September 14, 2009
Updated list of Christopher Kelly posts/videos/timeline
Hi Jaimeferrino.
Whew. That’s a lot of questions.
Yes – Cutler is a lemon. It was like the ghost of Brett Favre was there…haunting Cutler. He said going to Green Bay would be like going to Kansas City even though he swears he grew up a Bears fan. He would know it’s nothing like KC. Welcome to the NFC. It explained why he looked completely frightened – not frazzled – frightened. I made a bet he doesn’t make it past the Bengals/Browns. I hope I’m wrong. Looks like Uhrlacher was right when he called him a pansy. ps Orton won.
Anyway.
Oak Forest Hospital is a community hospital in the Cook County system of hospitals. It is standard procedure to transfer within the hospital system. Simple business sense – keep the patient in the system – keep the payment. Same doctors are on staff in the same system and sometimes patients are only covered only at certain hospitals – which can mostly be overriden in true emergencies. Kelly himself could have asked to be transferred to Stroger.
Only two hospitals were involved – not three. Stroger Hospital is the same as Cook County Hospital – just a name change. There is nothing nefarious about Todd Stroger and the hospital, as regards this. It was named after his deceased father.
Stroger is the premier Level One Trauma Center in Chicago – it’s the hospital “ER” was based on. If they can’t treat it – it’s not treatable – though the wait in the ER (as in waiting room) can be over 24 hours.
Kelly arrived at Oak Forest Hospital ER for treatment. Yes, there are quite a few hospitals in the area he could have been taken to – most with more advanced ER care. He could have requested to go Oak Forest or his alleged girlfriend who allegedly drove him there might not have known where else to go. Also it’s possible Kelly’s doctor was either on staff there or on staff at one of the Cook County hospital system. He had had recent surgery and prescribed pain medication so he had to have had a physician.
Don’t hold me to this but I think it’s evident it was an OD. It was reported that the girlfriend was texted by him saying he wanted to commit suicide, he certainly had reason, at court earlier in the week his behavior was different than usual – including saying he knew his life was over and talking about his next life, drugs/drug wrappers were found in the car, vomit was found at the scene, in the care and “soaking his clothes”, he was initial coherent and then hours later worsened and a few hours after that was pronounced dead – consistent with an OD. (Absent gross medical negligence.)
“Trauma Center” or “Level 1 Trauma Center” does not mean he had a traumatic injury in need of a trauma surgeon. A Level 1 Trauma Center just means it is the highest level of care one can get. They can handle any/everything: poisonings (ODs), burns, pediatrics/neonatal ICU, high risk OB, dialysis, psychiatric, adult ICU, general surgery, neurosurgery and, yes, trauma. Physicians of all specialties are available 24/7 starting with in-house residents.
It also denotes the highest level of ER care available. The ER physicians are trained to deal with all emergencies and do so on a daily basis. They would have had no problem dealing with an OD of whatever source and if Kelly needed emergency dialysis he could have gotten it – in the ER or in the dialysis unit (if there is one). Whatever possible treatment he would have required would have been accessible from the ER.
An OD can be treated at a community hospital and might have been treated appropriately initially. What I don’t understand is the long delay in transfer. He was in the ER for 5 hours and 4 hours into his stay he was still alert and able to talk. He had vomited a huge amount so one would assume that if he had just ingested it an hour or so previous – not all of it would have gotten into his blood stream. The vomit that I saw on the pavement looked like partially digested food as well as liquid, so the food would have slowed down the absorption. And he was a big man.
Problem is he may have been unknowingly overdosing while taking his prescription pain medicine. Narcotics are commonly mixed with aspirin (Percodan), tylenol = acetaminophen (Vicodin), or ibuprofen (Vicoprofen). So if he had been taking extra doses of his pain medicine and supplementing with tylenol, aspirin, naproxen (Aleve) and/or ibuprofen (Motrin), he could have been reaching toxic – maybe even lethal doses before he took an acute ingestion, which would raise levels even higher.
Acetaminophen overdose leads to acute liver failure. The liver is responsible for metabolizing the drug and gets overwhelmed and basically congeals. But there is medical treatment – an antidote of sorts – N-acetylcysteine (NAC) – that can prevent the acetaminophen from destroying the liver cells. It is usually successful if given in the first 16 hours – provided of course it’s not too massive an acute dose and it’s not an acute ingestion added to a chronically elevated level that had already caused liver damage. For some folks just taking a few extra Vicodin or Tylenol can cause liver failure and death. NAC should have been available in the hospital pharmacy. If not, they should have known to transfer him immediately.
