Death at Polk: Family looks for answers
Frustration builds over why woman who died last year had unexpectedly high levels of drugs in her body
Sunday, March 14, 2004
By Cindi Lash, Pittsburgh Post-Gazette
The telephone rang just as Barbara Wynn was about to turn in for the night.
The Wilkinsburg widow had been jumpy for hours, ever since officials from Polk Center in Venango County notified her that a hospital had admitted her mentally retarded adult daughter, Sharon Smith. But just before 11 p.m., Wynn said, a nurse telephoned to reassure her that her daughter didn't need the family at her bedside that night.
So when the phone jangled again 15 minutes later, Wynn smiled to herself, figuring Sharon had charmed someone at the hospital into allowing her to say "good night" to her worried mom.
Instead, it was a nurse delivering the jaw-dropping news: Smith was dead.
"I couldn't believe it," said Wynn, 74. "They'd assured me all day that there was no reason to rush up there, that everything was fine. In 15 minutes, it went from that to, 'Sharon has passed.' It was some night, I tell you."
Over the next few days, Wynn and her family would be puzzled by doctors' inability to even suggest what caused the unexpected death of a woman who'd previously shown no signs of life-threatening medical problems. Weeks later, they would be staggered when toxicology tests uncovered startlingly high levels of anti-depressant and painkilling drugs in Smith's body, triggering an ongoing state police investigation.
A year after Smith, 51, was buried in Monroeville's Restland Memorial Park, her family's bewilderment has turned to frustration: How did a potentially lethal amount of the anti-depressant Elavil, as well as a high dose of the painkiller Dilaudid, get into the body of a woman who was incapable of overseeing her own care? And did those drugs cause her death?
"For a year now, we've been sitting here, waiting for some word on what happened to my sister," said Wanda McGinnis, of Penn Hills, who, with her family, recently hired an attorney to help them uncover that information.
"Not knowing this takes a toll on my mother, on the whole family," McGinnis said, her voice breaking. "We want some kind of peace."
Venango County Coroner H. John Greggs ruled that Smith's death March 11, 2003, was caused by amitriptyline toxicity after tests performed as part of an autopsy revealed that her blood contained a potentially fatal dose of that drug. Amitriptyline, also known as Elavil, is an anti-depressant that is administered orally or by injection.
In three sets of toxicology tests performed last year, two laboratories reported that Smith's blood contained 9,311 nanograms of amitriptyline per milliliter. That amount is between 37 and 77 times the recommended amitriptyline level for effective treatment.
The therapeutic range for amitriptyline generally is between 120 and 250 nanog/ml, according to those lab reports. Death from amitriptyline ingestion has resulted in patients with blood levels as low as 3,000 nanog/ml, or a third of Smith's level, according to the lab reports.
Toxicology tests on Smith's blood also revealed 39 nanog/ml of hydromorphone, also known as Dilaudid, a semisynthetic narcotic used for relief of severe pain. The therapeutic range for effective use of that drug ranges from 8 to 49 nanog/ml, according to Allegheny County Coroner Dr. Cyril H. Wecht; it also can exacerbate the effect of other drugs, such as Elavil, that depress brain activity.
Smith's family members said they believed that Elavil was among the medications prescribed for Smith while she lived at Polk, and a hospital emergency room report they later received also appeared to indicate that. But they said they didn't know how much she may have been prescribed or how she took it.
Nor do they know where she obtained the Dilaudid, although their attorney, Anthony J. D'Amico, said he believed that someone administered the drug to Smith for pain after she was transported to UPMC Northwest in Franklin, Venango County. D'Amico, who has obtained Smith's autopsy reports, said he had asked Polk and UPMC Northwest to produce Smith's medical records and would retain his own toxicologist to review them.
UPMC Northwest spokesman Chris Potter declined comment on Smith's case, citing patient confidentiality laws. The state Department of Public Welfare, which operates Polk Center, conducted an internal investigation last year and "found no wrongdoing on the part of the center staff," spokeswoman Stacey Ward said. The department now is cooperating with state police in their investigation, she added.
The unanswered questions about the drugs found in Smith's body have prompted the Venango County coroner to withhold a ruling on the manner of her death -- homicide, suicide, accident or natural causes -- while state police continue to investigate.
"This was a sudden death that wasn't expected," Greggs said. "She really had no [serious medical] problems. For this lady to up and die, we wanted to make sure we knew why."
But the delayed ruling leaves Smith's family members unable to collect on two insurance policies, totaling about $4,500, that would enable them to settle their debt to the funeral home that buried Smith and to use the rest to mark her grave.
"We still owe that debt, and it shouldn't be that way. My father worked hard for the money to pay for [the policies]," McGinnis said.
Sharon Smith was born prematurely and with cerebral palsy on Feb. 22, 1952, in Braddock Hospital. Doctors rushed her to Children's Hospital, but warned her mother that she might never leave the hospital or reach the age of 2.
