02x04 - Prescription for Change

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[music playing]

NARRATOR A -year-old mother is found dead after apparently

ingesting over pills.

The death appears to be an open and shut

su1c1de, until Dr. G examines the victim's stomach contents.

I'm not finding any pills.

NARRATOR If a massive OD didn't k*ll her, then what did?

We're not sure exactly what we have.

NARRATOR Then, a woman arrives at Dr. G's morgue

without a shred of medical history to go on.

DR. G (VOICEOVER) She was not followed by a regular doctor.

So we really don't know what's her problem.

NARRATOR But the condition of her body

compels Dr. G to ask some difficult questions.

DR. G (VOICEOVER) So then, I specifically ask

the husband, why did she not seek medical attention?

NARRATOR Altered lives, baffling medical mysteries,

shocking revelations, these are the everyday cases of Dr. G,

medical examiner.

-year-old Melissa Aino has been locked in a battle

with herself for years.

And today, once again, she is losing the fight to stay sober.

NOREEN (VOICEOVER) Her eyes told it all.

I said, I can tell by looking at you,

you're hired higher than a Georgia pine.

I said, you're on your prescription dr*gs again.

NARRATOR Melissa lives in Kissimmee,

Florida with her mother Noreen and her teenage daughter Nessa.

Her life has been fraught with hardship, drug abuse,

arrests, and su1c1de attempts.

But these, days Melissa isn't fueling her addiction

with dr*gs scored on the street.

Melissa has found a new way to get high,

buying prescription narcotics on the internet.

NOREEN (VOICEOVER) She was going on the internet

and ordering the prescriptions, every two to three weeks.

NARRATOR For years, Melissa's mother

and daughter have tried to reverse her steady slide

into addiction.

But on this particular evening, her daughter has finally

reached the end of her rope.

Melissa is sitting at the kitchen table,

eyes glassy, speech slurred, when

Nessa gets into an argument with her over her drug abuse.

She said, mom's slowly k*lling herself

over prescription dr*gs.

NARRATOR But Melissa isn't interested in hearing

a lecture.

NOREEN (VOICEOVER) She got mad, went in her room,

packed some clothes to wear, went

over to her girlfriend's house.

I asked her when she was coming back.

She said, a few days.

She didn't care.

And she knew that her daughter would be taken care of,

because she was here with me.

NARRATOR But in fact, Melissa Aino would never return

home to her daughter again.

Six days later, an urgent call is made to .

EMS and police arrive at the Kissimmee residence.

But when they get to the victim, she's

no longer in need of any help.

The woman is Melissa Aino.

And she's been dead for at least an hour, on the floor

at her girlfriend's house.

The problem is no one who lives in the residence seems

to know what happened to her.

There was two people, witnesses, inside the house.

And their statements basically were

that she had been up in the kitchen area of the house

making a sandwich and everything appeared

to be normal at that point.

About an hour later, they found her deceased.

NARRATOR Crime lab investigators

are brought in to process the scene and collect evidence.

As they proceed, they find a vital clue.

Next to Melissa's body is a purse

containing two bottles of recently

filled prescription medication.

One is a potent and highly addictive pain

reliever, oxycodone.

The other, a muscle relaxant, carisoprodol.

But what troubles them is there are

pills missing from the bottles.

When we found that, the mass amount of pills that were gone

from a prescription filled earlier in the day,

we weren't sure if we had a su1c1de.

We're not sure if we had an accidental overdose.

We're not sure exactly what we had.

At that point, we notified the medical examiner's

office to respond.

NARRATOR Melissa's body is taken to the District Nine

medical examiner's office, where Dr. Jan Garavaglia,

better known as Dr. G, will be responsible for solving

the mystery.

Eight hours later, it's Friday morning and Dr. G's

appointment is Melissa Aino.

DR. G (VOICEOVER) When we first get the call,

we think that there-- it may be drug-related,

but we don't know.
[ … ]

She's a known drug abuser, both heroin, cocaine.

So we know she uses recreational dr*gs.

Possibly in the past.

She seems to have switched to prescription dr*gs.

NARRATOR For Dr. G, Melissa's abuse of prescription dr*gs

is a scenario that has become all too common

in the District Nine morgue.

