Metropolis: Wednesday, November 30, 2005
Hilario and Maria Rodriguez are struggling to cope with her extensive health problems.
Falling Through the Cracks

Maria Rodriguez’ health problems snowballed when she went to the hospital.


This time last year Maria Rodriguez was getting ready for Christmas. This year Maria will spend Christmas in a wheelchair. She can no longer walk, breathes with difficulty, gets her food through a tube, and has lost nearly all muscle control in her hands. A shunt drains excess fluid from her brain. Her husband Hilario quit his job as an aluminum solderer to take care of Maria and their kids. They live on the largesse of a local church and whatever family members can pitch in.

Maria’s condition began as an awful illness. But her husband and a local Hispanic activist believe her problems may have been exacerbated by less-than-sterling care from the John Peter Smith public hospital.

On June 1, Hilario brought Maria — then nearly nine months pregnant with her fourth child — to the JPS emergency room with a high fever and a splitting headache that wouldn’t go away. Medical staffers gave her aspirin and sent her home. Three days later, the headache even worse, Hilario brought her back. This time she was admitted and given a battery of tests. The results showed that Maria’s headache was due to obstructive hydrocephalus, a condition that causes excess fluid on the brain. The Rodriguezes had no insurance and no money for hospital expenses, so JPS sought payment from Medicare.

On June 10, doctors proposed drilling a small hole into Maria’s skull and inserting a vent to allow the liquid to drain. Without it, she ran the risk of stroke during childbirth. But the procedure also created the risk of meningitis because of the brain being exposed. Maria and Hilario agreed to the surgery. The day after it was done, she gave birth — complicated and requiring its own surgery — to a healthy baby girl.

Although doctors had not yet found the underlying reason for Maria’s hydrocephalus, and although they apparently had no reason to believe the fluid would stop building up, they removed the vent and closed the incision.

“When they closed the tube in my wife’s head ... I saw blood at the place where the hole was,” Hilario told Fort Worth Weekly in Spanish. “I ... asked if that was normal. They said yes. But I was afraid of infection.”

By June 16, Maria was running a fever, and a spinal tap was ordered to check for meningitis. Other tests had already shown that she had cysticercosis, an infection caused by a tapeworm, which might have been responsible for the excess fluid on her brain.

What did the spinal tap show? Maria’s discharge papers don’t give the answer, and Hilario said he was told nothing about it. Four days later, with nothing more said about the possibility of meningitis, Maria was released, over Hilario’s objections. The discharge papers listed her condition as good — but four hours later, she was back in the hospital.

The discharge papers — in English, which neither Hilario nor Maria can speak or read — noted that Maria could perform activities without assistance and didn’t need home health care, social services, or physical therapy. Hilario told the Weekly he didn’t know what he was signing. “The doctors just said to sign and that my wife was fine,” he said.

Before Maria left the hospital, healthcare workers had removed the stitches on her head, and “lots of liquid came out,” Hilario said. “They told us everything was OK. But my wife had a fever and was in a lot of pain. By the time we got home I knew she was not fine. She was still very ill, and so I brought her right back to the hospital and told them her head was giving a lot of fluid and she was freezing cold. I put two blankets on her in the car, and she was still shivering. So they readmitted her.”

The next morning when Hilario returned to the hospital, he found Maria had been diagnosed with meningitis and was in a private room because the hospital feared it might be contagious. Fortunately, it wasn’t.

Three days later, Maria fell, splitting her lip. It was the first time she was unable to stand alone. Hilario picked her up and noticed she had a high fever. “The nurse took her temperature, and it was 104,” he said. “The nurse told me to go to the store to get some vitamin A for her lip and that she’d give my wife Tylenol to bring her fever down.” But when he got back, “I felt that she was even hotter. The nurse told me she forgot the Tylenol. By then my wife’s temperature was 105.5.”

At the end of June, feeling that his wife wasn’t getting adequate treatment, Hilario filed a formal complaint with JPS. “I wanted an investigation into why my wife was having water on the brain. And why she was sent home when she was so ill, so at risk,” he said.

Maria stayed in JPS for nearly two months. During that time her cognitive skills declined dramatically — one of the side effects of hydrocephalus. “She didn’t know anything, even who she was sometimes,” said Hilario. She also contracted pneumonia, which led to a complete respiratory failure and a tracheotomy. A permanent shunt to relieve the fluid on her brain was inserted beneath her scalp, draining into her abdomen. The tracheotomy prevented her from eating, so a feeding tube was implanted to carry nutrients to her stomach. She was also diagnosed with hypoglycemia, cardiac dysrhythmia, and several other disorders.

By the time she was released on Aug. 19, Maria could hardly walk, was still receiving nourishment through the tube, and had lost much of the muscle control in her hands. Her discharge papers note that she was to receive home healthcare visits to monitor both the tracheotomy wound and food intake — but Hilario said no healthcare worker ever visited. She was referred to a neurologist for once-a-month visits.

Around that time, Hilario received an answer to his complaint. In it, hospital representatives explained that his wife’s case had been full of complications, but that it was possible some errors in judgment had been made as well and that there would be an investigation. He’s heard nothing since.

By Aug. 30, Maria had developed an infection in her stomach from the feeding tube — and went back to the hospital. “I try to keep it clean, but she got the infection anyway,” Hilario apologized. Maria’s patient records a week later included a note that she was improving generally and that her cognitive abilities were slowly returning.

Last month the neurologist determined that the shunt is malfunctioning and needs to be replaced. The fluids in Maria’s brain are building up again. But hospital officials told Hilario he’ll have to pay $4,500 to have the shunt changed. He doesn’t have it.

JPS officials told the Weekly they were unable to discuss Maria’s case for privacy reasons. As to why a Spanish-only speaker would have been asked to sign discharge papers in English, a spokesperson said that any person who requests a translator is provided one.

Hector Carrillo, president of the local council of the League of United Latin American Citizens, said the level of treatment Maria Rodriguez received at JPS is not unusual for poor people.

“I believe that the system at a certain point broke down for her,” he said. “The question is whether or not that breakdown came because she is an illegal without money or insurance or whether it would have broken down anyway. I believe that it happens more often with poor people — regardless of their legal status — than with people who have good insurance.” The worst part, Carrillo said, is that hospital workers “believe that neglecting undocumented people will not have repercussions.”

Mark Hainey, a local civil rights attorney who is currently working on another case involving JPS, agreed. “In my opinion, JPS is inadequately staffed and funded for the number of people it has to treat, and that has an adverse impact on the services delivered to those with lesser means,” he said.

Attorney Chad Fillmore goes further. “Less than good treatment at JPS is something we hear about on a frequent basis,” he said. “And since the Tort Reform Act of 2003 limited the amount a patient can receive from a malpractice lawsuit, we’re seeing medical personnel who know there is no accountability for their actions. The good doctors, nurses, and healthcare workers will always do their best, but for those who are only in it for the money, they know that less than great care will not cost them. And that is going to lead to a lesser quality of care, particularly for the poor.”

Hilario is doing the best he can taking care of Maria. The three older children, from two to six years old, still live with them, but another family member is taking care of the baby.

“I just wonder what would have happened if she had been admitted the first time we went to the emergency room, if they’d taken water from her brain a week earlier, or if they had not sent her home with meningitis,” Hilario said. “Would she be a little better than she is?

“All I want is for my wife to get better,” he said. “And I want to know that the hospital and the neurologist are doing all they can to help.”

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