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Questions remain in embolism death of 23-year-old patient

Tue, 18 Jul 2023 15:23:14 GMT

The blood clot that killed Emily Adkins had likely been in her body for some time. How did doctors miss it?

Nine months later, her family’s pain has not lessened. Emily Adkins drank deeply of life. She played basketball and soccer growing up, also enjoyed piano or marching in the school band. A sense of purpose carried her into healthcare, and she was handling human resources for her father’s two adult living facilities when she fell and broke her ankle.

Less than six weeks later, she was dead. The cause was a pulmonary embolism, her family said. The same medical event kills tens of thousands every year.

But unlike heart disease and cancer, blood clots often go underestimated, said Dr. Jeffrey Kline, a professor and research chair at Wayne State University School of Medicine. A longtime emergency room physician and editor-in-chief of Academic Emergency Medicine , Kline named blood clots the third leading cause of cardiovascular death in the United States, and the second-leading cause of sudden unexpected death behind acute coronary syndrome.

“Despite it being a killer and being extremely common – the estimates are that somewhere around a 1 in 1,000 people will develop blood clot in the lung sometime in their life – we don’t know the exact epidemiology because it’s understudied, it’s underfunded. We have a lot better data on stroke and heart attack.”

Doug Adkins, Emily’s father, complained to the state’s Department of Health that Emily’s death was preventable and should be investigated. His objections go beyond Kline’s critique of medical readiness to Emily’s unique risk factors.

Among them are being overweight and having had both gallbladder surgery and the ankle injury within five weeks of each other, coupled with instructions from her orthopedist he regards as overly conservative, discouraging her from putting any weight on the ankle.

Nor was Emily prescribed blood thinners or even aspirin, her father said.

He recalls the phone call he got from Dr. Shane Shapiro, the orthopedist, on Oct. 24, offering condolences three days after Emily died.

“He said it’s just one of those things, we don’t know why this happens,” Doug said. Doug told the doctor, ‘Look, I don’t know what the standard of care is in orthopedics. But I’m going to find out.’”

At that point, he said, Shapiro mentioned prescribing anticoagulants, or blood thinners, but said the field was divided on that issue, that there was ‘broad disagreement.’”

Doug contends that those kinds of disagreements don’t speak to his daughter’s special conditions.

“They want to talk to you about broad disagreement about blood thinners,” he said. “But what there’s no disagreement about is these risk factors – overweight, family history, immobilized for four weeks, recent surgery – and if you have an ankle fracture, hands down it’s a different ballgame in terms of surveillance, detection and prevention. All the literature agrees on this.”

The Adkins have another point of contention with Dr. Shapiro, who did not return multiple calls for this story. It concerns the online medical record of Emily’s visit on Oct. 13, after she got her cast off.

Her mother, former state Rep. Janet Adkins, was with her. Janet Adkins remembers waiting in a small examining room waiting for the doctor, Emily’s fresh x-rays visible on the computer screen.

“The ankle really didn’t look like we thought it should look,” she said. “And I remember Emily saying to me, ‘Let’s just wait for the doctor. Let’s not make any assumptions.’”

When Shapiro arrived, he apologized for mother and daughter having had to wait for the cast to come off, Janet said. The consultation with Shapiro lasted 10 to 12 minutes. She remembers sitting closest to him, with Emily further away, in a wheelchair.

During that time, Janet said, Dr. Shapiro never left his position from behind his computer.

The hospital initially declined to give Doug the online record Shapiro made of that visit, made eight days before Emily’s death. But his attorney succeeded in retrieving it. It notes the lack of deformity in her lower leg but a mild swelling, and ankle fracture itself and then this: “Calf squeeze is unremarkable.”

That’s a problem. Janet Adkins, a woman accustomed to detail, Nassau County’s current supervisor of elections, recalls no such calf squeeze. Such a maneuver would have been prudent – perhaps even basic – given that physicians can sometimes physically feel blood clots in the calf, a finding that would inform next steps to reduce the danger to patients.

But as Janet remembers that Oct. 13 visit, Shapiro never left his computer. And to get to Emily in that room, he would have had to step past Janet.

“I was there the whole time for that appointment,” she said. During that time, Shapiro never touched her daughter, she said.

The report is dated Oct. 23 – a Sunday – two days after Emily Adkins died.

On April 14, the Department of Health responded to Doug Adkins’ complaint against Dr. Shapiro, alleging negligent care. The letter from the Prosecution Services Unit of the Office of the General Counsel said the case will undergo a legal review, a process that could take several months.

“The panel will then decide whether to initiate formal disciplinary proceedings,” the letter stated.

– Andrew Meacham is a former reporter for the Tampa Bay Times.

A promising future cut short, followed by questions

Tue, 18 Jul 2023 15:22:41 GMT

Emily Adkins, 23, died while recovering from a broken ankle. Her parents are interrogating her care at the Mayo Clinic.

YULEE, Fla. – Janet Adkins, Nassau County’s elections supervisor, was leaving work October 21, 2022, when she got the call.

