Reliance on high-tech and high-turnover leading to lawsuits in ‘hospitalist’-heavy San Antonio

De La Zerda and her daughters ended up waiting in an ER for nearly two days before an observation room became available. She was alert, but hungry, anxious and eager to get back to Chandler when a health care worker administered blood pressure medication, according to relatives.

The family thinks steroids from breathing treatments raised her pressure. They warned the hospital that she could only take small doses of blood pressure meds, if any at all. About one hour after the pressure medication began, De La Zerda’s condition suddenly worsened, prompting doctors and nurses to rush the woman into an ICU, relatives said.

The disagreement escalated, the family says, when relatives objected to sedation with anti-psychotic drugs. Critics of the drugs include Dr. Louis R. Caplan, a professor of neurology at Harvard Medical School, who says hospitals overuse anti-psychotic meds to restrain “restless” patients in spite of evidence that the drugs impede recovery in the elderly. “My bias is against anti-psychotics for chemical restraint,” Dr. Caplan told the Current. “Anti-psychotics are not for someone with mild agitation, and they should never be used on old people.”

The timing of her hospitalization forced De La Zerda to miss the wedding of her neighbors — Jewel Etter and Holman Massey. De La Zerda was looking forward to the big event since her daughter, Reyna, organized a shower for the 93-year-old and 92-year-old. The fairytale story of their nursing home romance garnered multiple articles in the Express-News. Meanwhile, De La Zerda’s hospital stay, as her family describes it, descended into a Kafkaesque scenario more fitting for a Margaret Atwood novel, before her March 12 death.

Family members with power of attorney, including Reyna, attempted to remove De La Zerda from the hospital. As her condition worsened, they wanted to transfer her to hospice care, where they hoped she would rebound or, at the least, die with dignity. But the IPC hospitalist assigned to her care refused to recognize their legal position or release her, relatives said. At one point, the tension between the family and health care workers was so intense that hospital staff banned Reyna from the hospital and called the police to escort her off the property.

The family was especially upset after learning that the hospitalist — whom they say they rarely saw during the hospital stay — did not consult with De La Zerda’s family doctor before administering medications or ordering multiple tests, resulting in a $500,000 bill.

“We are aware of the De La Zerda family’s concerns. We welcome the opportunity to confidentially discuss these issues with them by phone or in a meeting,” said King, the Metropolitan Health care spokeswoman, in response to my questions about the case. “However, due to patient confidentiality, it is inappropriate for us to answer any of the family’s concerns through the media.”

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