Aspirin (acetylsalicyclic acid aka ASA) works in a different fashion and affects the entire metabolic system of the body throwing off the pH – you know the acid/base balance from Chemistry class? It disrupts the functioning of the cells. Suffice it to say that the excess acid is treated with base = sodium bicarbonate, which is given intravenously along with a large amount of fluids to excrete the ASA in the urine. If the kidneys begin to fail, then hemodialysis can be done. Which in Kelly’s case (if it was ASA) could not have been done emergently at Oak Forest Hospital.
Aleve (naproxen) or Motrin (ibuprofen) or other non-steroidal anti-inflammatory drugs (NSAIDS) are a different story. There is no direct antidote and levels may not correlate with lethality. Treatment is usually symptomatic and supportive — watch and wait. Chronic ingestion – and even acute ingestion can lead to bleeding in the stomach and/or intestines. Hard to believe that was the case since there was no visible blood in the vomit and one would assume they had a tube into his stomach that would immediately have shown the bleeding, which then could have been treated. And NSAIDs can also lead to kidney failure, which again could have been treated at Stroger. Death can occur after the acute ingestion – even 24 hours later when the patient appeared to be asymptomatic in the interim. It basically causes the energy producing part of the cells to stop working => death.
Narcotics – opiates – even heroin overdose could have been treated very easily using Narcan, which reverses the effects of the narcotic. If he had snorted a long acting opiate like Oxycontin or even heroin, the results could have been delayed but he had to have been under observation and they would have noticed a change in his respiration.
From how they described him, he didn’t sound like he acute toxicity from cocaine, ampethamines, ecstasy, LSD, PCP or Ketamine, which would have made him agitated, combative and maybe even psychotic. He was alert and conversive 4 hours in (approx 6 hours after ingestion). Also didn’t sound like he had taken benzodiazepines (Ativan, Valium, Xanax) in large amounts again because he was alert. Same goes with barbiturates. Marijuana there is no overdose. Rohypnol and GHB (aka date rape drugs) also would have caused some incapacitation that would have been present initially and depending on the dose – 6 hours later.
I think that covers street drugs – at least the ones I know.
If he took Tylenol PM with Benadryl (diphenydramine) there is added toxicity and the risk of irregular heart rhythm. In some folks it can lead to agitation similar to stimulants and in others – sedation. If he took OTC could syrup or sinus medicine with phenylephrine – he would have had an elevated BP (possible stroke) and probably agitation/toxicity along the lines of stimulants.
Alcohol could have complicated matters but he clearly was not comatose from alcohol. If he took something like antifreeze, they should have been able to catch it on labs/urine. The vomit I saw was not that characteristic neon green and he arrived at the ER with the vomit on his clothes so they would have seen/smelled it. If he took something like bleach or drain cleaner, he would have had severe esophageal damage and would not have been able to be talking.
That’s the garden variety substances used to overdose. You asked about cyanide – that characteristically causes immediate death. It has a characteristic odor – bitter almonds – like if you toast them a little too much. But only part of the population can smell it. You can get all James Bond and say he had a capsule with him that he used later but if he was going to do that – why go through all that nasty treatment? A man is none too pleased to have a tube shoved up his urethra. Have to say I got a chuckle with that and all your other scenarios, like pushing air into his IV. You have quite the active imagination. CSI fan are you? If someone wanted him dead, they certainly would not have waited till he ingested something and then helped him along inside a very busy ER.
If you’re right, I’ll buy you the DVD collections of all the CSI shows.
Most all overdoses are treated the same way. In adults, that means a tube in the stomach that suctions out all the contents. Sometimes extra fluid has to be pumped in (gastric lavage) to remove all the particulate matter. And then activated charcoal is put through the tube and the tube clamped off. Charcoal will bind the drug and also has a laxative effect. So hopefully the tube will remove the pills from the stomach and stop absorption and the charcoal will remove the pills/pill fragments that have passed in to the intestines and stop further absorption. Charcoal is given in multiple doses – with the desired effect charcoal diarrhea.
