A widow’s quest for autopsy answers is a years-long struggle

“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.

The DASH Diet and Why It is One of the Best for Everyone

Pop diets come and go but it seems the DASH diet is here to stay. DASH stands for “Dietary Approaches to Stop Hypertension.” Beside lowering blood pressure and cholesterol, the DASH diet is associated with a lower risk of kidney stones, cancer, stroke, heart failure, heart disease and developing diabetes. On November 1, 2011, US News and World Report ranked it one of the healthiest diets for the entire family.

US News and World Report reported David Katz, director of the Prevention Research Center at Yale University School of Medicine, said, “Most diets aren't about the family, and that really is a fundamental flaw. It is typically an every-man-for-himself scenario, and inevitably, people leave their families behind.”

The DASH diet is family-friendly, making it a top choice for all kinds of people. While it deflates blood pressure, it also keeps weight in check. The DASH diet is easily tailored for everyone from children to seniors. Meals include vegetables, fruits, fat-free or low-fat dairy, lean meant, poultry and fish and grains. Included in the diet are buckwheat pancakes, fruit smoothies and southwestern-style potato skins.

Teresa Fung, a nutritionist at Simmons College in Boston, said, “I don't think the typical American diet looks anything like DASH or Mediterranean. Most families get pizza or go out to eat twice a week.” She stated moving a step closer would be an improvement for families.

According to the DASH diet website, the diet is recommended by physicians for people with hypertension or pre-hypertension. The National Institute of Health sponsored studies and found the diet plan has been proven to lower blood pressure.

The DASH diet is low sodium and endorsed by several health industry leaders including the American Heart Association, the Mayo Clinic, the National Heart, Lung and Blood Institute and the 2010 Dietary Guidelines for Americans. The DASH Diet also was the basis for the USDA MyPlate. The DASH diet is low fat, high fiber and rich in potassium, magnesium and calcium.

Benefits of the DASH diet include lower cholesterol, weight loss and maintenance and reduced insulin resistance. It can even improve the response to medication for people with severe hypertension.

While the DASH diet may have the same name as the Kim Kardashian store "Dash," there is no connection to the socialite. Other family-friendly diets that landed on the Best Diets rankings of U.S. News include the Mayo Clinic Diet, Mediterranean Diet, Vegetarian Diet and Volumetrics.

Should the FDA to remove weight-loss drugs like Alli from the market?

When you take a weight loss drug that contains orlistat, about a quarter of the fat you consume passes through the body undigested and is excreted. Drugs that contain orlistat have been associated with severe liver injury, kidney stones and pancreatitis. Two weight-loss drugs that contain orlistat are Alli (generic) and its prescription form Xenical. Alli is available over-the-counter. Recently Glaxo decided to get rid of Alli according to a report in the Wall Street Journal: Glaxo to Shed Its OTC Diet Drug, Alli

Dorry Samuels of Public Citizen reports that Public Citizen petitioned the Food & Drug Administration (FDA) on April 14, 2011 to remove two weight-loss drugs containing orlistat from the market because they can cause severe injury to the liver, pancreas and kidneys. Alli has 60 mg of orlistat per pill and Xenical contains 120 mg per pill. The weight-loss benefits are marginal and the risks are high.

In April 2006 Public Citizen petitioned the FDA to remove Xenical because it caused pre-cancerous lesions in the colon. The FDA refused to remove the drug. Many cancers including pancreatic cancer are thought to be associated with inflammatory processes such as painful pancreatitis which may be a precursor to pancreatic cancer, a major killer and basically untreatable. The liver, kidneys, pancreas and colon do not need any more abuse than they already get. Alli and Xenical appear to trigger the destructive processes when a meal contains high fat content in the range of 15 grams or more. The first signs are upset stomach, loose stool and other digestive upsets.

According to Public Citizen the FDA Medwatch reported 47 cases of pancreatitis (39 were hospitalized and 1 died) and 73 cases of kidney stones (23 were hospitalized). Public Citizen reports that 3 people taking orlistat developed acute kidney failure because calcium salt crystals formed throughout the kidneys. Although use of the drugs is declining, there were still 110,000 prescriptions of Xenical in 2009. The percentages and trends are of little importance to someone who takes the drugs and develops a serious health problem.

How do you feel about the FDA allowing a drug with this history to get on the market in the first place and then stay on the market with the known consequences? It seems shocking to me.

To protect yourself and your family from dangerous drugs go to WorstPills, a website created by Public Citizen to get the truth out about dangerous drugs. Better yet, join Public Citizen and support their work on behalf of consumers. Public Citizen is hands down the best consumer organization in the United States. Robert Weissman leads the organization which stands up to the powerful forces of government and corporations. I am a member and support the work of Public Citizen. If you want to contribute to a great consumer organization, Public Citizen will use your contributions well.

Extra Pounds Increase Chances of Kidney Stones

ISLAMABAD : The more overweight a person is, the more likely he or she will have kidney stones, says a University of Texas Southwestern Medical Center study in the April issue of Kidney International.

This is the first study to identify a direct link between excess body weight and uric acid kidney stones, which occur in about 5 percent of kidney-stone patients and in about 30 percent of diabetics with kidney stones.

"This is yet another price to pay for being overweight or obese," Dr. Khashayar Sakhaee, a professor of internal medicine and program director of the General Clinical Research Center (GCRC) at UT Southwestern, says in a prepared statement.

Kidney stones form when waste materials in urine do not dissolve completely. Starting as microscopic particles, they eventually grow into kidney stones, which remain in the kidney or break loose and travel down the urinary tract.

Sakhaee and his colleagues tracked about 5,000 kidney-stone patients in Dallas and Chicago. They found that overweight and obese people were more likely to develop kidney stones, even if they restricted the types of food they ate. The results were the same for men and women.

"Larger people have very acidic urine even when they control their diets. Other studies we have done in the GCRC support this concept. For the first time, we are advising weight loss as part of our therapy. That connection had not been made in the past," Sakhaee says.