Family wants answers after woman dies unexpectedly in mental health unit

Kary and her kids
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INDIANAPOLIS (WTHR) — An Indianapolis family is outraged.​

Kary Dangler's parents and siblings want to know how the 38-year old mother died, hours after checking into a hospital's mental health unit. Kary was diagnosed with bipolar 1, a disorder that isn't deadly in and of itself.

Kary Dangler

Now her family is speaking out about their fight to get details in what they call a case of medical neglect. 13 Investigates examines the timeline, the gaps and important information families need before a crisis hits.

Kary Dangler could have been anyone's next door neighbor. She was a young mother who cared deeply for her children and community.

In 2015, she appeared on WTHR talking about improving her west side neighborhood.

"There is so much potential here, " she said smiling and looking down at her newborn baby girl.

She was talking about the homes and businesses just south of the Indianapolis Zoo.

Bipolar Episode Escalates Into Crisis

Her calm and pleasant demeanor reflected life before her first bipolar episode in 2016.

Experts describe an episode as an imbalance in the brain causing drastic changes in mood, energy and the ability to carry out daily tasks. Sometimes there is psychosis, symptoms of mental illnesses that result in strange or bizarre thinking, perceptions (sight and sound), behaviors, and emotions; disconnection from reality.

That's exactly what doctors believe Kary experienced December 1, 2017. Her sister Shannon Poole got a call; Kary was hallucinating and hearing the voice of God. It was her third episode.

"Not combative, very sweet, huggy and weepy," recalled her sister, who convinced her mother that the only good option for Kary during this crisis was a visit to the closest emergency room. In fact, her words still haunt her.

"Mom get her to Eskenazi, or you're going to have to deal with me, and you won't like it," she said. But now, "I regret saying that to my mother every day. They did not take care of her," she told 13 Investigates.

Kary Dangler's Timeline: Dec. 1-2

AfternoonKary hallucinates, says she hears the voice of God
5:08 p.m.Kary arrives at Eskenazi Hospital Emergency Department. Doctor places Kary on emergency detention because of her symptoms and safety concerns. Kary is placed in behavioral restraints.
7:25 p.m.Kary is sleeping.
7:26 p.m.Medical staff records Kary's vitals, including elevated pulse and blood pressure.
7:39 p.m (approx)Kary transferred from Emergency Department to Midtown Mental Health Unit via wheelchair
12:30 a.m. (Dec 2.)Kary observed to be "up from bed in triage" while staff changed the sheets, according to notes filed by counselor at 1:20 a.m.; Counselor's notes report Kary was "too sedated to be assessed."
6:16 a.m.Medical record indicates Kary slept 8 hours, was drowsy and refused food.
11:22 a.m.Code blue called; Doctors report Kary was cold and in rigor mortis when they arrived; Chaplain arrived in Kary's room.
11:28 a.m.Kary is declared dead
1:50 p.m.Responding emergency room doctor lists Kary's death as "significant event."
2:27 p.m.Marion County Coroner's Office removes body.
3:10 p.m.Chaplain meets with Kary's family; Chaplain's notes say the family expressed anger and said they felt like the hospital was trying to hide something.

Kary checked into the ER just after 5 p.m. on December 1. A check of her vitals revealed a dangerously high pulse rate at 130 beats per minute.

Medical experts consider a resting heart rate above 100 beats per minute dangerous, even for an agitated patient who is bipolar. But records show there was no follow up on her racing heart by hospital or mental health staff.

Just One Set of Vitals Taken Despite High Pulse Rate

"That was the only set of vitals that was done," said Shannon pointing to the numbers as she combed through the medical records her family fought to get.

Those same records show Kary was sedated, put in restraints and a "blue suit." Some facilities use certain color bed gowns for patients being admitted to mental units as a form of easy identification in order to prevent the patient from eloping from the facility.

Eskenazi Health

Doctors said "she was a danger to herself and others ... flailing on the bed."

They also wanted to make sure she didn't escape.

By 8:30 p.m., doctor's orders came for "emergency detention." Kary was transferred to the 10-bed Midtown Mental Health Triage unit inside the hospital.

That unit was supposed to be her lifeline.

Shannon said the family believed this was the best place for Kary at the moment. "You know like it's going to be fine. She's not going to die of this, nothing is going to happen to her," she said, describing what they were thinking when doctors chose to admit her for a stay.

But later that night, Kary's mother discovered her daughter was listed as a "no info" patient. Kary had no living will, power of attorney or mental health surrogate, so her family was locked out of her care.

Only after her death and with a legal subpoena could they get access to her medical records to tell her story.

At 12:30 a.m. on December 2, 2017, Kary was seen "up from bed in triage." That's according to a social worker who saw the note in Kary's chart. She was not in restraints but "still too sedated to be assessed."

Family Discovers Possible Fall From Gurney

At some point, Shannon told 13 Investigates that Eskenazi Risk Management reported that Kary fell from a gurney and hit her head.

"We were all like what? That's no where in her chart, but risk management had a record of it," Shannon revealed.

On the night in question, nothing is charted for Kary from 12:30 a.m. until shift change.

Shift Change Entry Conflicts With Timeline

At 6:16 a.m.,almost 45-minutes before shift change, a nurse reported Kary had been asleep for 8 hours, was drowsy and refused a meal.

However, medical notes had that she had been up just 6 hours earlier.

