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My step dad recently passed away while in a nursing facility for rehabilation. A nurse called that night and recounted the events of my step dad choking to my mother over the phone. When we arrived at the facility, the administrator was there and he also said he choked. Now the death certificate states that it was cardiovascular disease and the administrator says they conducted an investigation and determined he didn't actually choke. He had been eating only puréed meats and vegetables up until the day of the incident when therapy determined he was ready for soft solids. I feel like this is a cover up but because he's cremated I'm not sure what our options are.

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I agree with Shane1124. Put the medical records/malpractice issue on the back burner for now. There is a time limit (statute of limitations) to bring suit (varies by state). Find out what it is for your state (generally a few years).

We were a party (plaintiff) to a medical malpractice (resulted in death) lawsuit. It would be taking a very big step to file one of them. But there are steps before getting to that point, which would involve consulting a med malpractice attorney, records review, etc.
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I can see both the pro's & con's to pursuing a medical malpractice case but it is very difficult to prove negligence, as someone stated.
I understand the concerns and questions you may have. I may have missed it, but was an autopsy performed? If not and he was cremated it would make in more difficult.
As far as cause of death yes it's termed a cardiovascular event but something triggered his death - from my experience I believe when he choked and started coughing his heart did have what is called a "vasovagal response" - a nerve response gets triggered sort of automatically due to a reflex from sensors in the body specifically blood vessels, causing HR to drop which adds to the heart needing to work and rebound quickly from the vasovagal response and perhaps at that time his poor heart could not rebound back to normal. Aspiration could have been there prior as well, which causes an increase in respiratory effort. It is likened to a "special storm" due to all the physiological changes present at the same time and his body could not recover quickly enough.
For peace of mind ask for a copy of his medical records (go through whoever currently has the authority to place the medical record request) and pay an attorney to review for evidence of a cover up. While I am aware they occur, I don't believe this was a cover up, as it sounds as if he was acutely ill and suddenly took a turn for the worse.
Take time to grieve your step dad now and comfort your mom. Those medical records aren't going anywhere for now.
Again I am not saying it wasn't a cover up and as a practicing nurse myself, I can state that the majority of healthcare workers in a nursing home are usually good people who work hard with no malice. But the number is not 100% - sad but true and  there will always be "what if" scenarios that are part of the grieving process. 
Check the CMS website or google search "Nursing Home Compare" and find out if other complaints existed using the NH provider # they all receive and review what & how they were investigated if applicable and what they did to fix the citation.
I am sorry for your loss. Give yourself & your family the time to grieve now.
I wish you peace!
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I was wondering if there could be an issue between the staff "he died of choking" which they observed, but the death certificate was done by a doctor who was more careful and particular with language. For example, the heart of a cancer patient gives out - did they die of cancer or of heart failure? Sometimes common language usage creates a problem when the professional uses terms proper to the profession and not necessarily in common usage. Had this explained to me by a lawyer when I talked about "mediation", meaning sitting down and talking with others in a dispute in front of say a clergyperson who all respected. She objected vigorously - "mediation" is a formal process conducted in a certain way - she was thinking legal term "mediation" - after all she is a lawyer, but I was just using "mediation" as a common vernacular word, meaning discussion. So I think it would be possible for the staff to see the choking, but the medical examiner would think of it in terms of the heart failing and the choking being just contributing factor, or even coincidental.
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I am sorry for your loss. It is hard to accept that a loved one has passed whose care you entrusted to professionals. The truth is that people pass away despite receiving quality care. I don't know what you will do with the knowledge you are seeking. I wish you the best.
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An autopsy is not required prior to cremation. My mother, father, and grandmother were all cremated and none of them had autopsies.
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I just have to re-post this from MaryRose, because it merits repeating over and over and over again,

"I'm also sorry people can't simply ask questions here and receive answers without the OP's motive for asking being attacked and the question itself being criticized. "

I would also request that if you're too heartless and stupid to already know better than to do this, please do us a favor and get the h*ll off this site!!