DR. G (VOICEOVER) To me, it's like an epidemic.

It's unbelievable how it's taken off.

Over % of our drug deaths are due to prescription dr*gs.

NARRATOR Fueling the increase in prescription drug abuse

is the ease with which they can be

purchased, illegally, online, and without a doctor's

prescription.

There are legitimate and legal internet

pharmacies who comply with state laws and federal regulations.

And then, there are businesses that

will make products available on the web

that absolutely are not legal.

NARRATOR The proliferation of illegal online pharmacies

has grown so destructive that the US Drug Enforcement Agency

now has its own diversion control

program and budgets over $ million annually

to combat them.

While Dr. G suspects that prescription dr*gs k*lled

Melissa, she is less certain as to whether her death

was an accident or a su1c1de.

DR. G (VOICEOVER) She's somebody's mother.

And she somebody's daughter.

And I want to know why she d*ed.

And I'm sure her family's gonna want to know why she d*ed.

And they-- and they'll be-- want specifics on why she d*ed.

NARRATOR Coming up next, Dr. G examines Melissa Aino's body

and finds physical evidence of a past su1c1de attempt.

She's got marks on her wrist.

NARRATOR When "Dr. G, Medical Examiner" continues.

Dr. G begins the external examination of suspected drug

overdose victim Melissa Aino.

DR. G (VOICEOVER) She's obese and she weighs pounds.

Doesn't look like she takes care of herself very well.

NARRATOR The night before, Melissa was discovered dead

at a friend's house with pills

missing from two prescription bottles found in her purse.

She had two vials of medicine that were

just prescribed the day before.

NARRATOR Now, Dr. G must confirm if prescription dr*gs

played a part in her death and determine

which part that might have been, an accidental overdose

or a su1c1de.

Even though she suspects Melissa's death is

drug-related, as Dr. G examines her body,

she's keen to look for any indications

of foul play or injury as well.

DR. G (VOICEOVER) We look at the external examination.

Very carefully, on her body, I'm looking

for external signs of trauma.

And I'm looking for anything that gives us a hint about her.

Well, lo and behold, we do see a little hint about her.

She's got marks on her wrist.

So I do believe the story with the su1c1de.

You can see it right there.

NARRATOR Perhaps, this time, instead of cutting herself,

Melissa swallowed a handful of pills.

For Dr. G, it's looking more and more like a su1c1de,

but not to Melissa's mother Noreen.

I think she did-- did it accidental.

I'd been saying this for about six months before she d*ed.

I told everybody in the family.

I said, let me give you a little bit of information.

She's gonna die from overdosing on her painkillers.

NARRATOR Only a full autopsy can tell for sure.

OK.

So then, it's time-- after we take

our identification pictures, it's time to open her up.

And carefully make the Y incision,

look at everything in situ, or in the body.

And then, take our toxicology.

Cause toxicology is probably gonna be key in this case,

I know that from the start.

So Primo number one is to get some good tox specimens.

NARRATOR Lab tests on fluid samples

will check for the presence of thousands of compounds.

But the two Dr. G is most interested in

are the prescription dr*gs found in Melissa's purse,

oxycodone and carisoprodol.

These are dr*gs that can suppress your brain activity.

And at levels high enough, could make you go into a coma

and cause you to stop breathing.

And those dr*gs are typical ones we see that people are abusing.

I see it every day in the morgue,

bad decisions that people make.

Was it that good a feeling that she would alienate her family

and not really have a life, because of the dr*gs?

I doubt it.

NARRATOR With toxicology samples complete,

Dr. G begins the routine of inspecting each of Melissa's

internal organs, looking for any indication

of natural disease or injuries that may have k*lled her.

Once again, there is nothing out of the ordinary.

But drug overdoses don't always leave an obvious calling card.
[ … ]

So it's not unusual to find nothing.

DR. G (VOICEOVER) Everything else is pretty much normal.

But that's OK, because that's still fits our hypothesis

that it's probably dr*gs.

The problem is, what was it?

Was it an accidental or was it suicidal?

One thing that's important to do in a case like that

is to take the stomach contents.