Her daughter, Emily Adkins, was having trouble breathing.

Janet told her she would call 911. On her phone, a video doorbell app showed ambulance attendants had beaten her to the house in Fernandina Beach and were carrying Emily out on a stretcher. Janet called her husband Douglas, telling him what had happened and to meet her at the hospital.

Emily died that night at Baptist Medical Center Nassau. She was 23. The cause was a pulmonary embolism caused by a blood clot, her family said.

More than 100,000 Americans suffer the same fate each year, according to the National Blood Clot Alliance. Now Emily’s parents have launched an all-out effort to determine what standards of care are being used to detect blood clots before they become fatal.

The Florida legislature has begun a volunteer study group to gather data and issue recommendations, the result of bipartisan legislation called the Emily Adkins Blood Clot Prevention Act. Many legislators who sponsored bills in the Senate and House already knew Emily through Janet Adkins, a four-term Republican state representative from 2008 to 2016. The goal of the work group is to get answers why so many preventable deaths due to blood clots go undetected and what can be done about it.

Douglas and Janet are also honoring their daughter by creating scholarships for healthcare students and low-income assisted living candidates in her name. They set up a Holy Land scholarship for fellow parishioners of Blackrock Baptist Church to visit Israel.

Those things help, but cannot assuage a mixture of anger and grief over losing their daughter, who loved reading and travel, Hogans Heroes and I Love Lucy, angels and anime, Kelly Clarkson and Imagine Dragons.

That evening in October, she was still mostly living with her parents in Fernandina Beach. She had not quite finished moving into a brand new house in Yulee, which she had spent months designing. To this recent visitor, her imprint lingers, and intentionally so. Douglas and Janet have left the house mostly unaltered since she was last there.

Emily’s 2017 Honda Civic still sits in the garage. Papers and notebooks from her job take up part of the interior. A health administration graduate from the University of North Florida, she was serving as the human resources director (or “success officer”) at DaySpring Village, an assisted living facility owned by her father.

Her keys hang on a rack in the entrance hall alongside a favorite cap, a scarf and a couple of hoodies for cooler weather.

Sea green walls open up to spacious views of the back yard in a way that makes each view feel like an opening, a clearing. Douglas decided to accept a delivery for $8,000 worth of Ethan Allen furniture that came after her death. The only other conspicuous change also speaks to a longstanding wish, one that walks on four legs.

Gracee, a 9-month-old Aussiedoodle, throws her chew toy a foot or two and retrieves, jumps up on the couch and back down, a tireless fount of enthusiasm. Emily had been looking at the breed.

“This house was part of her identity as she graduated from college and started on her career path,” Douglas said. “She had her whole life standing in front of her as a young woman.”

That trajectory would likely have carried her not only to one day succeed her father at the helm of his companies, but along the way, to take after her mother. Janet Adkins was 8 months pregnant with Emily when she ran for school board, her first political office. Emily also had her eye on a school board spot to benefit the children she planned to raise. Later, who knew? Maybe the legislature.

In the meantime she relished simple pleasures, including lunch after church at Gator’s Dockside, which specializes in wings and hand-breaded chicken tenders. That’s part of what makes Sundays the hardest for Douglas and Janet. Emily’s future seemed assured from almost any direction she desired, with nothing impeding it other than a couple of health-related setbacks, and neither of those seemed major at the time.

The first came midway through August, when an emergency room physician took out her gallbladder. Emily got back to work at DaySpring within a few weeks, but slipped on freshly washed floor and injured her ankle.

She went to Jacksonville’s Mayo Clinic two days later, where Dr. Shane Shapiro diagnosed a break. Emily returned to the clinic Oct 13 to get her cast off. She left in a boot. In between she had a follow-up with Shapiro. The ankle was healing.

Her phone call to her mother came eight days later. “I could tell she was in distress,” Janet said.

Janet parked at the hospital and inquired about her daughter. Hospital staff told her Emily had suffered cardiac arrest but had still had a heartbeat and that doctors were working on her. Doug soon arrived and was led to the waiting room to join his wife.

At that point, they said, some hope permeated their shock. Yes, something bad had happened but she had a heartbeat and she was in the right place.

Then a doctor entered the room. “He comes in,” Douglas recalled, “and he starts shaking his head.”

Through her shock, Janet knew one thing: She needed to be with her.

They stood nearby her bed and prayed for Emily – prayed with her, as Douglas described it – and encouraged the doctors who were doing chest compressions.

As hope dwindled, unreality pervaded. “I just can’t think it,” Janet was thinking. “She’s 23.”

The next week entailed making funeral plans and trying to get answers from Emily’s caregivers at Mayo Clinic. Chief among his questions were how this death could have happened. The story on Monday, “Emily’s Medical Care,” examines Emily’s risk factors, the advice she received at the Mayo Clinic, and how a record by her orthopedist contradicts what Janet Adkins says she saw.

Dr. Shapiro did not return a call requesting comment for this story.