I don't know how many times I reached out for help here and some idiot's response made it worse... or made me feel like I now had to defend myself, on top of everything else.

Sometimes people forget that there are actual human beings behind this words.
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I understand your concern about a coverup. If someone choked to death, the nursing facility SHOULD NOT list a different cause of death. They're very good at covering themselves, and lying.

It's not too late. Get a lawyer and file a wrongful death suit. It will cost you nothing; the attorney will be paid from your award. It will then be up to the nursing home to defend themselves with proper documentation. I encourage you to do this to show them that they are no all powerful just because they are dealing with very vulnerable people. A lot of them start to think that way, and it's disgusting.

In the meantime, get someone on your side. If there is anyone you are friendly with who was there at the time, like one of the aides, take them aside, and ask them to level with you. Have a mini-recorder hidden in your pocket. It is not against the law to tape a conversation if at least one party (you, in this case) knows the conversation is being taped. I've discussed this kind of thing at length with my attorney, so I'm sure of what I speak.

I'm so sorry you are going through this. I hope everyone who responds has the common sense to at least show you a little compassion. Be well.
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Veronica, thanks for information on the unsettling experience of choking. I think anyone who hasn't seen someone with dysphagia choking doesn't realize how frightening it is.

I also wasn't aware of the extra pressure exerted on the heart; I really appreciate your sharing that.
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A "cover up"? Does it really matter "how" he died?

Without an autopsy--which, on an elderly person, is not always conclusive--the "real" cause of death is not known. The ultimate cause of anyone's death is cardiopulmonary arrest. What precipitated it is what an autopsy would look for. I would say that it would be practically impossible for the nursing home to say that he died from choking unless there was someone there to witness the choking episode. Whatever "investigation" occurred or how it was done is a mystery.

You do not say how old he was, why he was in a nursing home or his medical history. I assume sincere was eating pureed food that he had swallowing problems--from a stroke perhaps? Was he able to feed himself or did he require assistance? Did he have an active DNR?

My advice would be to drop the suspiciousness of a "cover up". He died. He was likely old & had medical issues. Going after the nursing home in a situation like this is worthless. I don't know what you're looking for, or what you hope to accomplish. It doesn't sound like there was any foul play on the nursing home's part.
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To careisgiving,
I'm sorry that you felt attacked by me.
That was not my intention, and you have every right to feel as you do. You sound like you are still suffering from your loss, and I'm sorry to have added to that.
I don't mean to carry this on.
I just wanted you to know this.
I believe that learning to forgive is the greatest gift we give ourselves.
 Please forgive me.
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I have dysphagia and a J tube to prove it. I can eat a certain amount of regular food but after a fairly small amount I can feel it still stuck in my throat. I was able to see this on the screen when they did the swallowing test although one GI Dr suggested I was perceiving it. because she was unable to identify a cause.
I have choked and it is a very terrifying experience. You gasp for breath and make an awful noise. Was able to do the heimlich manouver by leaning over the back of a kitchen chair.
Think what possibly happened in the OP's stepfathers case was that he choked on some food and trying to cough it up caused what is referred to as "Vagalling out" This means the vagul nerve was stimulated which caused the heart rate to drop suddenly and the heart quickly stopped sending him into fatal heart failure. So it is perfectly reasonable to give the cause of death as heart failure.
When I was in rehab I was not allowed to eat alone, I had to sit at a special table in the dining room and wear a bib! Very degrading as I consider myself still to be of sound mind!!!!!!!!!!!!!

If you suffer from dysphasia you have to be very alert when eating and drinking and eat soft moist tender food and take small mouthfuls and sit upright. Having to be supervised was very annoying but I understood the reason. Many other elders are not able to understand the best way to eat and by having a J tube I am in the minority because only about 25% are approved by Medicare. I was never watched when in the hospital just given a sloppy inedible diet. I had my own little fridge which hubby kept stocked.