Because if she truly took pills of the oxycodone,

some of those pills would still be in her stomach.

Some of that material would still be in her stomach.

Even if the pills had dissolved, she'd have d*ed way

before that all got absorbed.

NARRATOR There's only one problem.

When Dr. G inspects the contents of Melissa's digestive tract,

there are no pills to be found.

DR. G (VOICEOVER) I'm not finding any pills.

I don't-- I don't see--

I don't see pill material.

I don't see intact pills.

NARRATOR Could Melissa's death not be drug-related?

Coming up next, the truth behind Melissa Aino's death.

I'm presuming it's dr*gs, but I've been fooled before.

NARRATOR When "Dr. G, Medical Examiner" continues.

The autopsy of Melissa Aino is over.

And now, Dr. G and Melissa's family

must wait for the results of her toxicology tests.

DR. G (VOICEOVER) At this point,

I'm done with the autopsy.

I do my dictation.

I record everything we know.

And the death certificate has to say pending.

We have to pend until we get the toxicology,

we look at everything else.

So we have to wait for our tests to come back.

NARRATOR Dr. G did not find any pills in Melissa stomach,

even though there were pills missing

from the prescription bottles found in Melissa's purse.

She now wonders whether Melissa's death

was not a drug overdose at all.

DR. G (VOICEOVER) Sometimes you're fooled.

So you keep your mind open.

You don't want to sway how this case goes.

You want the facts to tell you what's going on.

NARRATOR Five weeks later, the results finally arrive

at the District Nine morgue.

However, they arrive with a twist.

According to lab tests, Melissa Aino

did not have the two prescription

dr*gs in her system.

She had four, a combination commonly known as a drug

cocktail, ingesting multiple dr*gs in order to boost

their effects in the body.

Apparently, Melissa didn't only take the pills that

were in her purse, oxycodone and carisoprodol,

but two other prescription dr*gs as well,

alprazolam, an antianxiety drug, and hydrocodone,

a narcotic painkiller.

It turns out she's got four medications in her blood

that are central nervous system depressants.

NARRATOR But the question is, which one k*lled her?

While the levels of all four are high,

none is high enough to trigger an overdose.

DR. G (VOICEOVER) The oxycodone was the highest,

but not a super high level.

The other three dr*gs, the carisoprodol, the alprazolam,

the hydrocodone were at a level that were high, but not lethal.

NARRATOR So then, what k*lled Melissa Aino?

DR. G (VOICEOVER) It was a combination.

It was a mixed drug toxicity, a mixed dr*gs--

a combination of these dr*gs k*lled her.

NARRATOR In other words, Melissa did not

die from a drug overdose in the classic sense,

but from an interaction of multiple dr*gs

that the body simply couldn't tolerate.

Taken individually, each of the dr*gs

that Melissa consumed affects the brain by decreasing

the production of neurotransmitters,

chemical compounds that act as messengers between cells

in the central nervous system.

But in combination, the effects of the dr*gs

are significantly amplified, resulting

in a drastic reduction of neurotransmitters

and, as a result, dangerously decreased

brain function and central nervous system depression.

But there is still one question.

Why did Melissa take the four dr*gs?

To take her own life or was it an accidental overdose?

DR. G (VOICEOVER) A lot of times,

it's hard to pick it apart.

We have to get the whole picture.

What did the autopsy show?

What did the toxicology show?

What was the circumstances?

You have to put it all together.

NARRATOR Her conclusion, Melissa's mother was right.

DR. G (VOICEOVER) She's mixing the dr*gs.

And it's typical what we see in recreational death from dr*gs.

It did not look like a su1c1de when we

started looking at the levels.
[ … ]

She took enough to get really high.

But unfortunately, too much.

And it k*lled her.

Melissa, my daughter, left her daughter, me, her brother,

nieces and nephews, why?

Over a bottle of pills?

Come on.

Stop and think of the amount of damage that this is doing.

DR. G (VOICEOVER) When I first started in forensic pathology,

I mean, the big ones were the cocaine and the heroin.

Heroin deaths are going down, although it's

still the most fatal drug.

Cocaine still hanging in there.

But prescription drug deaths are, by far, our most common

cause of drug deaths now.

