Alcohol / Drug Council of North Carolina

A discharged patient dies, leaving questions about his care and the drug found on him.

BY MICHAEL BIESECKER, Staff Writer

Two hours after he was discharged from a state psychiatric hospital in Goldsboro last month, Jeffery Scott Swaim’s mother found him slumped in the seat of a Greyhound bus in Wilmington.

He died the next day.

Sheila Buckner, his mother, says emergency room doctors told her they found an adhesive patch containing a powerful prescription painkiller in her son’s mouth. Though the cause of Swaim’s death July 16 has not yet been officially determined, Buckner says doctors in Wilmington told her he likely died of a drug overdose.

She now wants to know why her son, who had a history of substance abuse problems, was sent home from Cherry Hospital in Goldsboro with a supply of fentanyl. A synthetic opiate 100 times more potent than morphine, the drug has been linked to hundreds of overdose deaths nationally; it is often abused by those seeking a high.

Swaim, 40, is at least the 11th person treated at the troubled state hospital to die under questionable circumstances since 2003.

“He went there because he wanted help,” said Heather Swaim, Jeff’s wife. “And they gave him the drugs that killed him.”

Swaim was admitted to Cherry on July 3 because of alcohol abuse and suicidal thoughts, according to copies of his psychiatric records released to The News & Observer with his family’s consent. He was discharged less than two weeks later.

Buckner says Swaim begged hospital staff members to let him stay because he wanted long-term treatment. Swaim called home shortly before he was taken to the bus station.

“They’re telling me that I can’t stay, they can’t help me and they can’t find me a place to go,” Buckner said he told her.

It was the last time she spoke with her son.

Philip R. Cook, director of Cherry Hospital, expressed sympathy for Swaim’s family.

“We are looking internally to review what happened and what we might have done differently,” Cook said. “Certainly there’s things in hindsight, as we look backwards, we can identify things we would like to have done differently. Anytime we have a situation that occurs that has an adverse outcome for anyone, we want to work to make changes so it’s less likely to happen to anyone moving forward.”

Cause of death unknown

Cherry’s official report of Swaim’s death, prepared by one of the hospital’s doctors, omits any mention of his being prescribed fentanyl or that he was found with the drug in his mouth. The two-page form lists his cause of death as “unknown.”

Questions about Swaim’s care come at a sensitive time for administrators at the mental hospital.

Cherry’s certification to receive Medicare and Medicaid monies was revoked in September after the death of patient Steven H. Sabock. Sabock choked on his medication, hit his head and was then left sitting in a chair without food, water or medical attention for nearly a day.

Cherry administrators are trying to regain federal certification. Every month that the hospital operates without Medicare and Medicaid approval costs state taxpayers about $1 million in lost revenue.

“When it comes to Cherry, the state seems to be taking one step forward, two steps back,” said Vicki Smith, executive director of Disability Rights North Carolina, an advocacy group that investigates deaths involving state hospitals. “We’ve been concerned about the culture at the hospital and competence of staff for a long time.”

Cook, who took over at Cherry this year after his predecessor was forced to step down, said he is focused on the future.

“I do believe the hospital is moving forward on a very constructive track to reorganize and redirect itself,” he said. “I feel confident, as the months go by, we’re going to see a very much improved Cherry Hospital.”

Swaim, who worked as a body shop mechanic, had struggled with alcohol and drug addiction since he was a teenager. According to his psychiatric records, Swaim had been averaging a bottle of vodka every day before he came to the hospital. His wife said he also took prescription pain medication for recreational use.

Years of heavy drinking had left Swaim with acute pancreatitis, an inflammation of the pancreas that can cause severe abdominal pain. He also suffered from depression and uncontrollable mood swings, according to a written assessment by Cherry staff members.

Drinking and drugs

Troubled by his drinking and drug use, Swaim’s wife in late 2007 moved out of the home they shared in Burlington. After losing his job last year, Swaim went to live with his mother and sister in Southport. The Swaims did not have children.

Swaim had no health insurance, and Buckner said getting him into an inpatient treatment program was difficult. As a last resort, Swaim asked his mother to have him involuntarily committed to Cherry, which serves as the primary public psychiatric hospital for 32 Eastern North Carolina counties.

Like other state hospitals, Cherry routinely has more people seeking treatment for mental problems or substance abuse than available beds. In June, the most recent month for which data was available Friday, prospective patients were turned away 21 out of 30 days. Some waited more than a month for space to open up, state records show.

To help ensure that Swaim would be admitted, Buckner said the family was given some unorthodox advice by the staff at a substance abuse treatment center in Wilmington.