I think the OP should request the medical records which may bring comfort. i also agree that if definite malpractice is apparent then it is fair enough to take legal action. She should also ask herself if she wants to put herself through the added stress of legal action when she is already so stressed by her stepfathers sudden death.
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Kittynurse: If you're from the nursing/medical field then you have a bias which I respectfully understand, really I do, as this is your experience.

I was speaking from my experience. I'm not the only person in the entire United States to have experienced the money-driven side of healthcare. No way.

I never stated that the nursing home wanted the loved one to die. However, medical negligence and mistakes do happen and that's why I stated to get an outside party to review the records so this patient's family doesn't spend months wondering what happened. Clearly this poster has solid reservation and doubts, otherwise this poster would've accepted right away what was told to the family and moved on to the grieving process. As long as these doubts fester, this poster and the family will not experience peace.

I have friends who are doctors and nurses who have stated candidly that medical mistakes happen and it's widely known in the health care community but not discussed, obviously as it's a taboo. It was reported in the news months ago over 300K people die annually due to medical mistakes.

Is medical negligence and/or mistakes rampant? No. But does it happen? Yes. Does this happen - sometimes - due to ego getting in the way instead of listening to the patient and/or his advocate? Yes.

As for my statement: "...go after those bastards teach them a lesson." I'm aware this reads hash and cold but I won't apologize for my viewpoint - because I've very, very painfully experienced the money-driven side of healthcare - as many others have, too, and they won't disagree with my statement. And this is one reason why the books Being Mortal and When Breath Becomes Air, both authored by surgeons, are nationwide bestsellers.
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Heatherkiger,
I am sorry for your loss of your stepdad.It's obvious that you loved him and miss him.
Sometimes people just die unexpectedly. He had complicated medical problems and they caused his death. It was his time.
We are all going to die this way - our bodies will no longer be able to keep us alive, and we will die. In the end it really does not matter which of his illnesses caused his body to no longer work.
Why would the staff at the nursing home want him to die? They don't stay in business that way.
Then there are the folks that are supporting this thinking.
Talking about getting the staff. "go after those bastards teach them a lesson" after all they are uncaring, arrogant, egomaniacs.
This is not what will bring you peace and healing.
No one who works in long term care is there for the glory of the work, or the money. The work is back breaking and wages are far below what they could make in another setting.
Can you believe that it was his heart that gave out, and because he was eating he started to choke?
Try it out when you are feeling angry and helpless. Then surrender it to who or what ever you believe in.
Asking for peace is so much more healing than seeking vengeance.
Peace
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I'm sorry for your loss and concern. I'm also sorry people can't simply ask questions here and receive answers without the OP's motive for asking being attacked and the question itself being criticized. It's understandable someone could think choking could be a possible negligence on the part of the staff whereas a heart attack couldn't have been caused by negligence, therefore, if the reason for dying changed to a heart attack, anyone would wonder what's going on. And it's understandable one would feel they're neglecting a loved one if they don't look into it. Regarding the answers that did offer some good suggestions, I agree that one hint that leaves me feeling it's probably okay is that the staff themselves were upfront about him choking at first (kind of seems like they'd cover up from the beginning if they were going to), and the fact that a heart attack can trigger choking and visa versa. But still, if staff says one thing and death certificate says another, I see nothing wrong with pursuing an answer as some have given directions for doing.
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Heatherkiger, whenever a love one passes we all go through the "what ifs". Some of us let it rest after a few days, others will go on for years trying to find an answer.

Something cause your Step-Dad to choke, it could have been a heart valve issue which I have which causes me to cough up a storm every now and then. For someone older, it might be difficult for that person to catch his breath. And since your Step-Dad was eating puréed foods, that tell me he also had an aspiration type issue.

My own Dad passed quickly from aspiration pneumonia, food was going into his lungs. Tests showed Dad couldn't swallow food correctly, thus the pneumonia. There wasn't anything modern medicine could do to correct this issue.

