CREVE COEUR 鈥 Kat Dunkus was doing better. She had moved in with her niece after completing an alcoholic treatment program two years ago. The program helped her learn better ways to cope with her schizophrenia and trauma.
鈥淪he was trying to find her way back to more stability. She was trying to find happiness for herself,鈥 said her niece Rachael Benns, 31, of Creve Coeur. 鈥淪he kept saying, 鈥業鈥檓 finally in a safe place.鈥欌
That was until April 21, when a schizophrenic episode landed Dunkus, 48, in the emergency room at Mercy 狐狸视频 in Creve Coeur. Once inside, she was taken to the emergency department鈥檚 behavioral health unit for patients in a mental health crisis.
The unit is locked and separated from the rest of the emergency department. Little to no medical care is provided there, as patients wait, often for several hours, for an open bed in a psychiatric facility.
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At 7 a.m. the next day, Dunkus was found dead. An autopsy released June 12 revealed she died of complications related to long-term alcohol abuse. Her heart had failed.
Hospital workers directly involved with the care of patients in Mercy鈥檚 emergency behavioral health units say how Dunkus was treated exemplifies the poor conditions inside these units.
鈥淚t was not a matter of if this would happen. It was a matter of when,鈥 said one worker.
The worker was one of four, including a nurse, who spoke on background to the Post-Dispatch, citing concerns about losing their jobs if they were named.
Dunkus鈥 family members say they have been given few answers from the hospital. Her medical records, copies of which her family provided to the Post-Dispatch, indicate numerous medical concerns, leaving them with more questions.
The records show Dunkus had dangerously low potassium 鈥 an electrolyte that can affect the heart鈥檚 electrical signals. An electrocardiogram (EKG) showed she had a concerning heart rhythm. Her blood pressure was high.
Benns said she also told doctors about her aunt鈥檚 history of alcohol abuse and how she had been complaining of chest pains.
Yet Dunkus was kept in the behavioral health unit with no heart monitoring, her records show. The only treatment she received was intravenous fluid containing potassium and magnesium. No or were used that could help regulate her heart.
鈥淭hat wasn鈥檛 the appropriate place for her to be,鈥 said her sister Cheryl Ketter, 56, of Ferguson. 鈥淵ou can鈥檛 just shove them into a corner somewhere and think that they are OK.鈥
The autopsy report notes that Dunkus was last seen alive at 11 p.m. 鈥 eight hours before her dead body was discovered. From a central nurses鈥 station, she was supposedly observed every 15 minutes via a video camera.
鈥淎ll they did was just leave her in a room,鈥 said her niece Rose Taylor, 25, of Mehlville.
Mercy officials say federal privacy laws prevent them from speaking about Dunkus鈥 death. In response to allegations about the quality of care provided by its emergency departments, hospital officials only released a general statement.
Officials insisted that all patients coming into a Mercy emergency department are appropriately screened to rule out emergency medical conditions and to determine if any tests or procedures are needed.
Patients are safe, they say, despite higher numbers they are having to care with behavioral health issues.
鈥淧atients are monitored by nursing and other personnel throughout the ED visit to ensure their safety,鈥 the statement read. 鈥淚ncreasingly, due to lack of access to mental health resources across the U.S., high-volume emergency departments such as Mercy have become a regular source of care for patients who are often in crisis situations.鈥
A difficult life
It was important to Dunkus to be at the births of every one of her 11 nieces and nephews. She babysat any time she could and hosted sleepovers.
鈥淪he was always that aunt that was there for a lot of us,鈥 Benns said.
Dunkus was one of five siblings who grew up in the 狐狸视频 area. As children, they ended up in foster care after their mother left and their father couldn鈥檛 take care of them on his own, though he remained close with them.
Dunkus鈥 medical record shows her father also had , a serious mental illness that typically manifests in early adulthood and can cause hallucinations, delusions and extremely disordered thinking.
