Medication help & natural death procedure

Sage said:

Hey, I'm searching for a medication (probably best if tends to be prescribed for an older person) that would present enough of a problem if the wrong amount was prescribed that a pharmacist might be moved to make a house call to correct the mistake, but not so much of a problem that negative effects would be apparent early on. The person receiving the medication is a bed-ridden old woman. It doesn't matter whether a pharmacist would actually make the house call, just that it be plausible to the family of the elder woman (since the pharmacist in question is not really a pharmacist).

Another related question: If someone dies of natural death in their house, especially if it's been a long-expected death, what is the procedure for the rest of the family? Assuming they know resussitation is not an option, who do they call?

Thanks in advance, especially since the latter one might be kind of personal. I appreciate it.

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The first person you call is the police...who then will call the coroner

On natural death...


It depends on the specific circumstance and likely varies from state to state but when my father-in-law died at home (cancer) as expected, the family was instructed to call the hospice people and then the funeral home. However, per my father-in-law's wishes, his sons and other family members were called first (by family who were present) and the other calls were not made until they had arrived.

johnnysannie said:

On natural death...


It depends on the specific circumstance and likely varies from state to state but when my father-in-law died at home (cancer) as expected, the family was instructed to call the hospice people and then the funeral home. However, per my father-in-law's wishes, his sons and other family members were called first (by family who were present) and the other calls were not made until they had arrived.

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I don't know about this johnny...even if someone is on their deathbed, the police must be called to rule out any foul play...or anyone that might want to speed that (death)up.
So sorry about your father in law.

My husband is a paramedic. He still gets called to homes after someone has died, even if it was an expected death. Sometimes it's because the family doesn't know if the person is really dead, other times it's because they need someone to transport the body.

In a case like this, they confirm the death (placement of EKG leads on the body to ensure the heart has stopped functioning, taking a temperature reading on the body, checking the pupils to see if they are fixed and dilated, examining the body to see if the blood has pooled towards the bottom of the body and to check for rigor.) They then have medical command call the coronor. When speaking to the coronor, they are always asked by him/her whether there is any appearance of foul play.

If the death was expected and there was no appearance of foul play, (i.e.--terminal cancer or disease process) the body might go straight to the funeral home. If the circumstances do look suspicious or the death is sudden and unexpected, the body gets transported to the hospital for the coronor to examine it.

In West Virginia, the police are supposed to at least show up at every unattended death. But they are rarely the first ones called in the event of an anticipated one, and they may call in their response.

In Ohio, where I live, we don't need a police officer--dealing with the coronor and the victim's own doctor is sometimes enough.

Hope this info helps answer at least some of what you need.

Sage said:

Hey, I'm searching for a medication (probably best if tends to be prescribed for an older person) that would present enough of a problem if the wrong amount was prescribed that a pharmacist might be moved to make a house call to correct the mistake, but not so much of a problem that negative effects would be apparent early on. The person receiving the medication is a bed-ridden old woman. It doesn't matter whether a pharmacist would actually make the house call, just that it be plausible to the family of the elder woman (since the pharmacist in question is not really a pharmacist).

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Sage, what sort of time frame are we taking about between beginning taking the drug and the visit? That would definitely make a difference.

kimmi 57 said:

I don't know about this johnny...even if someone is on their deathbed, the police must be called to rule out any foul play...or anyone that might want to speed that (death)up.

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Perhaps where you live, but it's not universally true. When my mother passed away from cancer, we did not have to call the police. We just called the hospice nurse, who I believe had the proper authority to do whatever she did. I don't recall if it was she who called the funeral home or one of us, but the mortician came later after the hospice nurse had come and verified that my mother had passed away.

Although we dealt primarily with the hospice nurse, the attending physician was still the one who had to put his signature on the death certificate.

No cops, paramedics, whatever at all.

kimmi 57 said:

I don't know about this johnny...even if someone is on their deathbed, the police must be called to rule out any foul play...or anyone that might want to speed that (death)up.
So sorry about your father in law.

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Not in Missouri - not when it is an anticipated natural death. In his case, there was no doubt that the death was due to cancer. His condition was well documented by his doctors, the hospice people, and in medical records.

As I said, I'm sure such things vary from state to state and even from one case to another. In the event of an unexpected natural death, law enforcement members do have to be called and a ruling made by the coroner but different conditions apply to a anticipated natural death. My father in law - by choice - basically went home to die and this was a matter of record.

One of my cousins is a top law enforcement official in this state and he concurs that in the event of a documented, completely natural death where a medical professional (such as a hospice nurse) can confirm death, there is no need for law enforcement to come out to rule out foul play because cause of death is documented and death was the sole possible outcome.

