Patient’s records show pain, need for opiates

The medical record of 91-year-old Ellen Anderson, a patient who died while under the care of Robert Weitzel, MD, shows that she was in considerable pain despite contrary arguments from law enforcement officials.

When Weitzel was charged with murder, prosecutors argued that the patient had no conditions that would cause substantial pain, and therefore the morphine prescription was unnecessary and administered for the purpose of hastening her death.

According to a synopsis of the patient’s records provided by Weitzel’s defense team, Anderson had appeared extremely anxious and was constantly screaming for the months preceding her death. She had severe osteoporosis, with a hip fracture six months prior to admission, and history of ankle and wrist fractures, as well as spinal compression fractures. At the nursing home, she received an occasional Lortab, but mostly Tylenol for pain.

On admission, the patient was continued on her usual medications, and trazodone was ordered for sleep. However, she took no oral medications during the hospitalization, refusing all those given. Here is an excerpt from the patient’s chart:

At 7:30 p.m., three hours after her admission, the charge nurse called and got a telephone order for morphine 10 mg intramuscularly (IM), citing what appeared to her to be the patient’s "severe pain [patient becomes rigid and screams when touched] related to profound osteoporosis." The patient did well for the next four hours — "was calmer . . . after morphine . . . very needy," indicating normal pharmacodynamics for her age. At 3:30 a.m., about 11 hours after admission, a different nurse called the physician to report the patient was "moaning and screaming" the nurse said the patient was in severe pain, and another morphine 10 mg IM was given; the patient then "appeared to sleep."

At 8:55 a.m., she was found with no respirations and no heart rate. Death was ascribed to probable myocardial infarction, and acute pneumonia was seen as contributory, with the benefit of the later autopsy results.