NARRATOR Part of the reason for the rise in incidents of abuse

and deaths is accessibility.

The thousands of illegal online pharmacies

it is, in the eyes of Dr. G, a public health crisis.

DR. G (VOICEOVER) To me, I mean,

we're just showing different problems

and different ways you die.

And that's what a medical examiner is about.

You know, sometimes laws get changed

because of the information that we find out.

It's not just giving the information to the family.

It's not just signing the death certificate.

It's actually statistics and public health.

NARRATOR But in any issue concerning public health,

Dr. G must tackle one case at a time.

And in the death of Melissa Aino,

there is still another question left unanswered.

If she did not ingest the missing pills,

what happened to them?

Dr. G learns the truth from Melissa's mother.

DR. G (VOICEOVER) She was selling them.

She'd go on the internet, get more prescriptions

and then sell them.

NARRATOR Dr. G now knows exactly how Melissa Aino d*ed.

She records her findings into her case file.

After a fight with her daughter over her drug abuse,

Melissa leaves to stay at a girlfriend's house.

Three days later, Melissa binges on a drug cocktail made up

of four prescription medications, several of which

she obtained illegally on the internet,

oxycodone, carisoprodol, hydrocodone, and alprazolam.

But it's not to k*ll herself.

It's to achieve an intense high.

She's taking four central nervous system depressants

at very high levels.

NARRATOR Sometime that night, Melissa

ingests another potent combination of the dr*gs.

Within only hours, the drug cocktail begins to overwhelm

her central nervous system.

In her brain, the production of neurotransmitters

is greatly reduced.

Her breathing slows and her heart rate weakens.

Melissa stumbles up the stairs and passes out.

Within minutes, Melissa's brain ceases to function.

And without any signal from the brain to prompt respiration,

she stops breathing.

Her heart ceases to b*at and she dies.

OK.

The only thing I would say to people on dr*gs

is try to get off.

Try to find something else.

Try to find something in life that gives you happiness

and get off the dr*gs.

That's not the answer.

Because you know what?

Somebody like me is gonna see you, dead.

NARRATOR Coming up next, Dr. G wrestles

with a disturbing case.

Most people don't get necrotic feet.

Most people do not get necrotic feet.

NARRATOR When "Dr. G, Medical Examiner" continues.

It's a winter evening in Kissimmee,

Florida, when receives a call from Simon Atani.

He claims his wife Kim is unresponsive and not breathing.

Paramedics are dispatched to the caller's

residence, a single room rental in a small motel.

There, they find Kim Atani unconscious on the bed.

She is disheveled and appears to have a terrible festering

injury to her left foot.

According to Simon Atani, Kim's husband

of years and her sole caregiver, Kim is also blind

and her health has been declining for a very long time.

Paramedics worked to revive Kim and rush

her to the nearest hospital.

But on the way, she suffers a full cardiac arrest.

Her heart stops b*ating.

And Kim Atani is pronounced dead on arrival.

Emergency room physicians have no explanation for Kim's

sudden decline and death.

And Kim's husband Simon is at a loss as well.

To find answers to these questions,

Kim is transferred to the District Nine morgue.

DR. G (VOICEOVER) Well, the synopsis

that had been given that this is a woman who lives in a hotel

room with her husband.
[ … ]

He had come home and found her on the floor.

He put her to bed.

She wasn't doing very well.

And then, she became unresponsive.

was called and taken to the hospital.

And that's pretty much the story I had.

NARRATOR It's also the only story.

Dr. G soon learns that Kim Atani has

no medical records for her to consult, except those

from the emergency room.

No significant history.

Minor back pain.

She was not followed by a regular doctor,

not taking any prescription meds.

Does take Tylenol.

So we really don't know what's her problem.

NARRATOR It means that Dr. G must begin

the autopsy of Kim Atani without any information

about her patient.

She must rely solely on her own observations.

And what she sees is a woman who appears

to be in very poor health.

She looks ill.

She looked very unkempt, unkempt looking.

Her hair is messed up.

She hasn't taken very good care of herself.

NARRATOR Kim's teeth are fractured at the gum line.

These are some bad teeth.

NARRATOR She has bedsores.