Then at 11:22 am, after five more hours, a code blue. A code blue is an emergency alert generally announced over a speaker in a hospital setting to indicate a patient is in need of resuscitation or immediate medical attention, most often as the result of a respiratory or cardiac arrest.

Kary was pronounced dead 6 minutes later.

According to two ER doctors who responded to the code blue, Kary was "cold and in rigor mortis."

"She was already stiff and cold by the time they found her," Shannon said. "Kary was probably dead 8 hours prior to that. That's what it says to me."

Rigor Mortis Sets In Within 6 to 8 Hours of Death

Rigor mortis generally starts 2 hours after death and settles in between 6 and 8 hours. It's troubling because a nurse said Kary refused food and was drowsy within that time frame.

"This negligence is horrifying," said Shannon with eyes full of tears.

13 Investigates asked Eskenazi what happened to Kary and about the staffing in the mental heath unit. No one would speak on camera.

"You Don't Die From Bipolar Disorder"

13 Investigates took its questions about bipolar disorder treatment to a psychiatry expert and researcher at the Indiana School of Medicine. Dr. Alexander Niculescu III sat down to talk about the benefits of getting treatment before a crisis hits.

"You don't die from bipolar disorder," he said. "It's highly, highly unusual."

Instead, he said data shows more patients die as a result of not getting treatment, mostly due to suicide or bad decisions. In 20 years of practice, he's only heard of a few patients dying while seeking care.

"It's a tragedy that something like this happens," he told 13 Investigates.

Dr. Niculescu did not review Kary's case specifically, but said in general, "These are highly manageable, sometimes lifelong disorders that if managed well, should not impact the quality of life."

Dr. Niculescu urges patients to continue to seek treatment to avoid crisis episodes, "We do have effective medications. We do have effective therapies that together can keep people functioning well. There are a lot of famous people throughout history who suffered Bipolar, Winston Churchill, VanGogh." he said.

Marion County Coroner Can't Determine Root Cause of Death

The Marion County Coroner's Office ruled Kary died of an intestinal hemorrhage but can't say what caused it.

"That first finding of bleeding out in her abdomen was just shocking," said Shannon. Especially because emergency room doctors had noted that Kary's abdomen was soft and autopsy reports showed no "free fluid" in her body.

According to Kary's family, Midtown administrators admitted Kary was monitored by video and "hearing checks." A hearing check means basically looking at her from the door of the room. Michelle O'Keefe, an Eskenazi spokeswoman later told 13 Investigates, "It is the practice of Midtown Triage that all patients are monitored by video as part of the ongoing assessment process, so there is no specific policy on video monitoring for that unit."

Internal records provided to 13 Investigates by Marion County Health & Hospital Corporation, the entity that oversees Eskenazi and Midtown Mental Health, shows just one registered nurse and a support worker regularly staffed in the unit. That was the staffing level in the 10-bed area when Kary died.

Hospital Investigates Kary Dangler's Death as a Significant Event

One of the Eskenazi ER doctors who responded to the code blue later called Kary's death a "significant event." That prompted an internal investigation. According to Eskenazi's Comprehensive Performance Improvement/Patient Safety Plan, a review is required after an unexpected event resulting in death and a "root cause analysis is initiated within five (5) days of notification of the event." The findings are submitted to the Medical Staff Oversight Committee and then forwarded to the appropriate departments to make necessary improvements. The event is also reviewed by the Quality Subcommittee of the Board.

"Something wrong happened here," said Shannon, who also works in the medical field and is familiar with outcomes that prompt those types of investigations. Eskenazi is not required to release the findings of its internal probe. The review is supposed to help hospitals and their staff to understand what what happened in order to prevent other adverse outcomes. Shannon and her family want answers. too. for themselves, and Kary's preschooler and teenage daughter who now have to grow up without their mom.

"Kary's going to miss out on France's black belt and all of Lucy's life," she said trying to wipe away a steady stream of falling tears.

"It doesn't make sense. I'd like to know how my sister died," she said.

In a statement, Dr. Ashley Overley, CEO Midtown Community Mental Health said:

"Our mission is to serve individuals with serious mental illness and chronic addiction. These issues are often extremely complex and difficult for all involved, especially individual patients and their loved ones. We care deeply about people who experience mental illness, and we must prioritize dignity and respect for this vulnerable population, which includes confidentiality across the continuum of care."

Kary's family has obtained an attorney to help navigate the mental health system in hopes of getting more details.

They don't want any other family to suffer the same plight and urge families to get those important decision-making documents signed that will allow a designated person to be involved in their loved one's care.

Ensuring your care

WHAT IS AN ADVANCE DIRECTIVE?

“Advance directive” is a term that refers to your spoken and written instructions about your future medical care and treatment. By stating your health care choices in an advance directive, you help your family and physician understand your wishes about your medical care. Indiana law pays special attention to advance directives.

POWER OF ATTORNEY

A “power of attorney” (also referred to as a “durable power of attorney”) document is used to grant another person say-so over your affairs. Your power of attorney document may cover financial matters, give health care authority, or both.

LIVING WILL

A “living will” is a written document that puts into words your wishes in the event that you become terminally ill and unable to communicate. A living will is an advance directive that lists the specific care or treatment you want or do not want during a terminal illness.

PSYCHIATRIC ADVANCE DIRECTIVE

Any person may make a psychiatric advance directive if he/she has legal capacity. It expresses your preferences and consent to treatment measures for a specific diagnosis. The directive sets forth the care and treatment of a mental illness during periods of incapacity.

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