The disease that killed his daughter was discovered too late to properly fight it. That spurred a Dunedin [Florida] man to try to make sure it doesn't happen to anyone else.

By JAMIE THOMPSON
Published August 21, 2005

DUNEDIN - One hour passed, and then another, and he was still awake, still alone, still thinking. He paced quietly, walking from room to room. His wife was asleep upstairs, but Carl Flatley knew he would not sleep tonight. And so he walked, and waited, and played it through his mind once again, every mistake, every horrible moment of it. He could still see her face: Help me, dad. Please.

He had spent three years reliving his daughter's last seven days. He knew what everyone did and failed to do. He knew it all now, but could do nothing. He had tomorrow, at least. Come morning, he would walk into the courtroom for her malpractice trial. He dreaded reliving it all out loud. But the whole story, at least, would be told. Maybe then, he could rest.

* * *

Erin Flatley told friends she was having mouth surgery. The truth was too embarrassing. She didn't like to talk about it, not even with her father, who already had the procedure done twice: a hemorrhoidectomy. Doctors said it wasn't essential, but Erin, 23, had been having pain.

Her mother drove her to Morton Plant Hospital on April 24, 2002. The surgery was uneventful. After six hours, the doctor sent Erin home with a prescription for Vicodin. She would hurt for a few days. Everyone had told her: It was minor surgery, with major pain.

The doctor reminded Erin and her mother that he was going out of town. If they had problems, they should call his covering surgeon. They also had an emergency number for the hospital. They weren't worried. What could go wrong?

They returned to the family home, a two-story on a quiet, shady street in Dunedin. The Flatleys have lived there for 23 years. Carl and Barbara started dating in the seventh grade. He went to dental school. She got her master's degree in education. First came Jennifer, then Erin, then John. Dr. Flatley owned four dental practices. His wife stayed home with the kids.

Dr. Flatley was always coming up with corny ideas for family time - the Annual Flatley Fishing Tournament, or the Annual Flatley Bowling Tournament. He even had cheap trophies made. "Making memories," he would say. "We're making memories."

Erin was perhaps the easiest to raise. She was a pleaser, sweet and mild mannered. Erin was a junior varsity cheerleader and liked to have her girlfriends around her at all times. She surprised everyone when she decided to go away to the University of Georgia. She joined the Delta Gamma sorority, showed a talent for keg stands, and graduated with a 3.0 in child and family development.

She moved back to live with her sister in Palm Harbor and began her master's degree in education at the University of South Florida. She talked about teaching fifth grade, getting married, having children.

Erin's mother helped her upstairs to her old room. A bulletin board by the bed held mementos from her days at Clearwater Central Catholic: prom pictures, dried rose corsages, a florist card with a note from her high school boyfriend, who was still her boyfriend: "Happy 7th month. Love, CJ."

Erin was in serious pain. Her mother called the doctor's office, asking for a stronger prescription. Because the doctor was out of town, the office said she would need to go to another doctor in St. Petersburg.

Mrs. Flatley didn't want to leave Erin. She called her neighbor, Dean Fauber. The family had known "Dr. Dean" for 30 years, and considered him and his wife, Mary Anne, good friends. He also had been Erin's pediatrician. Fauber called in a prescription for Demerol. Then his wife, a registered nurse, came over with a shot of pain medication, Toradol.

Erin had a restless night. The Faubers gave her two more shots, and the pain seemed manageable, until Friday morning, two days after the surgery. Erin seemed suddenly worse. Her mother was alarmed.

Mrs. Flatley drove Erin to Mease Dunedin Hospital. She wondered if she should have gone back to Morton Plant, where they had the surgery. But Mease was closer, a five-minute drive.

They walked into the emergency room before 8 a.m. That's when things began to go wrong, the Flatleys say. The emergency room doctor, Amanda Feusner, noticed Erin's white blood cell count was high, more than double the normal level, according to court records. She thought Erin had some type of surgical infection.

Dr. Feusner wanted to speak with the doctor who did the surgery. She was transferred to his covering physician, Mitchell Levine.

The elevated blood cell count was not uncommon after hemorrhoid surgery, Levine said, according to court records. And, he said Dr. Feusner might not want to start Erin on antibiotics, as they would give her diarrhea.

Dr. Feusner had another surgeon examine Erin. He agreed with Levine. Erin was sent home with a topical cream. This is going to be a horrible weekend," one doctor said, according to Mrs. Flatley. "So get ready." Minor surgery, major pain, Mrs. Flatley thought, and headed home.

The Flatleys say doctors did not tell them about Erin's elevated white blood cell count, which can indicate sepsis. Nor were Erin's levels retested before she left. In three days, the number would be off the charts.