“They suggested he be drunk when [the police] came to pick him up to go to Cherry so he’d stand a better chance of getting in,” she said. “So we proceeded to get Jeff drunk.”

The hospital’s July 3 intake form for Swaim describes him as “intoxicated, belligerent, aggressive.” But he wasn’t admitted just because he was drunk. The staff psychiatrist who interviewed Swaim wrote that he was suicidal, a diagnosis his mother finds difficult to reconcile.

“Jeff would never have contemplated suicide because he knew God didn’t approve of that and wouldn’t forgive you for that,” Buckner said.

A warning label

While at Cherry, Swaim complained of abdominal pain associated with pancreatitis. His medical records show a doctor prescribed Ultram, a synthetic opioid manufactured by a division of pharmaceutical giant Johnson & Johnson.

In May, the Food and Drug Administration sent a letter to the company’s CEO ordering him to withdraw promotional materials for Ultram that federal regulators said overstated its effectiveness and minimized the risk of addiction and overdose in those who use it.

The drug’s required labeling warns against its use by those with depression because of increased risk of suicide. It also warns against prescribing the drug to those suffering from addiction to alcohol.

On July 10, Swaim was transferred to Wayne Memorial Hospital in Goldsboro to be treated for pancreatitis. Doctors there concluded that Swaim was suffering from alcohol withdrawal and exhibiting signs of drug-seeking behavior, according to his medical records. Drug seekers are people who fabricate or exaggerate the level of pain they are experiencing to receive prescriptions for narcotics.

Swaim returned to Cherry on July 14 and was set for discharge the next day with instructions to find treatment for his substance abuse problems elsewhere. His records show a Cherry doctor prescribed him Duragesic, a slow-release fentanyl patch manufactured by Johnson & Johnson that is supposed to provide 72hours of pain relief.

Fentanyl is often abused by those seeking a high, and federal regulators have issued several warnings about the potential for overdose with the drug, which is known by such street names as Dance Fever, Goodfella, Murder 8, TNT, and Tango and Cash.

An FDA advisory about the medical use of skin patches containing fentanyl warns of dangerous side effects, including severe trouble breathing and cardiac arrest, even when the drug is used as prescribed.

Fentanyl has been linked to 766 deaths in the United States, according to the FDA. A 2007 review by a medical journal put the death toll even higher, at 3,545.

David P. Friedman, a pharmacology professor at Wake Forest University School of Medicine, said it is often difficult for doctors to judge a patient’s legitimate reports of pain against an individual’s desire for illicit drugs.

“Obviously, the doctor was caught between the twin evils of letting the guy stay in pain or giving him something he could abuse,” said Friedman, who researches the effects of alcohol addiction on the brain.

The long wait

About 6 p.m. July 15, Sheila Buckner sat in her van at the bus station in Wilmington, her 4-year-old granddaughter asleep in the back seat, waiting for her son to get off the bus from Goldsboro. When he didn’t get off with the other passengers, she woke Swaim’s niece and went looking for him.

Buckner found her son in the back of the bus, leaning out of his seat and into the aisle. He was unconscious and not breathing.

“His lips were blue, and he had this brown stuff coming out of his mouth,” she said.

With the help of the bus driver, Buckner lowered her son to the floor of the bus and started CPR. A police officer soon arrived, followed by paramedics. The medical personnel managed to restart Swaim’s heart, but doctors at New Hanover Regional Medical Center later told Buckner that her son’s brain had gone without oxygen too long and that he was on life support.

He died early the next morning; his retinas were harvested for transplant.

Buckner said Thursday that she is trying to focus on good memories.

“He had such a kind heart,” she said, crying. “He was the type of guy that if he found an animal on the side of the road hurt, he would take it home.”

After the autopsy, Swaim’s body was cremated. The family plans to gather in Burlington on Saturday to scatter his ashes at a leafy park that runs along the banks of Rock Creek.

michael.biesecker@newsobserver.com or 919-829-4698

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Patient deaths

Jeffery Scott Swaim is at least the second patient who may have died of a drug overdose shortly after being discharged from Cherry Hospital this year.

Scott Hart died Feb. 28, four days after he was discharged following treatment for depression, suicidal thoughts and a history of abusing prescription medications.

According to records released Thursday, Hart, 39, was found unconscious on a couch at a friend’s house in Supply. Tests on his blood determined he died of an overdose of the prescription painkiller oxycodone. The autopsy report says he was not prescribed narcotics while at Cherry.

Staff writer Michael Biesecker

http://www.newsobserver.com/2771/story/1630920.html