“Your husband is dead,” the doctor told Linda Carswell.
This was not supposed to happen. Jerry Carswell had been admitted to Christus St. Catherine Hospital in Katy, Texas, with kidney stones. The previous night, he’d been walking around his room, talking about basketball and the upcoming presidential election with his son, Jordan. The plan was for the 61-year-old to be discharged that morning.
Instead, at about 5 a.m., a phlebotomist entered Jerry’s room to draw blood and found him lying across the bottom of his bed, not breathing, mottled and blue, without a pulse. Staffers performed CPR for 25 minutes to no avail. Carswell was pronounced dead at 5:30 a.m. Jan. 22, 2004.
Upon learning the news, Linda and Jordan Carswell rushed to Jerry’s bedside. Lying there, sheets and blankets folded halfway up his chest, he looked as if he could be dozing, except for the tubes running out of his mouth — remnants of the failed resuscitation effort. Linda shrieked and grabbed her husband’s cold hands, trying in vain to stir him.
The on-call doctor suggested that the Carswells authorize an autopsy, launching the family on a traumatic journey that still isn’t over.
Clinical autopsies, once commonplace in U.S. hospitals, have become an increasing rarity and are conducted in just 5 percent of hospital deaths. Grief-stricken families like the Carswells desperately want the answers that an autopsy can provide. But they often do not know their rights in dealing with either coroners or medical examiners, who investigate unnatural deaths, or health care providers, who delve into natural ones.
For the past year, ProPublica, PBS “Frontline” and NPR have examined flaws in the U.S. system of death investigation, finding that mistakes in America’s morgues have sometimes helped convict the innocent and allowed the guilty to go free.
The Carswells’ experience illustrates a different kind of injustice. Their case would play out in pathology labs, lawyers’ offices and courtrooms for more than seven years. It led to a rare $2 million fraud judgment against Christus St. Catherine, which was found by a jury to have deceived Linda Carswell about Jerry’s autopsy. It also led to state legislation designed to strengthen families’ entitlement to comprehensive, independent postmortem reviews.
It has not, however, led to closure or accountability. Thanks to an incomplete autopsy, Jerry Carswell’s cause of death remains unknown. He also has not been laid fully to rest. His heart, retained by the pathologist who conducted his postmortem examination, sits in a refrigerated cabinet in a hospital lab to this day.
None of the hospital employees involved in the Carswell case would answer questions from ProPublica. In a written statement, hospital officials said they provided good care to Carswell, and that his autopsy was sufficient.
Linda Carswell, an English teacher at one of Houston’s elite private schools, said her family’s macabre saga has left her lonely and disillusioned. She’s had to navigate complex establishments — medical and legal — while processing the shocking loss of her husband. Measured and proper, with black hair streaked by strands of white, she cannot seem to make peace with her loss.
Linda and Jerry, a history teacher and track coach, had been married for 33 years, raising two sons. She recalled how they would sit on the couch, her head on his chest, listening to the thump-thump of his heart. She is determined to get it back.
“It’s not just a piece of flesh,” Linda said. “Your heart stands for love. It stands for who a person is.”
Jerry Carswell had been a patient at Christus St. Catherine for two days before he died.
A scan performed on admission showed that, in addition to kidney stones, he had a cancerous tumor on one of his kidneys. It was in an early stage and not considered life-threatening, his hospital doctor said. At times, he was given medication to treat intense pain. He was administered the narcotic Demerol in the hours before his death, records show.
State law required that the hospital report Carswell’s death to the county medical examiner’s office because it was unexplained, unobserved and had occurred soon after he had received medical care.
But it’s unclear whether this step was taken. Hospital records show that the night administrator made a minute-long phone call to the medical examiner’s office at 6:35 a.m., but the office later provided an affidavit saying it had no record of the call.
It may not have mattered. Medical examiners rarely investigate deaths at health care facilities, experts say. Often, their resources are stretched by homicides, suicides and other suspicious deaths. They are seldom inclined to dig further if staffers at a medical facility ascribe a death to natural causes.
In court testimony, the night administrator at Christus St. Catherine said she had reported hundreds of hospital deaths to the Harris County medical examiner’s office and it had never taken a case.
As she sat with her husband’s body, Linda Carswell was unaware of the hospital’s reporting requirement, or that the medical examiner was supposed to assess his case. She and Jordan said no one at the hospital would answer questions about how Jerry had died. They knew Jerry had been administered narcotics during his stay and wondered whether the drugs had played a role in his death.
Linda said that when she asked Patty Elam, a daytime charge nurse, to call the medical examiner’s office to request an autopsy, Elam told her the office had turned down the case. Elam declined to comment for this story but said in court testimony that she did not speak with Carswell about the call to the medical examiner’s office. Linda did not press the matter further, a decision she came to regret.
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