State Adds New Giuffre Death To Probe Of Patient Care

Posted: April 28, 1988

The Pennsylvania Department of Health will investigate the case of a 76- year-old North Philadelphia man who died Friday at the James C. Giuffre Medical Center, a department spokesman said yesterday.

The review of the care of Percy Walker of the 2600 block of North Warnock Street will be part of the department's continuing probe of patient care at the hospital, located at Eighth Street and Girard Avenue, said spokesman Gary Froseth.

"Given the current situation at Giuffre, I think we would probably be remiss if we did not look at this particular incident," he said.

Walker, a diabetic, died in the hospital's intensive-care unit, where he was being treated for high blood sugar, according to hospital employees and family members.

On April 18, while insulin was being fed into Walker's body intravenously in an attempt to lower his blood sugar, the blood sugar dropped to a critically low level, hospital employees said.

"Nobody monitored the intravenous insulin," said a hospital worker. ''There was nobody paying attention."

Although the hospital employees were critical of Walker's treatment, they said they could not say that it contributed to or caused his death.

"The guy had enough wrong with him that he might have died no matter how he was treated," said one worker. "But it was not good medicine. . . . It's poor, poor medicine."

Giuffre's administrator, William L. Vazquez, said he could not comment on the case until "a responsible review" had been completed by the hospital.

The state already is investigating the cases of dozens of patients who were treated by surgeons at Giuffre between January 1986 and last month. The state is expected to release a report soon on its findings.

The Inquirer reported Sunday that an examination of hospital records and of the state's review of Giuffre patient charts shows 29 cases in which patients who underwent surgery or diagnostic tests either died of unexpected complications, were accidentally injured, received major stomach surgery for ulcers instead of being treated with commonly prescribed drugs, or were operated on for problems that pathology reports did not confirm.

Interviews with hospital workers and family members provided this account of the Walker case last week:

Walker, a retired dockworker, was taken to the hospital early on the morning of April 18 after falling out of bed, according to his stepbrother, Thomas Trower.

Walker, who had been a diabetic for years and had heart and lung problems, was diagnosed as suffering from diabetic ketoacidosis, a metabolic disturbance caused by insufficient insulin and characterized by high blood sugar, dehydration and excess acid in the body. Late in the morning, he was taken to the intensive-care unit, where he was hooked up to intravenous tubes. He was given insulin to lower his blood sugar and saline solution to relieve the dehydration.

By 6 p.m., Walker's blood sugar had plummeted from more than 400 milligrams per deciliter to 27 milligrams, according to hospital workers who saw the printed results of lab tests done on samples of Walker's blood.

Normal blood sugar level is between 80 and 120, depending on the individual, according to four doctors interviewed by The Inquirer who specialize in treating diabetes. The doctors said a person being treated with insulin for diabetic ketoacidosis needs to be monitored very frequently to ensure that the blood sugar level does not drop too fast or too low. The doctors said that normally, glucose is added to the intravenous mix when the blood sugar level reaches about the 200 level.

Too low a blood sugar level can effect the functioning of the brain, causing seizures, coma or death, the doctors said.

According to Walker's chart, no physician saw him in the intensive care unit until about 6 p.m., when a doctor on duty at the hospital noted his low blood sugar level and ordered that glucose water be pumped in to raise the level back to an acceptable level, according to a hospital worker.

After being treated with glucose, Walker's blood sugar returned to an acceptable level, hospital employees said. But on Friday morning at 5:48, he died. According to his death certificate, he died of a heart attack, with diabetes being a secondary contributing cause. An autopsy was not performed.

Walker had been assigned to Dr. Francis Braconaro, a staff physician who specializes in internal medicine, when he was admitted in the morning. According to Walker's chart, Braconaro did not visit him until the following day, a hospital worker said.

Braconaro declined to comment on the case. A secretary referred all questions to Vazquez, the hospital administrator.

An anonymous hospital employee reported Walker's death to the state Health Department.

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