– Andrew Meacham covered obituaries and the performing arts for the Tampa Bay Times before his retirement in 2018.

HEALTHCARE SCHOLARSHIP AWARDED

Mon, 08 May 2023 14:48:48 GMT

“We are pleased to announce EMILY’S PROMISE, INC. has selected KATE TURNER a student from West Nassau as the 2023 winner of the EMILY ADKINS HEALTHCARE PROFESSIONAL scholarship.

Kate is a kind and compassionate person who seeks to pursue a degree in nursing at UNF. We were impressed with her values, hard work, commitment to promoting kindness as a cultural value and her determination to achieve her goals. We had many great candidates apply and all had wonderful attributes and we believe will make a positive impact on the community and the provision of healthcare in Nassau County.”

“We are thrilled to provide this $5000 scholarship to KATE TURNER and look forward to watching her grow and become a practicing nurse one day. Our daughter EMILY ADKINS was passionate about the development of good healthcare workers and in her short time as our People Success Officer had developed the skills to identify top talent – which starts with empathy and compassion.”

“Congratulations to KATE TURNER and all the other students who applied, we wish you all the greatest success in pursuit of your dreams to make a difference in Nassau County as a healthcare professional.”

Florida Passes Measure to Create First-Ever Blood Clot Work Group House Approves SB 612 - the Emily Adkins Prevention Act

Thu, 04 May 2023 20:50:57 GMT

House Approves SB 612 - the Emily Adkins Prevention Act

TALLAHASSEE, FL - Today the Florida House of Representatives authorized SB 612 by Sen. Clay Yarborough/Rep. Dean Black, legislation that would require the Agency for Health Care Administration and the state Surgeon General to establish a policy workgroup to understand how blood clots and pulmonary emboli impact Floridians. The Workgroup would consider recommendations regarding standard of care guidelines and determine how many Florida residents are affected. It would identify how data is collected and emerging treatments and therapies and would develop a recommendation for risk surveillance systems.

The issue was initiated by Doug and Janet Adkins, whose 23-year-old daughter Emily Adkins died unexpectedly in October 2022 of a pulmonary embolism – the result of a blood clot while recovering from a broken ankle. The "Emily Adkins Prevention Act" was sponsored in the House (HB 483) by Rep. Dean Black and in the Senate by Sen. Clay Yarborough (SB 612) and garnered bipartisan support, passing unanimously out of its respective committees and by both chambers. With the bill's passage by the House and previously the Senate, SB 612 will now be sent to Gov. Ron DeSantis for his consideration.

"I'm grateful to the Adkins family for their willingness to share their story and bring this issue to the Legislature. This bill is about having a better understanding of blood clots, who it affects and how they can occur so we can save lives," said Rep. Dean Black.

"Florida is once again leading the way on an important public health issue," said Sen. Clay Yarborough. "This legislation will give other states a model to follow to help ensure that families have access to information and more standardized care to help prevent tragic outcomes."

According to the National Blood Clot Alliance, over 900,000 Americans are diagnosed with a blood clot each year, with nearly half sustaining long-term health effects as a result. “Better awareness and screening can help prevent countless deaths and injuries,” said Leslie Lake, President of the Alliance. “As a pulmonary embolism survivor, this legislation gives me hope that we can bring this model to other states and get individuals the information they need to navigate the issues that can follow a blood clot diagnosis.”

"From the beginning, our goal was to raise awareness about blood clots and what can be done to prevent a pulmonary embolism," said Doug Adkins. "This is an important issue that affects families across Florida and the country, and we're grateful to Senator Yarborough and Representative Black for leading their colleagues in ensuring the passage of this bill and to the entire Legislature for helping us honor Emily's memory."

Together with their son Douglas, Janet and Doug Adkins established Emily's Promise, a nonprofit foundation dedicated to the memory of their daughter and to raising awareness about blood clots and pulmonary embolisms. For more information about Emily's Promise, visit www.emilypromises.com .

Janet and Doug Adkins have been long-time members of Florida Health Care Association. Prior to her passing, Emily worked in human resources with her father at Dayspring Senior Living in Hilliard, a town in Nassau County just northwest of Jacksonville. FHCA was proud to support this initiative, especially given that the elderly are at increased risk for pulmonary embolism because of both the conditions common to this age group, and the immobility that often accompanies them.

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ABOUT THE FLORIDA HEALTH CARE ASSOCIATION
The Florida Health Care Association (FHCA) is a federation that represents 86% of the state's nursing centers and other long-term care facilities that provide skilled nursing, post-acute and subacute care, short-term rehab, assisted living, and other services to the elderly and individuals with disabilities in Florida. The mission of FHCA is to advance the quality of services, image, professional development, and financial stability of its members. As Florida’s first and largest advocacy organization for long-term care providers and the elderly they serve, the Association has worked diligently since 1954 to assist its members with continuously improving quality of care and quality of life for the state’s growing elder care population. For more information about the Florida Health Care Association, visit http://www.fhca.org .