She's also got a--

a pressure sore, a decubitus ulcer.

She had breakdown of the skin over the buttocks,

where she'd been in bed for so long.

The skin was starting to break down, not real

deep, but superficially, but showing that she'd been

in one position for a while.

NARRATOR And then, there's her festering left foot.

DR. G (VOICEOVER) She's got a necrotic ulcer,

on two parts, the back of her heel and her leg.

It was incorporating most of her foot.

And we're-- we're talking about an area of maybe six

to eight inches maybe by six--

six to eight inches, with a secondary area also.

A lot of the tissue on her foot is dead and infected.

Most people don't get necrotic feet.

Most people do not get necrotic feet.

NARRATOR To Dr. G, the necrotic or dead tissue

is a sign that Kim Atani has gangrene, a condition often

caused by a significant bacterial infection and a lack

of circulation to the area, which results in the death

and decay of body tissue.

I realize, I have to dissect this out.

I have to see how far did this infection go.

NARRATOR As she dissects the gangrenous tissue

on Kim's foot, Dr. G determines that the infection

is extensive.

It runs through the skin and muscle down to the bones

in Kim's leg.

For Dr. G, the observation is significant.

Once I'd examined the foot and cut

into how deep that infection was,

I was pretty certain that that wound probably had

something to do with her death.

NARRATOR But which something?

Was it the cause of her death or only a symptom

of a deeper medical problem?

For those answers, Dr. G will need

to analyze the infected tissue.

She takes tissue samples and sends them

to the lab, where the bacteria can be cultured,

identified, and studied.

I'm actually trying to grow bacteria that may be infecting

the foot, that would possibly show us what type of bacteria

or infection is in the blood.

NARRATOR And while getting the culture results

may take several days, there is one conclusion

Dr. G can draw right now.

Her foot was so bad, I'm sure they would've

had to amputate her leg.

NARRATOR A gangrenous leg, signs of long-term, untreated

illness.

No medical records.

Dr. G now has two concerns.

Not only does she need to determine

what k*lled Kim Atani, but she must also answer the question,

why was this woman apparently not under any physician's care?

DR. G (VOICEOVER) It is so obvious.

It defies why anybody wouldn't go to the doctor.

NARRATOR Given the disturbing circumstances so far,

Dr. G has to consider whether Kim Atani's death

might be a case of negligence.

Coming up next, Dr. G performs the internal exam on Kim Atani

and discovers that her diseased foot

is only the tip of the iceberg.

She had a lot of things wrong with her.

NARRATOR When "Dr. G, Medical Examiner" continues.

Dr. G is now ready to perform the internal exam on Kim Atani.

Did you get your pictures already?

So we're ready to roll.

NARRATOR She has already determined
[ … ]

that Kim was in poor health and suffering

with an infected foot that should have been amputated.

And she also learned that Kim was apparently not

receiving medical attention.

She really didn't have any private doctor

or anything like that.

NARRATOR Now, Dr. G must answer two difficult questions.

What exactly k*lled Kim Atani?

And could her husband's inaction have contributed

to her untimely death?

OK.

NARRATOR In order for Dr. G to judge whether Kim's death was

the result of negligence, she must

determine if her husband failed to provide

his wife with proper care.

DR. G (VOICEOVER) Is it neglect?

Is it ignorance?

We have to weigh that as a medical examiner.

Because if there is neglect involved, that can be criminal

and we may be able to press charges.

NARRATOR But before Dr. G can draw any conclusions

as to the manner of Kim's death, first she

needs to determine the cause.

As Dr. G opens the body with a Y incision,

she immediately makes an observation.

Look at that.

Unbelievable.

NARRATOR Kim Atani's body doesn't harbor just

one possible k*ller, but many.

These kidneys are very ill.

This kidney's so bad, you--

NARRATOR Her liver too is abnormal, mottled in appearance

and congested.

And Kim also has significant cardiovascular disease.

Some of her heart's coronary arteries are up to % blocked.

DR. G (VOICEOVER) She had a lot of things wrong with her.

We had a lot of pieces of the puzzle to fit in together.

NARRATOR A massive infection, kidney

and heart disease, immobility, significant

periodontal disease.

