Tetanus: When Gardening Becomes Life Threatening

There are several factors which increase your risk
of tetanus happening to you.

Right next to having an accident in the first place
and failing to have a current tetanus inoculation,
is failing to get proper medical attention.

While this may seem highly unlikely to happen to you,
consider this: what if you have a bit of cognitive dysfunction?
What if you're older (most people who are reported as having tetanus are older)
and what if you aren't as clear as you once were?
What if you are so overwhelmed by the pain
and your back muscles bending you backwards
that you don't say things quite right, or calmly?
What if you don't say you were worried about some food you ate?
What if you don't ask if cold could cause muscle contractions?
What if the first sounds the ER doctors heard from you were screams?
What if the doctors didn't see the muscle contractions in your back?
or didn't see the contractions at all and thought you had stomach cramps?
What if you told the doctor you have a bit of brain damage
and it's hard for you to explain
and the doctor began asking you about brain operations?
What if you became exasperated and shouted that didn't matter
that the problem was the tetanus, that you'd jammed a needle into your toe?

Imagine how much differently the ER doctor would evaluate you
if you came in and calmly said you'd had some extremely painful muscle contractions in your back,
that you were concerned about some food you'd eaten, but that you also wondered
whether cold weather could have caused the muscle contractions.
What if you added, without undue emphasis, that you'd stepped on a darning needle
two months ago after you'd been gardening, but you doubted that could have anything to do with this.

These are two very different presentations.

In the first, your communication suffers from the stress of the situation
and the doctor chooses between seeing you as having a mental problem and having a physical illness denies that you
could have tetanus and has you undergo a psychological evaluation
then gives you the smallest course possible of antibiotics and a token tetanus shot.

In the other, the doctor has a choice between food, cold and a puncture wound to account for your illness.
The fact that you don't think it could be tetanus, allows the doctor to show his superior knowledge
when he explains why most likely it is tetanus.

Karen Marie Kline

Santa Fe, New Mexico 87507
                                                                    November 16, 2004
Alex Valdez, CEO
St. Vincent Hospital
465 St. Michael’s Drive
Santa Fe, New Mexico 87505

Dear Mr. Valdez,

I am writing to you because St. Vincent Hospital, which is “classified as a sole community provider by Medicare”
has failed in its legal duty under the ADA, title II.

I am qualified under the ADA, Title II. Tests administered through the Department of Vocational Rehabilitation
show that I’ve lost about half of my working memory and my processing speed. These losses are a disability.

On October 7, 2004, because I was in extreme pain from muscle contractions in my back, I had difficulty
explaining what was wrong. I asked a nurse and Dr. Raboff to call Corrine Romero, my TBI case manager, and
tell her I was in the ER, and ask her to come to help me explain. Corrine Romero had observed the first
contraction I had, a week earlier.

Corrine did not came. After I was released, I asked Corrine about it and she said that no one had called her.

Because I was refused accommodation for my disability: TBI, I am suffering from the same thing that caused me to
be taken to the ER on October 7, 2004, and this is causing me serious damage.

As a point of law, this is an ADA case and not a medical malpractice case. This means I do not need an expert
medical witness to go to trial on my complaint that the hospital failed to provide guidelines and oversight to ensure
that my disability was accommodated.

The reason the failure to accommodate is so serious, is that the medical records that were created in the absence
of clear input from me (absent because I was denied accommodation of my disability) are dangerously inaccurate;
“Dangerous” because those inaccurate records have been relied upon by other ER doctors and Whole Life Clinic
to deny me not only treatment, but medical examination since October 7, 2004.

Some of the inaccuracies created by the failure to accommodate my disability are shown on the Abdominal Pain
sheet:

1.        Under “Historian:  patient  HX Exam Limited By:” it says “will not allow MD to move pt”
a.        fails to note that movement caused painful contractions
b.        fails to note guarding against extreme pain
c.        fails to note TBI which I stated I have
d.        fails to note that I asked for my case manager to be called to help me explain

2.        “Pt. uncooperative” I can’t read the next bit, then “Hostile & Threat”
a.        the contraction pain was dictating my behavior to a large extent
   i.        the contraction pain made me very irritable
   ii.        Several times I screamed, “If you want to see pain like this continue, Vote for Bush;” that is
             not a “threat.”

3.        Under “HPI”
a.         “generalized myalgias”
   i.        there was nothing general about the extreme pain from the contractions of my back muscles
            on the right hand side.
b.        “muscle cramps” –
   i.        what I was feeling and what caused Whole Life Clinic to call an ambulance was not cramps;
            it was muscle contractions that pulled me backwards in the most painful way that made me
            scream the same way I did when I was giving birth to my son.

