Las Vegas Sun

October 1, 2014

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Do No Harm: Hospital Care in Las Vegas:

Missouri family loses its rock

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Leila Navidi

Michelle Butts, center, and her children, from left, Stephanie Hilaman, 21; Lisa Butts, 12; and Dennis Butts, 15, are shown this summer at their Mountain Grove, Mo., home.

David Butts

Michelle Butts, center, and her children, from left, Stephanie Hilaman, 21; Lisa Butts, 12; and Dennis Butts, 15, are shown this summer at their Mountain Grove, Mo., home. Launch slideshow »

David Butts died within hours of being administered a painkiller while trying to pass a kidney stone at Spring Valley Hospital Medical Center.

His death in 2003, while visiting relatives in Las Vegas, left his wife, Michelle, alone with their five youngest children back home in rural Missouri.

“I don’t think you ever get over it,” Michelle says. “I still wear my wedding ring.”

Hospital attorney Ken Webster said Butts died from an “unrelated complication that stemmed from his chronic cardiac disease.”

But an autopsy by the Clark County coroner’s office determined Butts, 50, died from oxygen deprivation brought on by intravenous injection of hydromorphone, a narcotic painkiller, and promethazine, a nausea medication that can induce drowsiness, according to court records.

Butts received multiple doses of narcotics to treat his pain the evening before his death and a nurse who administered the final dose did not properly monitor him, records show. He was found unresponsive.

A jury in 2009 concluded a nurse’s negligence caused Butts’ death and awarded the family $1.5 million. Dr. Janie Kwak-Tran settled her part of the lawsuit for $350,000, according to documents submitted to the Nevada State Board of Medical Examiners.

On Dec. 4, 2003, Butts went to the Spring Valley emergency room in severe pain, was hydrated to flush out the kidney stone, and then administered various painkillers in multiple doses over several hours. Still in pain, he was admitted to the hospital and put under the care of Isabelita Nesmith, a traveling nurse employed by an agency and assigned at the time to Spring Valley Hospital.

Narcotics must be administered with care because they build up in the system after repeated doses and can slow a patient’s breathing.

As Butts received dose after dose, his oxygen levels were dropping, according to medical records. At one point Butts awoke and complained of severe pain. Nesmith called Kwak-Tran.

The doctor, who according to Nesmith had not examined Butts, said in a deposition that she ordered 2 to 4 mg of Dilaudid every two to four hours, according to court records. The nurse was to start at the lower dose and “watch and observe” and only increase to 4 mg if necessary, Kwak-Tran said.

Nesmith administered the higher dose immediately — pushing 4 mg of Dilaudid and 12.5 mg of Phenergan into Butts’ IV. Butts went to sleep.

Nesmith said in her deposition that she was following the doctor’s order.

At 4:49 a.m., Nesmith noticed Butts wasn’t breathing and had no pulse. He was revived and placed on life support but tests showed no brain activity.

Michelle Butts was soon at her husband’s bedside, saying goodbye.

“I kept telling him he needed to wake up because there was too many children, and I didn’t know what to do,” she said. “He did everything for us.”

The medical board did not discipline Kwak-Tran, who did not respond to the Sun’s request to comment for this story. Nesmith could not be reached by the Sun.

Webster said the doctor ordered the drugs in accordance with her assessment, they were administered and the nurse properly monitored the patient.

Issues involving the quality of Nesmith’s performance as a nurse surfaced after the Butts case. She was disciplined by the Nevada State Board of Nursing for a Jan. 20, 2005, incident at Kindred Hospital at Desert Springs Hospital, where she is accused of failing to document patient assessments and narcotics administration, and left the facility without telling anyone, abandoning her patients.

She is no longer licensed in Nevada.

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