Kim Atani's multiple problems seem perplexing.

And yet, as a medical examiner, Dr. G recognizes

a connection between them all.

She actually looked like she maybe had had diabetes,

just by doing the autopsy.

NARRATOR Diabetes is a chronic disorder caused by the body's

inability to produce or use the hormone insulin, which causes

excessive and potentially fatal levels of sugar, or glucose,

to build up in the blood.

I mean, there's -- over million people in the United

States with diabetes.

And it's becoming a huge health problem.

NARRATOR Most of the time, critical blood sugar levels

can be managed successfully through diet,

medication, and, in some cases, insulin injections.

But even with treatment, diabetes

harbors many complications, such as heart and kidney disease,

as well as atherosclerosis, a narrowing of the blood vessels

throughout the body.

Diabetes can also lead to blindness

and even nervous system damage.

There's so many things that having

diabetes can affect long-term.

You may not get any of those things right away.

But if you have it unchecked and have

that long-term elevated glucose, in , , years,

you're gonna get all these problems.

NARRATOR Dr. G strongly suspects that Kim Atani's

death was related to diabetes.

But in order to prove it, she needs to have a blood sugar

test run to determine whether or not

Kim's glucose level was high.

On the living, checking for diabetes is simple.

But on the dead, it becomes more complicated.

Let me know if it's enough.

What

I check is two things.

I can check the urine to see if you're

spilling sugar in your urine, but not the best test.

But I can check your eye fluid.

And your eye fluid is somewhat protected

in your immediate postmortem period.

So before you decompose, your eye fluid's

pretty much protected.

And I can get the--

the sugar level or the glucose level in your eye fluid.

NARRATOR When the results of Kim's postmortem glucose test

come in a few weeks later, Dr. G is shocked by the numbers.

A normal postmortem level would be close to .

Kim's is over .

DR. G (VOICEOVER) It was .

Massively elevated and clearly diabetic.

NARRATOR But Kim's diabetes wasn't just severe.

Microscopic analysis confirms that it

was longstanding as well.

I could tell under the microscope,

she's got some changes in her vessels

that we often see with diabetes, changes in her kidneys

we often see with diabetes.

So there-- there were definite evidence of
[ … ]

longstanding diabetes with her.

NARRATOR Moreover, lab results conclude

that Kim's foot infection wasn't confined just to her limb.

It was in her blood as well.

Kim Atani had sepsis, or blood poisoning.

What we call sepsis, the bacteria

gets into the bloodstream.

And then, it starts multiplying into your blood.

And then, you get the infection all over your body.

NARRATOR Once a person has sepsis,

a cascade of complex and deadly events

is triggered in the body in reaction

to the massive bacterial infection.

One of the most dangerous, an abrupt drop

in the person's blood pressure.

It can actually cause your--

your vascular system to collapse.

You can't maintain your blood anymore.

You can't pump blood, because your vascular

system has collapsed.

NARRATOR Soon, major organs become starved

of oxygenated blood and the body goes

into shock, which, in many cases, can lead to death.

Dr. G now has her answer.

Well, ultimately why she d*ed is sepsis,

meaning bacteria in her blood due to her infected foot, which

is a complication of diabetes.

So ultimately, she d*ed of diabetes with the mechanism

being the infected foot causing a sepsis

or bacteria in her blood.

NARRATOR Dr. G now knows the cause of Kim's death.

And normally, the case would be closed.

But given the circumstances, there's one more issue

to contend with, Kim's husband.

Did Simon's inaction contribute to his wife's death?

Coming up next, Dr. G confronts Simon Atani.

I specifically asked the husband,

why would you not seek medical attention for her?

Why did she not seek medical attention?

NARRATOR When "Dr. G, Medical Examiner" continues.

With lab results in her possession

and the cause of Kim Atani's death now known for certain,

Dr. G prepares for the next task at hand,

speaking to Kim's husband.

Dr. G found that Kim ultimately d*ed from sepsis,

a bloodborne bacterial infection caused

by her gangrenous leg, a direct complication of diabetes.

But she remains puzzled as to why

Kim's husband Simon apparently did not

seek medical treatment for her.

How could she have diabetes right under his nose?