But the frail, 4-pound baby rallied and eventually went home. Living with her family in North Braddock and Wilkinsburg, she learned to talk, walk with braces and draw with crayons. She attended classes, played with her four siblings and memorized the words to "Jesus Loves Me," the hymn that, for the rest of her life, she sang at every opportunity.
Her family doted on her, and her late father, George Wynn Jr., worked several jobs as a janitor, mill worker at Mesta Machine and practical nurse to support his family and cover the costs of her care. Her mental age was akin to that of a 5-year-old, however, and she could not handle money or care for herself.
When Smith reached her teens, doctors and health-care workers convinced Smith's family that she would need more care than they could provide at home. Her family reluctantly agreed to move her to Polk Center, a state residential facility for the mentally retarded. They visited her frequently and brought her home for weekends, holidays and summer visits.
"I loved Sharon, and I would never have traded her for another sister. She liked her nails to be polished, so we'd bunk on my living room floor and put polish and perfume on," McGinnis said. "When you asked her where she lived, she'd say 'Pittsburgh, Pa.' "
At Polk, Smith lived in a cottage with other adults and a resident assistant. She folded napkins, dusted and performed simple tasks around the hospital, although for the last six years, her increasingly spastic legs forced her to use a wheelchair.
Wynn and McGinnis said their family was generally pleased with the care and supervision Smith received at Polk. Other than her cerebral palsy, they said, they knew of no serious health problems affecting her.
On March 11, 2003, Wynn said, Polk officials telephoned and told her that they'd sent Smith in an ambulance to UPMC Northwest because she'd seemed lethargic. She'd roused enough to eat her lunch, they told Wynn, but then got sleepy and sick again in the afternoon.
Polk workers also noted that Smith's abdomen seemed to be distended. According to coroner Gregg's report, a Polk doctor sent her to the hospital for an examination and blood tests.
Wynn, who doesn't drive, said she would have summoned another of her children to make the 85-mile trip to UPMC Northwest with her that night. But she said she was dissuaded from rushing there when she spoke on the phone with a Polk caretaker who accompanied Smith to UPMC Northwest and later with hospital nurses.
By that evening, Wynn said, nurses told her that her daughter had been moved from the emergency room to a regular room and that she would be fine until Wynn could get there the next morning. Then came the news that her daughter had died.
"I was out of my mind," said Wynn, who suspects the anxiety attacks she's experienced over the past year have been triggered by her grief and uncertainties over her daughter's death.
Greggs ordered an autopsy, which was performed by Dr. Eric Vey, a forensic pathologist for the Erie County coroner's office. The autopsy turned up inflammation and stones in the gall bladder, and blood and urine samples were drawn and sent to an Erie laboratory for testing.
Those tests, performed and "confirmed by repeat analysis" by Associated Clinical Laboratories, revealed the level of amitriptyline. That report, completed April 18, prompted Greggs to rule that Smith had died of amitriptyline toxicity, with gall bladder disease as a contributing factor.
It also prompted him to call the state police.
Troopers sent Smith's blood samples to another lab they routinely use, National Medical Services, of Willow Grove, Montgomery County. Twice the lab reported finding the same level of amitriptyline as well as the presence of hydromorphone.
Trooper David Wargo, a state police spokesman, said investigators had not established how the drugs got into Smith's body. He said police had asked for more information and clarification from the laboratory and didn't know how long that would take.
"At this point, we're unable to say where she got the drugs," he said. "She was in the hospital, so she may have been medicated there. We don't know what she may have been given."
Wargo cautioned, however, that investigators weren't sure that Smith's death was suspicious, saying that laboratory toxicologists have suggested that the level of amitriptyline may have seemed artificially high because of chemical processes that occurred in Smith's body after death.
"We think we have the [amitriptyline] explained," Wargo said. "The other drug is still being investigated by the toxicologists, and we are waiting to see the results of the toxicology tests."
But Wecht, an internationally known forensic pathologist who frequently testifies as an expert, disputed the suggestion that levels of drugs in Smith's body could be explained simply by chemical changes or by blood samples that were drawn from areas where drugs may have settled in high concentration after death. Wecht is not involved in the case, but D'Amico said he planned to ask Wecht to conduct his own tests and issue an opinion.
"These levels should be the real McCoy," Wecht said. "They are not found in food or the environment or water, only in the drugs. Whatever the [post-mortem] redistribution may be is of no consequence. A large amount was used, far beyond that which would be needed or prescribed."
Wecht said he questioned how Smith obtained the drugs and, like D'Amico, suggested an inquest might be needed to shed light on the circumstances of her death. Greggs declined comment on that prospect, saying he was waiting for state police to report their findings.
"When you don't know what happened, your mind starts putting things together. It's hard, not knowing," McGinnis said. "But on the other hand, you think if the state police are involved, we'll get an answer. We deserve that. Sharon deserves a headstone." |