The five children were split up in foster care. Dunkus stayed with Benns鈥 and Taylor鈥檚 mother as well as their uncle. Life was difficult, Taylor said, 鈥渂ut they had each other.鈥
Their mom learned about her sister鈥檚 schizophrenia and helped keep the symptoms at bay. Benns and Taylor said they rarely saw their aunt experience delusions.
Dunkus earned a degree in human resource management, Benns said. She worked various customer service jobs, where she enjoyed helping people. She loved photography. She was proud of her Native American heritage on her mother鈥檚 side and was a registered member of the .
But Dunkus also struggled with alcoholism, which with schizophrenia as a way to cope with the symptoms. It contributed to ending her 15-year marriage around 2016 and strained family relationships.
In 2010, Dunkus鈥 sister 鈥 Benns and Taylor鈥檚 mother 鈥 died. That was followed by the death of her brother in 2018 and father in 2020.
鈥淭he deaths really took a toll on her,鈥 Benns said. 鈥淪he was trying to find her way back to more stability.鈥
Two years ago, Benns agreed to let Dunkus move in with her after she completed an alcohol treatment program. Dunkus came out healthy and hopeful, Benns said.
Benns and Taylor said they had watched their mother gradually get sicker as she was in and out of the hospital. It was different with their aunt.
鈥淟ooking back on my mom, you could see it coming,鈥 Taylor said. 鈥淏ut with Kat, she was doing so much better.鈥
鈥楨ight hours?鈥
Two days before ending up in the emergency room, Dunkus began feeling paranoid, Benns said. The next day, she was hearing voices. Dunkus thought people were recording her. She was scared someone was coming to take her to prison. She accused Benns and her boyfriend of drugging her.
Benns said Dunkus admitted she had gone to a bar and was drinking again. Benns scheduled a doctor appointment for the following day.
The morning of the appointment, however, Dunkus left the apartment and ended up nearby at the Jewish Community Center, where an employee called police at 10:46 a.m., according to the police call log. Officers arrived a minute later to find Dunkus sitting in an office.
Police called Benns. The officer had called for an ambulance, which Benns followed to the hospital.
No police report was written, but Benns said part of the reason why police called for an ambulance was because her aunt said she had chest pain. Dunkus鈥 medical records show she arrived at Mercy 狐狸视频 at 11:44 a.m. for 鈥減sychological evaluation.鈥
Benns said Dunkus was taken straight to the locked behavioral health unit within the emergency department.
Benns found her aunt getting her blood drawn and in what her nurse called a 鈥 she was making tense, unusual movements, such as holding up her leg or her mouth open.
Benns said she talked to a doctor about her aunt鈥檚 chest pains. The doctor told her he would order an EKG of her heart and a CT scan of her organs.
Dunkus鈥 bloodwork revealed she had no alcohol or drugs in her system, according to the medical records, but her potassium level 鈥 2.7 鈥 placing her at higher risk of cardiac arrhythmia (irregular heart rhythm). Normal is 3.5 to 5.2. Anything lower than 3 is considered 鈥渟evere.鈥
Dunkus refused to take pills or eat, so she was given an intravenous bag of fluids to raise the level, which requires continuous monitoring, , to ensure safety.
Benns and Taylor stayed with her for several hours. The EKG machine was brought into the room, they said. To go to her CT scan, Dunkus had to be lifted into a wheelchair. She was quiet.
鈥淪he was slightly responsive, or she wouldn鈥檛 talk,鈥 Taylor said.
Benns and Taylor said the only concern staff shared with them was her potassium level was low, and the goal was to raise the level so she could be admitted to an in-patient psychiatric facility.
Dunkus eventually wanted her nieces to leave, thinking they were trying to hurt her, they said. They didn鈥檛 want to scare her, so around 7 p.m., the two left the hospital.
鈥淚 love you, and I hope you know we just want you to be safe and happy,鈥 Taylor said she told her.