4.        Under “started”
a.        “accidental needle” ... but what is the next word?
b.        “4 weeks ago” is wrong, it happened on August 14, 2004
c.        “removed 2 ½ weeks” is wrong, I removed the quarter inch of needle two days after it went into
     my toe and broke off
d.        “sa” what is that????
e.        I can’t read the next two lines, but if they say that the first problem was “Tweek” it would be
     wrong because I had some red lines under my toe nail right after I took the needle out. Because
     of the lines I soaked my foot for about 4 hours a day for about a week in Epsom salts, and I
     took 2 sm. Bottles of Vitamin C. The red lines got really faint after that so I stopped worrying
     about them.
f.        “Pt concerned about tetanus  Tricore had tetanus” I can’t read the next word.
   i.        This line is important because I was “concerned” about tetanus,
   ii.        whereas Dr. Raboff and Paolo G. were describing me as saying, “I have tetanus.”
           1.        the Behavior Health report describes me as “paranoid”
           2.        false reports of this nature are damaging
g.        “Pt claims chronic B12 deficiency resulted instability  fell

5.        Under “time course”
a.        “still present” and “constant” do not reflect the fact that the contractions stopped when I
     remained still
b.        “persistent since Tweek” doesn’t describe that the contractions started at Whole Life Clinic. I
     had one contraction a week earlier, but that one sudden contraction was not in itself ongoing. It
     was observed by Corrine Romero.

6.        Under “quality”
a.        “cramping” would have been more clear if sharp had been added to indicate the extremely
     painful nature of the contractions

7.        Under “location”
a.        only the front of the diagram is marked and it wrongly shows my arms and shoulders as being
     affected by the pain
b.        the back of the diagram should have been marked: The major pain had been in my back when
     the muscles there, on my right side, contracted.

8.        Under “severity” “relieved by”
a.        “nothing” is incorrectly circled. Holding myself totally still kept the contractions from happening.

9.        Under “similar symptoms previously”
a.        this is crossed out, whereas there was a contraction a week earlier

10.        Under “ROS”
a.        “trouble breathing” seems half heartedly circled, whereas the tightening of my diaphragm muscles
     was making breathing tough.
b.        “joint pains diffuse” is totally inaccurate. My joints weren’t painful at all.
c.        “back pain” is circled here, which appears to substantiate that the back side of the diagram
     should have been marked.
d.        “diffuse” is inaccurate since the contractions had been in precisely one set of muscles on the right
     side of my back
   i.        additionally, my abdominal muscles were tight
   ii.        my diaphragm muscles were tight
   iii.        my muscles on my sides were tight
   iv.        leg, arm muscles were not affected

11.        Under “prior work up”
a.        “head trauma” noted by not fact I asked for Corrine Romero to help
b.        “cognitive difficulties since” but still they did not call Corrine Romero as I asked
c.        “has difficulty” can’t read the rest... but still they did not call Corrine Romero as I asked to help
     me clearly explain

12.        I can’t comment on “Medications” ... “see nurses notes” because I haven’t got time to find the notes
because of how long it takes me to do things because of the loss of a significant part of my
processing speed.

13.        Under “Social HX” it fails to record that I said I do not use drugs.
a.        this failure is apparently related to the fact extensive drug testing was done on me
b.        while extensive drug testing was done, the doctor refused to look at my toe or touch it

Because of the enormous amount of time this take me, I don’t have time to do the second page.

This page shows, however, that several extremely important facts were ignored or recording in a conflicting
manner (no pain in back vs. diffuse pain in back, as an example).

What concerns me now, as it did then, is that the continuing muscle tightness that I am experiencing is tetanus.

The tightness was so extreme that to walk across one single square foot of saltillo tile, it took me three steps. It
was so extreme that I could not bend even an inch without making my back muscles feel like they might contract
again. The tightness was so extreme I couldn’t lift my Brita pitcher when it had more than an inch of water because
of the extreme pressure and strain that put on my tight muscles.

In the beginning, the tightness turned to pain very rapidly; Being up more than a minute caused pain, and that pain
increased by the second.

I want to make it clear that when I talked about my muscles feeling like they had after I had my appendix out, this
was in my letter to Dr. Bardwell, I was describing not a level of pain, but of constriction... after I had my appendix
out I couldn’t stand up straight. I got right up and walked around, but I couldn’t stand up straight.

The day I came home from the ER I had incontinence, and I had it again yesterday. Yesterday and several days
last week I relapsed.

It is very hard to sit up and soak my foot. If I had been heard, allowed to communicate my history with the help of
my case manager, then the hospital and doctors would have had a clear picture of what was wrong, Failing that,
they did not and I remain inadequately treated as a result of discrimination.

I am complaining because unless I complain you will continue to ignore the points I have previously raised, and I
will never be able to feel secure that ER or hospital care is available to me as a person with a disability.

I am extremely distressed that when I went to the ER a second time, on October 31, 2004, the inaccuracies of
October 7, 2004 appeared to affect my visit. That is, when I was asking the doctor about my toe, he interrupted
saying that he knew what I was going to say, and I didn’t have an infection. He did not look at my toe to make
that determination. He did not look at my toe at all. So, he must have made that determination on the basis of the
discriminatory notes from October 7. He appeared to take nothing I said seriously and when I asked him what
was wrong with me he said I should research fibromyalgia. If I had not been discriminated against, I would not
have a medical record from October 7, 2004 saying I’m paranoid. I really object to this kind of discrimination and
its impact on my health.

I have a web page with some pictures of my toe on it:
www.health-boundaries-bite-com/Gardening-Darning-Needles-And-Tetanus.html

      Sincerely,

                             Karen Kline