Try to let it go... you wouldn't want to think that your Step-Dad is looking down upon his family, and all they can think about is why did he pass away, that this was a cover up, etc. Dad would be happier knowing the family is remembering the good times. Just my thought.
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I am so sorry for your loss. It is definitely emotional, no matter the cause or timing. Big hugs.

As to cause, I agree with jeannegibbs and Madtoe. My own mother died in my brother's arms. She was choking, and he tried heimlich, but she had a heart attack. Who knows if the choking came first, or as a result of the heart attack? It upset him greatly.

I wish you peace and comfort, which will take time.
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Prior to cremation, it's required and by law to have autopsy results from the medical examiners or coroners. So, they cannot lie about how your father died of. The death certificate is the is actual evidence. However, if your father choked, it probably coincidental due to his heart failure. He may have had a sharp pain on his chest and then gasped while he was eating his food. Remember, CNAs are not doctors. They told you what they saw. Just go by what the death certificate says. Relax your mind and let your father rest in peace.
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You can contact you local State Human and Health Services department to see if you are eligible to file a complaint which will then require the State to open an investigation, reviewing the medical records and talking to the facility's personnel. There is no fee to submitting a complaint to the State. You can actually look up online the number of complaints, if any, filed at the State level against this particular facility. I forget the name of it but it's an impartial checks and balances public policy government type of organization that conducts research on medical and nursing facilities. Ask the local Human and Health services department about this organization or just simply ask them where can you find information on how many and what type of State complaints have been filed against this facility.

Doctors and nurses make mistakes; they're no different than any other professional. Medical negligence/error does happen, sometimes due to inexperience, but many times due to the ego, narcissism, arrogance of the medical personnel. We're raised to trust our doctors and nurses. It's not until we have personally experienced medical negligence before we see the actual light of what truly goes on in the health care industry which is very, very money-driven so it's not unusual for records to not reflect the entire picture to avoid a massive lawsuit. I have personal experience from this, unfortunately, so I know exactly what I'm talking about.

You need an outside party to review the records. Don't trust what any facility staff member says. If your gut tells you something isn't right, then follow-up with this instinct because the worst that can happen is that the State will report there was no negligence in the loved one's death...so you can peace of mind and work on the grieving process. If a lawsuit is warranted, then go after those bastards to teach them a lesson - because I guarantee that this facility has done something similar to another patient but this patient's family member was not educated enough to know that something wrong happened and that they trusted the staff on their decision of cause of death. 90% of the healthcare industry are filled with good people. 10% are used car salesmen that are trying to rack up as much money as they can before the insurance industry collapses; these individuals don't care what happens to the loved ones as long as a lawsuit is avoided so their wallet isn't affected. They simply don't give a shit - about your loved one.
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I'm not sure exactly what all of the story details are, but definitely get an autopsy done on this one because yes, it sounds like someone is covering it up.

Was he under guardianship by a professional public guardian? If so, there's your answer right there because the guardian could've very well been behind it. Have you ever heard of abusive guardianships where they target rich elders, have them kidnapped, involuntarily committed to facilities, milk their money and assets dry and then within a matter of hours of the last time being spent or should I say stolen, they conveniently die if not released from guardianship and turned out into the street with nothing. Have you ever heard of this? When they die, their families are usually never alerted until after the bodies are mandatorily cremated to destroy evidence. We the people really need to stand up and fight back even if it means going to war because this is exactly what it sounds like you're describing to me anyway. Knowledge is power and power gives you the ability to make educated decisions based on what you know that's a long time for us to fight back and even gang up on these greedy SOBs and bring this corruption to a screeching halt and stop it. There's an off a lot of corruption where you won't expect to see it and it's up for us to find out and fight back against it
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Many infirmed and older people have difficulty swallowing and often cough and choke. Just sit in a dining room at a nursing home and you'll see, and those people are sitting upright, not reclined in bed. Did you see any signs of bruising around the neck of your loved one? Are those bruises documented (ie. in nurses notes or photos). Short of that, the time to question was before the cremation. The easiest explanation is that the assessment that he could graduate to soft solids was permature, causing the choking scenario. I am sorry for your loss. Have doubts and questions concerning a loved ones care is upsetting. I've been there.....most people have been there, and it isn't easy.
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I agree with jeannegibbs. My mother died last May and I know that the nurse employed by the nursing home killed her. We had just put her on hospice and this one particular nurse just kept giving her Morphine every time I turned around. Even though she NEVER asked for nor did I ever request it for her. And before I could say anything to anyone they called me and told me she was gone! BUT, I did not have the money to pursue it and I was distraught and there was just no fight left in me. BUT, to this day I still am kicking myself and I need to stop this......and so do you because it will eat you alive and that is not healthy.
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Ultimately all deaths are cardiac arrest which only means the heart has stopped beating.
I have seen this listed on the death certificate and it was explained to me as I just stated.

