary idiopathic dementia,"  the loss of intellectual function that often afflicts the elderly (dementia), the cause of which remains unknown (primary, idiopathic).
      He also had high blood pressure and required insulin injections to control his diabetes (high blood sugar).  Upon arrival at the mental hospital, he was in good physical condition.
      One week later, the patient's blood sugar was tested and recorded at 387 mg percent (normal is 65 to 115 milligrams percent).
      Despite the very high sugar level, no insulin was prescribed to lower it, and no further tests were performed.  After another week passed, the patient was visited by his daughter.  
      She was alarmed at his severely emaciated appearance and dehydrated state. The daughter angrily complained about her father's condition and requested that he be transferred immediately to the regional medical center.  The shift supervisor said that such a transfer would not be possible until the following Monday.  The daughter left the hospital to confer with relatives.
      Meanwhile, blood tests were obtained, apparently prompted by the daughter's visit.  The man's blood sugar was alarmingly high, as were his blood urea nitrogen and creatinine (these measure kidney function).
      Realizing his diabetes was severely out of control and that he was in kidney failure as well, the physician at the mental hospital had him immediately transferred to the regional medical center.
      He arrived at the new facility that evening.  The admitting physicians determined the patient was in diabetic ketoacidosis (the end-stage metabolic dysfunctional state caused by uncontrolled high blood sugar) and that he was indeed in kidney failure.
      At the new facility, aggressive treatment brought his diabetes and kidney failure under control, but he continued on a stormy course.  He developed circulation problems in his legs, which        

progressed to outright gangrene.  Both legs were amputated in an attempt to save his life, but, despite their best efforts, he died. 

Dr. Witherspoon says:

      Neglect.  Pure and simple.  It's hard enough for insulin dependent diabetics to keep track of their blood sugar when they have their wits about them, let alone when demented.
      This is an old story and, thankfully, not nearly as common as it was back then.
      But it still happens.  Staff members caring for institutionalized patients (mental hospitals, nursing homes, etc.) would do well to read about these cases and remind themselves to avoid the complacency  that leads to sad tales such as this.
      Those who walk the floors each day and carry out the rituals involved with the care of these folks may not notice the insidious changes that occur when some aspect of healthcare has been neglected.  In this case, when the daughter entered the ward, she had not seen her father for two weeks.  He was a ghastly sight! I'm sure the nurses were perplexed by her  response.  To them, he looked the same as he did yesterday.
      Well, no excuses.  One simply does not allow the blood sugar of a demented diabetic to get wildly out of control right under one's nose.  There's no way to wiggle around that.
      Remember: frequent visits are a wonderful incentive for folks to spiff the place up and look sharp.  When you visit mom or bad, cast a critical eye about.  Be complementary if you like you see and let 'em know about it if you don't!

Based on medical malpractice cases filed in the courts or personal experiences of practicing physicians.