So at the very least one would expect that the ER physician started IV fluids, put the tube into his stomach, gave him charcoal and watched his urine output by putting a tube in his bladder. That could have been accomplished in an hour or so as well as the basic blood work. They may not have had the capability to do full toxicology screens for NSAIDs – but an hour in – at most two (unless they were overwhelmed with patients more ill than he) they should have had a pretty good idea as to what was going on.
What was he doing there 5 hours later?
No idea.
If it was a significant OD, they had to have known they were going to have to transfer him. Oak Forest does not have an in-patient psych ward. If indeed it was a suicide attempt, he would have had to been admitted under the care of a psychiatrist and evaluated/observed for further suicidal behavior.
It’s unknown if they had planned to transfer him or he decompensated quickly, requiring the transfer. If he was that acutely ill – paramedics should have been called (911) to transfer him to the nearest higher level ER, which would have been Christ Hospital – about 10 miles away.
As far as him being transferred via “private ambulance”? Again, it could be that they have a contract with the ambulance company. Some private ambulance services have highly trained paramedics comparable to EMS and who could have treated him all the way to Stroger. And again if Kelly was alert and stable he could have requested that type of transport.
I just find it highly unusual chain of events. If the timeline is as they said and he had not already had a chronic toxic level of whatever it was he took, they would have had a pretty good chance at treating him. Allegedly he took the medication (it appears at least two different kinds) one to two hours before presentation to the ER and had vomited quite a bit before he got there. Four hours after presentation, he was alert and coherent and able to talk with police. Around that time, he would have been showing symptoms from the drugs that had passed through his stomach into his intestine.
An hour later he was transferred. And less than six hours after arriving at Stroger, he was pronounced dead.
Was his initial treatment adequate? Did they miss something? Did he take more whatever while he was in the ER or after he got to Stroger? Was there some kind of treatment problem once he got to Stroger: allergic reaction, wrong medication, no medication, fatal drug interaction, lethal heart rhythm, foul play?
No idea.
If he had an unrelated heart attack, stroke or severe gastrointestinal hemorrhage resulting in his death that would have shown up on autopsy as well as drug-induced necrosis of the liver or kidney failure. If he had a chronic illness or newly-diagnosed terminal illness that would have showed up on the “ortopsy” as Chief Maxwell Smart says. But the autopsy was inclusive – pending final toxicology.
I wonder about two things: Why was he in Oak Forest Hospital so long before being transferred? Was he treated correctly – immediately? I think it’s fair to assume it was a mixed overdose so I wonder if a large amount of NSAIDs – Aleve – caused his death, despite appropriate and timely medical intervention.
That’s my best guess – NSAIDs. Though I can’t help but believe some aspect of inadequate medical care will have played into this.
No – don’t think barry or any of his Chicago minions had anything to do with it. I think it’s fair to assume was an intentional overdose. Whether after he did it he still wanted to die remains to be seen.
No – don’t think Blagojevich had anything to do with it. Kelly was his good buddy. Plus Blago is in New York.
No – don’t find it unusual that he notified was it Fox? at 3am. Whoever the gray haired man was – he was good friends with Kelly and knew about the Fed case against Blago – so it makes complete sense that he would have called Blago.
Don’t know where you got that story about his family finding him? It’s 100% clear Flores drove him to the ER (or at least was in the vehicle). There was no mention of his family being at Oak Forest and the crazy mayor said he hadn’t even talked with Kelly’s family.
No – the police being called had nothing to do with his sentence. He wasn’t due to surrender until the 18th.
Yes – the police are called to the ER whenever there is a suicide attempt. The mayor said he didn’t want to comment on whether it was – reports say Kelly didn’t tell the officer he attempted suicide. And in the press conference when the mayor was asked why the police were called, he and the police chief said it was normal for the police to be called in cases of attempted suicides. I think that answers the question of whether it was a suicide attempt.
Well. I think I answered all your questions.
Remember that we are going by preliminary comments made by an inappropriate and rude non-law enforcement mayor and that the autopsy was inconclusive.
Whatever happened, I hope Mr Kelly is at rest, his family is doing ok (he has three young children), the press leaves Flores alone and she sues the mayor for announcing her personal information when she is not in any way a suspect.