On a scale of one to 10, Erin rated her pain a 10. She had trouble urinating. Her neighbor, Mary Anne Fauber, the nurse, offered to catheterize her. Erin and her mother agreed. It was either that, or call the home health care nurse at the hospital, Mrs. Flatley said.

Erin spent the weekend back and forth between her bed and the bathtub. She lifted her shirt and showed her sister Jennifer her stomach, which looked puffy and distended. "I wish I had never done it," Erin said.

Late Sunday, Mrs. Fauber returned to catheterize Erin again. Her urine looked cloudy. "I think you need to take her back to the hospital," Mrs. Fauber said.

Their second visit to Mease didn't start off well. After they arrived early Monday, the woman checking in patients insisted that Erin sit down, Mrs. Flatley said. "She can't sit down," Mrs. Flatley said. "She's had a hemorrhoidectomy and she's in excruciating pain." The lady kept saying, "Well, she's going to have to sit down and answer these questions." Erin smiled weakly. She sat down. She was classified as a "non-urgent" patient.

Tests showed Erin's white blood cell count was at 40,000. The normal range is about 8,000. An emergency room doctor suspected a kidney infection and prescribed an antibiotic.

Despite the pain, Erin wasn't complaining. "She's got this mind-set going: just got to get through this," her mother said. By early afternoon, Erin was hungry and thirsty, but doctors said she couldn't eat until she had a CAT scan at 1:30 p.m. But that kept getting postponed because of other emergency patients, Mrs. Flatley said. Hours passed. Erin was shaking, thrashing in her bed.

An infectious disease specialist, Dr. Don Bercuson, saw her about 3 p.m. He thought she might have an infection and ordered three antibiotics. He believed the drugs would be administered relatively quickly, according to court records.

But about five hours later, he received a telephone call from the Flatleys' neighbor, nurse Fauber, saying Erin hadn't been given the drugs yet and her mother was upset. Dr. Bercuson was surprised at the delay, according to court records. Erin's white blood cell count kept rising, to 80,000.

When Dr. Flatley arrived at 5:45 p.m., he looked at the monitors near Erin's bed. The retired dental surgeon could see that her heart rate was up and her blood pressure was down. Something was wrong. "Where is the doctor?" he said. "That's him standing down there," nurses replied.
"Get him," Dr. Flatley demanded.

Dr. Anoop Goyal walked into the room. He had been called shortly after Erin was admitted to the hospital hours earlier. He had sent an infectious disease specialist to her room, ordered pain medication and a CAT scan, but hadn't seen Erin himself. When he walked into the room, he did not know that she had hemorrhoid surgery, according to court records. He said no one told him.

Erin had been in the hospital for more than 15 hours, yet no one seemed to know what was going on, her family thought. By that evening, Erin's boyfriend, C.J. Botsolas, was nervous. "You need to calm down," one doctor told him.

Dr. Flatley was worried. He asked a doctor what was wrong.
"I think she's septic," the doctor said. Erin's parents and her boyfriend went into a small room with a handful of doctors about 9 that Monday night. Erin was in septic shock, a surgeon said. She could die. Die? After hemorrhoid surgery? "Are you kidding me?" Mrs. Flatley said.

It had never crossed her mind that death was a possibility. It was supposed to be simple surgery - like getting your tonsils out, Mrs. Flatley thought. So many people in their family had hemorrhoid surgery - Erin's grandmother and grandfather. Doctors urged the family to go home. It was going to be a long ordeal.

Mrs. Flatley had barely slept in the five days since the surgery. She and her husband went home for a quick nap after midnight. Dr. Flatley couldn't sleep. About 3 a.m., he called the hospital. "You better come down," the nurse said.

Dr. Flatley walked into the room and looked at his daughter's monitor. He didn't know a heart could beat that fast. His wife stroked Erin's face. "Honey, you just got to keep trying, get better and then I'm going to take you home." Erin tried to get out of bed. She wanted to go home.

Erin looked so bad, Mrs. Flatley thought they might be fighting a losing battle. She called Erin's sister, Jennifer, and told her to come to the hospital. About 7 a.m., Jennifer went to the hospital cafeteria with their neighbor, Dr. Dean. He picked up a tray for food. Then Jennifer heard the announcement: "Code blue in the ICU." Dean Fauber dropped the tray and ran.

The nurses ordered Dr. Flatley out of the room. He stood outside. He thought about his daughter's face. She had looked so afraid. Her green eyes had been pleading with him: Dad, can't you so something?

At 7:30 a.m. on April 30, 2002, six days after [hemorroid] surgery, Erin Flatley was dead.

[For the complete article and further discussion regarding the seriousness of sepsis, please see the St. Petersburg Times (sptimes.com) article of August 21, 2005.]