Even cancer or a brain tumor, eventually the heart stops and they use that as the reason for expiration.

As jeannegibbs states, what is it you are hoping to accomplish? Nothing will bring him back. If you are thinking of suing the NH, your chances are slim at best.

If he was in a NH, this means no one was able to take care of him at home. He could have choked at home just as easily. My DH has Dysphagia and it is a swallowing disorder. The possibility of choking is just something we live with.

I am sorry for your loss - but I have heard it is very difficult to prove negligence.
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Your questions mentions your options. What if you had had an autopsy performed? Say it concluded that blockage of the air passage was the immediate cause of death -- then what? If the autopsy concluded he died of a cardiovascular event, what is your option? If it determined that a cardiovascular event and choking occurred almost simultaneously, what are your options? And what if the autopsy determined a different cause altogether?

What do you think your options would be if you knew absolutely for certain what caused your father's death?
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I'm truly sorry for your loss.

I don't understand your concern about a "cover up." What would they be covering up? Why would it matter to them whether the cause of death is choking or cardiovascular disease? Could it have been a heart attack brought on by the stress of choking? Or a heart attack that caused the choking?

In any case, choking is a high risk for people who have swallowing problems, and cardiovascular events are a very common way to die. I imagine that your dad could have died from either one, or from a combination. Again, I don't understand what you think they might be covering up, and why they would do so.
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my good wife died last week..the death certificate included the ailments from 12 years ago that triggered a massive stroke at that time...Thus the immediate cause of death was not the primary reason shown, but instead the initial events that cause it were: Atrial Fibrillation, and so on...

Grace + Peace,

Bob
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I assume he was on a dysphagia diet b/c of swallowing difficulties, and that he was subject to aspiration? Choking on foods is one of the dangers of aspiration. I've been advised that aspiration (and aspiration pneumonia) can still occur even on dysphasia diets.

I've seen some frightening episodes of choking, even when on a dysphagia diet. Coughing is intense, the face turns red, and sometimes it's hard to catch one's breath.

Heather, I suspect this is what happened, and that the death was in fact a result of the choking, perhaps aspiration, and perhaps even blockage. I'm not really sure about the cardio issue as cause of death. Can you contact the individual who completed the death certificate for an explanation?

Did you ever see an active videoscopic swallow study? If one was done for your stepfather, you might have been in the room watching the video monitor. I've seen several, but the most recent one was the most illuminating. I could see liquids and food being swallowed and being aspirated. I could also see food getting stuck and not being swallowed or aspirated.

After seeing this latest study, it was easier to understand how fatal choking can occur.

I assume your stepfather had some cardiovascular disease? Had he been treated for it in the past?

If you really think there's a cover-up, your best option is to retain a medical malpractice attorney, ask him/her to order the medical records and have them reviewed by a cardiac expert. That would give you a better idea what an independent physician might determine as a cause of death after reviewing the records.

I am sorry for your loss and hope this helps explain what could have happened.
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