MURPHY, BEVERLY
ME-C 2008-360

COMMONVVEALl'I( OF KENnJCKY
Justice Cabinet
OFFICE OF THE ASSOCIATE cmEF MEDICAL EXAMINER
Centra1j~ed I.abol'tltory Facility
100 Sower Boulevard - Suite 202
Frankfort, Kentucky 4,0601
(502) 564--4545

UNA
1.

Hypert\'ll1sive a.nd Atherosclerotic Cardiovascular Disease (Heart wt, 350 g).
A

B.
C.
D.
E.
F.

U.

Coronary lIrtery atherosclerosis: teft c;rcumfl"x - 10%, right coronary artery - 50%
stClloscd.
Calcificatiolls of aorta.
Severo nlilphrosc!erosis with benign renal cortioal cysts.
Ri.\lht pleLlral ofrusion - 250 m!.
Gllal scar of white matter fit right lateral ventricle.
History of sudden collapse.

Obesity: ;230 POU11ds for a 5 Feet 6 Inch Tall Female.

A.

Body Mass Index ~ 37 kg/m~,

m.

Diab~tes

IV.

I"'£epatitis C Infection with Cirrhos.is.
A.
B.

V.

, C.

Remote contusion, right frontal pole glial scar.
History of seizures.
.
Healed right burhole - 1.0 em.

History of Drug Abuse per Inves'Hgalion.

A.
B.

Vl1.

Splenomegaly - 300 gm.
Chronic ,in:flammationofthe liver,

Remote Cranilll Trauma.
A.
B.

VI.

M"elljt1Js. Type II.

Scars ofanns.
Polarizable foreign material oflungs.

Postmortem Toxicologioal :ax:.minat;on,

A.
B,
C.

D.
E.

Postmortem femoTal blood Fluoxetine concentration 1.2 mglL.
Postmortem femoral blood Amitriptyline concentratIon 0.8 mglL.
Postmortem remora1 blood Nortriptyline concentration 0.6 msfL.
l'ostmortem ~emor.l blood PhenytOin concentratiol'l 3.5 \'Og/L.
Presence ofFJuoxetine, Amitriptyline, Nortriptyline, and DOJ(epin in postmortem urine.
-)-

Summary of Review Team Findings:

Tht;: KDoe Rt;:view Team has idelltifled the following signifioant issues:

was

iI:icori'si~iit fihdiliiCiirli6fifu A:Vlfunofri6i:iil~d
'! MhfijiJj;:ly6eiiiic &'hypertt1Ycenrl6 'CijiJ.&H:itii[i;'. Nursing documentation
'IVIIS inappropriately completed on the segregation activity log. This same
important documentation WIlS not completed itl the medical record. for
clinielnn l·evlew. There is i.t100nsistent use of fonns to document refusal
of Accucheck and medicati.olJ.. MJ'i.'1;'I'i&1ti'di~~H6rtHrTfitetvlfilf&n;
~,t~i!1i.fdi:jUes in tespofislltotl'f!!" l'ef1.lSa!oHlliibetfu :llietiic.a:tl6i,i~mle laCk of
re:fhsal documentation and intervention techniques creates a perception
that it was acceptable to permit Ii patient to refuse medical treatment
despite diagnose,t mental health concerns and impaired reaeouins brOt.lght
about by a worsening medical condition.
2. "'TB~i?il'a·'~igil1:fiC'lJ.llt:l~:Of'I;IOI ..w.unieation:betweenTIUTSing~llid
The 'cliriiiiiari'cbti6eriJing triticiil pa:tienfoili'eiSW:=&'l'':''
3. The pra,clice of adm:inisterillg Accueheck end diabetic medication in the
Medical Area instead of the Segregation Unit created a "blllTier to
tl;ea1:nlen,t" IUl the inmate did not cooperate witl.. the applioa,tion offull
restraints for daily escort to the Medical. Area for t:reatlU,e);ll. As the
inmate beoame more withdrawn, her cooperatio:tl with the escort process
mel treatment declined. Upon placement in segregatioll on 6·13 -08, the
medioation review indicatesla"SubstantiaII1Ulnbe:r of :tnillSed'du~~f
'!i.iliMfh placing the illlD.ate at nsk.
"',' ,,'," "', ", , , ',
4. There is a significant lack of CO)1).llUulication between Medical, Mental
Health, Soourity, and Unit Management to provide integrated care and
1rc::atment plans for inmates with special needs. Each discipline should
underlltand and accept their individual responsibility in this endeavor.
5. In1u~t~ Murphy WIUl placed in a :tl;led~caJ observation roo~ ord..Ki fthe
phySICIan for the purpose of lJlOlUtonn.g he1' l11edicel condition. ~,
\1' phy~iciilli WlW" noi:: ,OonsUlted when iiec,iri'iY litiiff~rtI\'i\f~lfer:1i'bi.1i'\J:i~:
'\: ' '~medica1::area;to be·placed,in.segtegll.:ti."ll):1; There ~ no process
imptementedwhlch provided for the'same level of medical observation in
segregation as was provided in the medical observation area. A review of
the medical observation room fiods it to be a secure cell similar to that in
segr:egati on.
6. Medioat and Mental Ht;:alth dooumentation wa~ not entered into the
electronic fill!\ in a timely manner as required for seamless tn,edica1
treatment. \:For exattJ,~j:e,.n'colnpreh~siVe"i±i~?:!,~!!'ltg~£?i.\t~6fih4~g
6.18-0lrWM
entere.4 irtto tht i'eco~d Ulitil after the Inmate's del!t11.
'"
1. " DltibeHb mortit6rl:tig

?y

not

2