Benns, the main contact, was expecting to get updates throughout the night. Instead, Taylor got a got a call from a chaplain at 7 a.m. the next morning saying her aunt had died.
At the hospital, Taylor said a doctor and a nurse told her that her aunt was last checked on at 11 p.m.
鈥淚n my head, I鈥檓 like, 鈥楨ight hours? Is that normal?鈥欌 she recalled. 鈥淭hat is the only thing that stuck in my head, them telling me eight hours. They couldn鈥檛 even tell me when she died.鈥
Complications
The hospital reported the death to the 狐狸视频 County Medical Examiner鈥檚 office, in cases where the cause of death cannot be established. The office decided an autopsy was needed.
The examination concluded that the cause of death was complications from chronic alcohol abuse. The years of drinking had caused the .
When that happens, explained 狐狸视频 County Assistant Medical Examiner Dr. Joshua Akers, the electrical impulses that travel through the heart 鈥渒ind of get lost鈥 or travel slower.
鈥淭hat can create a cardiac arrhythmia, and a serious arrhythmia can be fatal,鈥 Akers said. The body is starved of blood and oxygen.
Death can occur in less than five minutes, he said.
One of the first signs of a severe arrhythmia would be losing consciousness, Akers said. If a person was sleeping, there might not be any signs.
After Dunkus鈥 lifeless body was discovered, CPR was administered along with two doses of epinephrine, records show. No heart activity was ever detected. She was pronounced dead at 7:07 a.m.
A doctor called to the bedside wrote 鈥渘o recent vital signs available.鈥 The doctor also described the body as 鈥済ray, cold to touch, had swelling on her back,鈥 medical records show.
Akers said such descriptions can be subjective and there鈥檚 no way of knowing the time of death.
The workers say Dunkus should not have been kept in the behavioral health unit.
After her arrival, Dunkus鈥 blood pressure was 140/100 and heart rate was 110 beats per minute 鈥 both high. Lab results came quickly, revealing the dangerously low potassium.
An EKG was completed within about two hours. The test showed a QTc interval 鈥 the time it takes for the heart to contract and recover 鈥 of 492. The interval is considered prolonged if greater than 460 in women, , and 500 predicts an 鈥渋ncreased risk of life-threatening cardiac events.鈥
Dunkus鈥 long-term and recent alcohol use were noted in the medical records, and the CT scan results showed liver disease consistent with chronic alcohol use.
No observations were noted after 2:18 p.m., when Dunkus was marked as 鈥渟table.鈥 Her last vital signs were taken at 1:04 p.m. Her blood pressure was still 142/92.
Dunkus鈥 blood was analyzed again, but the sample was damaged, possibly skewing the results that were released from the lab around 10:30 p.m., the records show.
Benns said after calling the hospital to try and learn more about how her aunt died, she was eventually told that Dunkus was watched via a video monitor and because she appeared to be sleeping, no one physically checked her because they didn鈥檛 want to wake her.
A travel emergency room nurse who has worked in hospital systems in the 狐狸视频 area says when she sees patients with a history of alcohol abuse in the behavioral unit, she is adamant they be moved to a medical bed because of how quickly they can deteriorate.
鈥淚f you have a patient who is an alcoholic, I absolutely will not take them on the behavioral health side. I will stomp my feet, throw a fit. No way,鈥 she said. 鈥淭hey turn too quickly, they do.鈥
鈥楯ust touch them鈥
The Mercy workers who spoke to the Post-Dispatch about Dunkus鈥 death described the behavioral health units at both Mercy 狐狸视频 and its sister hospital Mercy South.
At Mercy 狐狸视频, workers say, the unit includes nine patient rooms. Some basic medical equipment is kept behind locked doors in rooms, as well as a toilet. Patients can receive intravenous fluids. The central nurses鈥 station sits behind a high counter.
Mercy South includes 10 rooms, four of which are in an overflow wing. The patients share a bathroom in the hallway. The nurses鈥 station sits in a closed room with windows. No medical equipment is kept in the rooms, and family members are not allowed.