Thank you for your sympathy.

When my grandfather passed, in Florida, he had been ill for a long time and was in fact living in an assisted living facility. The first person my grandmother called was his doctor. The second phone call she made was to the National Cremation Society. There was no phone call ever made to law enforcement, nor was it required.

I know of no juridiction where it is required that law enforcement, coroner or paramedics are called to an expected death except - as someone noted - if the family has no one else to call and aren't sure that the person has died. Most areas - even tiny rural ones like the one I'm now living in - have a palliative/home care nurse who comes to the home to do meds etc. and will tell you if the person is dead or not and then whatever funeral arrangements need to happen get made.

(This is in London England) My mother-in-law died of cancer at home. My husband was alone with her when she died. He called the ambulance when she was failing, but by the time it arrived, she had died. As my husband had been alone with her when she died, the ambulance crew had to call the police. Once the police arrived, the ambulance crew left. The body was collected by the men from the morgue while the police were there. Because he'd been alone with her, they could have ordered an autopsy to ensure there was no foul play.

Oh, it was nasty. Imagine, you're alone with your mother when she dies--that's bad enough--but then to be told that because of this you're semi-suspected of foul play? (Incidentally, 2 days prior, we'd begged for her to be taken into a hospice, but they said she wasn't ill enough. A few days after she died, they phoned and offered her a place. "A bit late," I said angrily.)

When my mother died of cancer, I called the funeral home.

Sage,

Try lanoxin or digoxin--both are cardiac drugs, and they take awhile to build up to theraputic or toxic levels.

Also theophylline--it's a drug used to treat chronic respiratory problems like asthma, emphysema, or chronic bronchitis.

If you want more help or more info on these meds, let me know--I'll be glad to help you.

Perhaps morphine? I have never heard of a pharmacist making a housecall, though. Is she under hospice care? In that situation a pharmacist might, but I don't know. San Diego has a great hospice program (the name escapes me now, though).

We were instructed to call the Hospice nurse, and when she showed up, she confirmed the death, and called the paramedics and the funeral home. The paramedics re-confirmed the death but left the body for the funeral home to retrieve.

Sage said:

Thanks, Schwebb. I went with Lanoxin.

Midwife, thanks for the suggestion about hospice. Before this thread I didn't have much of an idea what hospice did, but as the thread went on, I started considering her pretending to be from hospice, & even though it took a little more research, that's what I decided to do.

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One thing to think about concerning Hospice - there were several nurses who came out, but we were familiar with them all by sight and by name, and this was in a metro area, not some small town. We would have thought it was odd if a new person had showed up.

Shwebb said:

If the death was expected and there was no appearance of foul play, (i.e.--terminal cancer or disease process) the body might go straight to the funeral home. If the circumstances do look suspicious or the death is sudden and unexpected, the body gets transported to the hospital for the coronor to examine it.

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I worked for a funeral home while in grad school and I'll confirm this for my state. This is especially true for a hospice death; however, the family is probably in contact with the doctor, and I think she'll be the first person they call. IIRC, one needs a professional to confirm the death. Then the funeral home is called. The coronor (sp?) can order a post (short for "postmortem" which is what they call an autopsy).

As for the drug, I suspect the most likely candidate will be an interaction between two or more meds. I don't know what to suggest. I think the pharmacist would catch the error when filling out the perspription, and it'd be the doctor who'd be alerted that something was wrong. But there's no reason to immediately assume that the doctor knows who the pharmacist is, or that the wrong dosage/meds are being given. Possibly, the doctor makes the mistake—pharmacists are there to catch those mistakes—so a sham pharmacist might not catch the errors.

Look up some sort of decongestant, maybe, because I think they might raise heart rates or blood pressure. Okay, here:

She's got respitory problems, so she takes phenylephrine, a decongestant. But she's got high blood pressure (why not?), and for whatever reason, she's on an antidepressant, one of the following: Antidepressants, tricyclic or Maprotiline or Monoamine oxidase (MAO) inhibitors, including furazolidone, procarbazine, and selegiline. This can result in "possibly resulting in hypertension and cardiac arrhythmias". I'll just post the links rather than code them.

http://www.emedicinehealth.com/phenylephrine/page2_em.htm
http://www.emedicinehealth.com/phenylephrine/page4_em.htm#Special Warnings With Phenylephrine
http://www.pharmgkb.org/do/serve?objId=256&objCls=DrugProperties#interactions
http://en.wikipedia.org/wiki/Decongestant

That's the best I can do. Caveat lector. ^_^