A family photo of Samuel Sweet fishing a few years ago on the Allegheny River.
By Sean D. Hamill Pittsburgh Post-Gazette
As far as Samuel Sweet was concerned, he only had a headache. It was a bad one, but nothing more, maybe something his chiropractor could fix with a little adjustment.
But three days after being admitted to UPMC Presbyterian for what his family was told was a treatable amount of bleeding on the brain, and six hours after his family saw him laughing and chatting about the Penguins' playoff chances, early in the morning of May 16, 2009, Mr. Sweet died unexpectedly.
Why he died is the subject of a civil case his family filed a few months later that is set to be heard by a jury as early as today in Allegheny County Common Pleas Court.
In the lawsuit, they allege a series of mistakes were made by his doctors and nurses. In particular, they claim that a doctor who knew Mr. Sweet was difficult to intubate -- that is, placing a tube into his lungs to help him breathe -- did not tell succeeding doctors. In addition, the lawsuit alleges while Mr. Sweet was in respiratory distress, a nurse improperly gave him a tranquilizer to calm him down, but it also stopped his breathing.
But in addition to the medical errors, through their attorney, Deborah Maliver, they also allege that after he died, hospital staff tried to cover up what happened by altering his electronic medical record. That's a serious claim that, if proven, could result in state sanctions against the staff members beyond any award in the civil case.
"Not only did the doctors fail at every step, but you dig deeper and there's more still," Mr. Sweet's son, Bill, 34, who is an operating room coordinator at UPMC Shadyside, said recently in an interview.
Instead of acknowledging their own mistakes in the case about Mr. Sweet's intubation problems and improperly giving him a tranquilizer, the lawsuit alleges the doctors and nurses later wrote notes that say Mr. Sweet refused intubation until it was too late, at one point slapping away a nurse's efforts.
"They're trying to blame this man; that he died because he refused intubation," Ms. Maliver said.
UPMC's lead attorney in the case, John Conti, said the claims of altering records are "repugnant" and untrue.
"The facts don't fit with the conspiracy theories as their lawyer puts forward," Mr. Conti said. "These doctors and nurses are people who tried to do their very best at the hospital."
"It's just unfair of their lawyers to try to create this aura of suspicion on the eve of trial," he said.
Mr. Sweet, who was from Cheswick, was 62 when he died, leaving behind his wife of 41 years, Janet, two adult sons and two grandchildren at the time. A former Marine who served in Vietnam, he spent the last 23 years of his life working as a mechanic for the Army Corps of Engineers in the Pittsburgh area, keeping the decades-old locks running.
"He was pretty much the center of our family," his son, Bill, said.
He loved to fish on the Allegheny River, work in his yard, attend Bible study at his church, and spend time with his family and friends, many of them people he worked with at the Army Corps, which placed its flags at half-staff.
Though he had been diagnosed with type 2 diabetes and hyperthyroidism in earlier years, they were being controlled with treatment, and he had lived a largely healthy life until 2009.
But on Monday, May 11, 2009 he woke up with a horrible headache that he thought was really the result of pain in his neck from sleeping awkwardly.
He went to work, but called his wife later in the day to tell her, "Man, this is killing me," and asking her to set up an appointment with his chiropractor.
The adjustment didn't work and on Wednesday of that week he went to the Veterans Affairs Hospital in Oakland and then was transferred to UPMC Presbyterian in May 2009. Tests showed he had a subarachnoid hemorrhage, or bleeding on his brain. An angiogram was performed to determine where the injury occurred in his brain and determine the underlying cause, such as if there was an aneurysm. But none was found and doctors told the family they could treat Mr. Sweet in the hospital with medication and he should be able to go home shortly.
To perform an angiogram at UPMC Presbyterian Mr. Sweet had to be intubated for surgery. During the intubation, the anesthesiologist quickly discovered that because of Mr. Sweet's short neck, being overweight, and having a small jaw, he was difficult to intubate. Special equipment would have to be used to get a tube properly down his throat to help him breath, equipment that allowed the anesthesiologist to do it without being able to see into his throat as you can with most people.
The anesthesiologist told Mr. Sweet's attending doctor, Raghavan Murugan, as well as Mr. Sweet's family, that he was difficult to intubate. But, according to the lawsuit, no one put that in his electronic medical record. And Dr. Murugan did not tell the critical care doctor on call, Penny Sappington, or the doctor who would oversee Mr. Sweet's care later, Amit Kaura. All three are named defendants in the lawsuit, along with Matthew Rosengart, a doctor who later tried to create an airway surgically. UPMC Presbyterian also is named as a defendant.
Not telling people that he was difficult to intubate meant that later in the week, after the tube had been taken out, when he began having trouble breathing because of pulmonary edema -- fluid buildup in his lungs -- that the doctors did not immediately call for specialized equipment and a special airway team for people like Mr. Sweet, the lawsuit says.
That's also the reason that Bill Sweet, who used to work at Johns Hopkins Hospital in Baltimore, where difficult intubation patients are immediately given green bracelets so everyone knows their situation: "If he was [at Hopkins] this wouldn't have happened."
When his family visited Mr. Sweet on the evening of Friday, May 15, he was chipper, talkative and happy. But five hours after they left, Mr. Sweet's breathing became increasingly difficult.
Dr. Kaura had authorized a nurse, Mary Bennington, to give him a tranquilizer if he got agitated. But, he later said in a deposition, he didn't mean for her to give it to Mr. Sweet if his breathing became an issue.
According to the official timeline the hospital gave the Sweets, Mr. Sweet stopped breathing at 1:18 a.m. At that point, doctors -- unaware that he was difficult to intubate, the lawsuit says -- worked on him for more than an hour trying to establish an airway without the necessary specialized equipment or personnel. By the time they were able to establish an airway, Mr. Sweet was brain dead.
But Ms. Maliver said UPMC's timeline came into question in early August 2011, when UPMC finally turned over -- after two years of discovery -- 1,200 pages of "results detail sheets" which show not only when something was written in Mr. Sweet's electronic chart, but who wrote it and how.
So, for example, Ms. Maliver alleges that the results detail sheets show that during the 21 minutes before Mr. Sweet was said to stop breathing, none of the information in his chart is straight from the computer monitors that would tell what his vital signs were during that period.
But the results detail sheets also show something more troubling, Ms. Maliver said.
She said she found evidence that three days after Mr. Sweet died, Richard Simmons, UPMC Presbyterian's head of quality assurance, tried to put a "Diff Intub" red-letter warning on Mr. Sweet's electronic medical record. That effort showed up on the results details sheets, according to Ms. Maliver.
Such a warning would tell anyone who opened the record that Mr. Sweet was difficult to intubate.
Dr. Simmons wasn't trying to alter the record, Mr. Conti said; instead he was in Mr. Sweet's medical record as part of the "peer review" process, assessing what happened in Mr. Sweet's case.
As part of that, he was in the medical record three days after Mr. Sweet died trying to figure out how one would create a warning about a patient's difficult intubation, Mr. Conti said. Moreover, Mr. Conti said, such a warning was irrelevant because "Dr. Kaura said he understood Mr. Sweet was a difficult airway just by looking at him."
Allegations that anyone at UPMC tried to alter the record after the fact "are entirely a fantasy of [Ms. Maliver's] imagination."
The day after Mr. Sweet stopped breathing and was declared brain dead, his family, abiding by his wishes, pulled him off the ventilator that had been keeping him alive and let him die.
Essentially the case will come down to two versions of what happened to Mr. Sweet and when, and who knew what and when about his condition.
"All I'm going to be asking is for a jury to decide what the truth is," Ms. Maliver said.