Patients in the units wear scrubs. Beds are bolted to the floor. Nothing can be in the rooms that can be used to hurt themselves or others. Doors to patient rooms must remain unlocked.
The units are staffed with a nurse, one patient care technician (two if patients are in the overflow wing) and a security guard.
Patients coming into the emergency room are supposed to be medically screened first and have blood drawn to check for abnormalities and drugs in their system before being sent to the units, the workers say.
鈥淚鈥檝e had them come straight from EMS, straight back here, and I鈥檓 like 鈥楲ook, nuh uh, this patient needs to go over there, medically should be over there,鈥 and they won鈥檛 take them back 鈥,鈥 said the nurse. 鈥淏ut we have open rooms 鈥 that鈥檚 how it鈥檚 looked at. The behavioral has open rooms, use them. And I鈥檓 like, 鈥楤ut I can鈥檛 monitor them.鈥欌
Patients in the behavioral units should be able to walk, speak, use the bathroom 鈥渁nd have no medical needs,鈥 she said, 鈥渕eaning that for the most part, other than their mental health, they are healthy.鈥
But patients are sometimes sent there who are incontinent or in wheelchairs, the workers say. Some are not in mental crisis but emotional from grieving a death or an injury. Staff use the units as a way to reduce wait times, they say.
鈥淭here are times when a patient is highly agitated and being on a locked unit is the safest path for sure, and they need to get them over there quickly. We all understand that. But that is not how the unit is used,鈥 one worker said.
That makes it harder for the one nurse staffing the unit to keep a watchful eye on all the patients, the nurse said. 鈥淚 can鈥檛 chart, I can鈥檛 look at orders, I can鈥檛 get the meds, do all that, plus look at the monitors, make sure everybody is OK, make sure I order meals and get the meals up here to them. You are only one person, you can only do so much.鈥
Patients in mental crisis who also have medical needs, the workers say, are supposed to be cared for in a medical room with a sitter continually watching them and noting their condition every 15 minutes 鈥 such as sleeping, calm or agitated.
Routine in-person checks should also happen in the behavioral health units, but instead patients are observed via a screen from the nurses鈥 station or not at all, as workers say they have caught patient care technicians doing homework or searching the internet.
鈥淗ow hard is it to get up every 15 minutes to do a safety check? It is their actual job, and they can鈥檛 get up to check?鈥 said one worker.
The nurse says patients should have their vital signs taken at least every two hours. Patients can refuse to have them taken, but staff should continue to try. And if a patient hasn鈥檛 moved after an hour, she said, they need to be checked physically.
鈥淚 have to count a lot on the (patient care) techs,鈥 she said, 鈥渁nd if they are like, 鈥極h, they are fine, they are sleeping,鈥 I鈥檒l say, 鈥榃hen was the last time you went in there? I need you to be in there and just try to wake them up, just touch them, see if they move, whatever.鈥欌
But, she said, she understands that dealing with patients in mental crisis can be extremely challenging, exhausting and dangerous. She and others have been attacked by patients.
Mercy officials, in their statement, encouraged workers to report concerns to Mercy鈥檚 internal safety event reporting system, used to address concerns related to patient care and workplace conditions:
鈥淲e rely on our co-workers, patients and visitors to be the eyes and ears to report events and give us the opportunity to address any issues and create a safer environment for all.鈥
Benns and Taylor said while at the hospital, staff never told them the results of their aunt鈥檚 EKG or CT scan. The severity of the low potassium was never explained. 鈥淲e should have been given this information so that we could advocate for her care,鈥 Taylor said.
They also don鈥檛 understand why Dunkus鈥 chest pains were not noted in her medical record.
鈥淭heir best solution for how to care for a catatonic patient with concerning health issues was to leave her in a room for eight hours,鈥 Taylor said. 鈥淚t really hurts us to know this is how someone we loved was treated.鈥
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