NARRATOR Dr. G returns to her office

to call Simon and assess whether or not he might have

been culpable in Kim's death.

DR. G (VOICEOVER) I needed to put all the pieces together.

So right after the autopsy, I talked to the husband

and explained to him what was going on.

One of the first things I asked him

is if he knew she had diabetes.

He was pretty much in denial.

He didn't think that could've happened.

So then, I specifically asked the husband,

why would you not seek medical attention for her?

Why did she not seek medical attention?

And he clearly stated, she absolutely

refused any medical attention, because she had had

a bad experience previously.

He didn't really elaborate what that bad experience was.

She didn't like doctors.

She didn't want anything to do with doctors.

And she was not gonna go to a doctor or a hospital

or a healthcare facility and that he was trying

to take care of it himself.

I admit it.

Some-- I can have bad--

I've had bad experiences with doctors too.

But ultimately, find one you like and get care.

I mean, it's ridiculous to die for a reason you don't need to.

OK.

Thanks. OK.

Bye bye.

NARRATOR After speaking with Simon Atani,

Dr. G now has all of the information she needs to report

the events that led to his wife's death

and to make a final decision on the question

of possible negligence.

Her years of untreated diabetes have

left Kim Atani nearly blind.

And she also suffers loss of sensation in her extremities.

She has difficulty walking and, at some point,

injures her left foot.

Because of their elevated glucose, they can't feel.

They don't feel as well as you or I. They

bump into things more readily.

If they have trauma, they may not feel it.

NARRATOR But because her blood vessels are narrowed

by atherosclerosis, the injured area

does not receive sufficient blood

and does not heal properly.

Instead, the wound worsens and becomes infected.
[ … ]

But Kim's foot was not OK.

And the infection wasn't gone at all.

It was simply deeper and had turned

into full blown gangrene.

It went from kind of a wet looking red

and inflamed down to kind of a shriveled black end.

And the infection had just gone deeper.

The outside tissue was already starting to really die.

He saw that as a sign of actually getting better.

NARRATOR Without any antibiotics

to k*ll the bacteria, the infection spreads.

And then, it crosses into the bloodstream

and begins to multiply.

Kim develops sepsis, a life-threatening bacterial

infection of the blood.

From there, the effects are swift and catastrophic.

That afternoon, when Simon returns home from work,

Kim is feverish from the raging infection.

The teeming bacteria throughout Kim's body

trigger a sudden loss of blood pressure,

which reduces vital blood flow to her body's major organs.

Her heart begins to struggle to b*at,

due to a lack of blood flow and oxygen.

Kim loses consciousness.

The damage from the sepsis is too severe.

On the way to the hospital, Kim goes into shock.

Her heart, starved of oxygen, suffers cardiac arrest.

Major organ systems begin to shut down, including

the central nervous system.

Doctors cannot revive her.

At PM, she is pronounced DOA.

As Dr. G sees it, what makes Kim's death so disturbing

is that her diabetes was entirely treatable.

And she could've lived a normal life.

Furthermore, if Kim had received care,

even just a few days earlier, there's a good chance

she could have survived.

DR. G (VOICEOVER) Yeah.

If she'd've had that amputated, maybe three days earlier,

she might have lived.

NARRATOR How she d*ed is now clear.

But one question remains.

Does the lack of care Kim received mean that she

was a victim of neglect?

In this case, Dr. G believes that ultimately the decision

to not seek medical attention was Kim's alone

and Kim's husband was not at fault for any lack of care.

In this case, I don't see that there's neglect.

I see that there is a problem with the way they handled it.

What was going on there is probably a lack of money,

a hatred of the medical profession,

and-- and maybe some unsophistication with disease.

He really cared.

I could tell on the phone that he really cared.

No matter whatever their cir-- you know, you don't judge.

I mean, everybody has different ways they live their lives.

That's the thing.

You know, I see a different side of our society

and human life than a lot of people see.

They're very comfortable in their circle.

My circle is everybody.

And I can see the shady side.

I see how people live.

I see how people live behind those closed hotel rooms.

And it's-- it's a whole different

world with some people.

And so-- and you know, I'm not to judge.

It's still their choice on how they live.

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