Hypothermia, drugs cited in Emery death

This story was published on April 03, 2008 on Page A1 in all editions of the Bangor Daily News

AUGUSTA – An Eastport man released from a Machias hospital and into a snowstorm earlier this year died from an unusual combination of hypothermia and a drug overdose, an autopsy report has revealed.

The 15-page document, obtained Wednesday by the Bangor Daily News from the state medical examiner’s office, also concluded that the death of 61-year-old Reid Emery was an accident.

Jim Ferland, an administrator with the medical examiner’s office, admitted that the report – which is filled with details about Emery’s physical condition and the prescription drugs in his system – is complicated.

“There is no way I can make it any simpler other than to say his death was caused by a combination of environmental conditions at the time and the level of medication in his system,” Ferland said Wednesday by telephone.

Emery was a patient at Down East Community Hospital in Machias from late December 2007 to Jan. 1 of this year. At about 8 p.m. on Jan. 1, he was released against doctor’s advice. He reportedly walked out of the hospital disoriented and without a winter coat or appropriate shoes. Police found his body the next day in a snowbank near the hospital.

Emery’s autopsy was conducted by Dr. Marguerite DeWitt, deputy chief medical examiner. Her report shows Emery suffered little physical trauma before his death, aside from small abrasions on his right foot and left hand. She wrote that his skin was “cold and doughy,” but her external examination of Emery revealed little useful information, according to the report.

Although the initial examination took place on Jan. 3, the day after Emery’s death, the medical examiner’s office requested several additional tests, including toxicology reports, which weren’t completed until mid-March.Those drug screens showed Emery had five different medications in his blood at the time of his death. The drugs were: meperidine, a fast-acting opioid used to relieve severe pain; normeperidine, a variation of the same medication; trazodone, a sedative and antidepressant; fentanyl, an opioid with a potency more than 80 times stronger than morphine; and norfentanyl, a variation of the same drug.

Asked whether Emery still would have died if weather conditions were not a factor, Ferland said there was no way to determine that. Additionally, he said, there was no way of knowing whether Emery could have survived the cold overnight hours if the drugs had not been in his body.

“Hypothermia is rare in and of itself, but it’s not fair to compare this case with other cases,” Ferland said.

Deputy Attorney General William Stokes said in February that, based on the information the office had received by that point, no charges were expected in the case. Stokes, head of the attorney general’s criminal division, did not return a call Wednesday for comment.

Emery’s death prompted an investigation of Down East Community Hospital by the Centers for Medicare and Medicaid Services. CMS is a division of the U.S. Department of Health and Human Services that oversees health care coverage at U.S. hospitals and ensures compliance with certain federal regulations.

The monthlong investigation concluded in February with CMS submitting a “statement of deficiencies” to the hospital indicating, among other things, that staff failed to meet the needs of the patient.

The document, also obtained by the BDN, indicates that Emery was taking many different medications during his stay at the hospital, some of which affected his perceptions and cognitive abilities.

As part of the investigation by CMS and its subsequent “statement of deficiencies,” DECH was required to submit a plan of correction on how to address those deficiencies. That plan outlined numerous policy and procedure changes the hospital has instituted or plans to institute in the wake of Emery’s death.

In an e-mail statement to the BDN shortly after the investigation was complete, hospital President and CEO Wayne Dodwell expressed sympathy to Emery’s family for the unfortunate incident. He also indicated that DECH was working to ensure another patient wouldn’t suffer the same fate as Emery.

A hospital spokesperson did not return a call Wednesday for comment.

Attempts to reach Emery’s family also were unsuccessful. They previously have declined to comment extensively about the case but have said they are considering whether to pursue legal action against the hospital.



A1 for Thursday, April 03, 2008

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