Couple dismayed by malpractice law preventing parents from suing over adult son's death

After the death of her 32-year-old son, Trenton, Penny Nusbaum sought answers - and justice. Nusbaum, of Thorp, lost her son to drugs. Trenton had struggled with mental illness his entire life and with drugs for years, but it wasn't abusing drugs that killed him. Rather, it was a prescription drug -- methadone -- given to treat addiction.

On Aug. 8, 2011, a year after Trenton's death, Penny Nusbaum and her ex-husband, Phillip Nusbaum, have had some of their questions answered. A subpoena and a medical examiner helped determine how their son died. But the family won't be able to pursue justice, at least in the courtroom: A decades-old state Supreme Court ruling prevents parents from filing medical malpractice lawsuits for the deaths of their adult children.

"No one can believe that we can't sue," Penny Nusbaum said. "You're a parent, you give birth, but you don't have any rights."

In Wisconsin, parents of minor children can file lawsuits to be compensated for loss of society and companionship if they believe their children died because of medical malpractice. However, the parents of adult children cannot file similar suits. Efforts to change Wisconsin liability law to allow such lawsuit have been unsuccessful.

"It's not the money, but it's the only way you can get these people," Penny Nusbaum said of the prospect of a lawsuit.

Troubled life

Trenton was born in 1979 in Sterling, Ill., where his parents lived at the time. Phillip and Penny Nusbaum divorced in the 1990s, and both eventually moved to Wisconsin. Their children - Trenton and Shanda, who died in 2000 - later moved north as well.

At times Trenton lived with his mother in Thorp; at other times with his father near Eau Claire.

At an early age Trenton was diagnosed with Tourette syndrome and attention deficit hyperactivity disorder; later he was diagnosed with bipolar disorder as well. He spent his youth in and out of counseling and psychiatric hospitals.

Later, he was hampered by addiction: While living in his home state of Illinois in his 20s, he got hooked on oxycodone, a frequently abused prescription painkiller.

"You wouldn't know it most of the time to see him," Trenton's mother said of his troubles. "He was a handsome, nice guy. He was really smart, but he had his problems."

Beginning in his teens, he had some run-ins with the law; at other times, he was sober and worked doing roofing and other temporary jobs.

"He'd want to work, work, work to get off of Social Security, but then he'd relapse," Penny Nusbaum said.

About four years ago, Trenton decided to kick the oxycodone habit and was prescribed methadone, a synthetic drug that mimics the effects of opioids, including street drugs such as heroin or prescription drugs such as oxycodone. Unfortunately, he developed an addiction to methadone as well: His mother said he began hallucinating and exhibiting symptoms of schizophrenia.

Eventually, Trenton spent three months in a locked inpatient center to treat his methadone addiction. He attended Narcotics Anonymous and Gamblers Anonymous meetings and lived in several group hopes, the last one in Lake Hallie.

Demons return

Last year, Trenton seemed to have finally kicked the drug habit, much to his parents' relief.

"He was doing wonderful and great -- for him," Penny Nusbaum said.

A few weeks before he died, Trenton moved into his father's town of Union home.

"He seemed like he was doing fine," Phillip Nusbaum said. "But according to his friends, he wanted to get back on the methadone."

Trenton told friends his demons were troubling him again. After an incident in which he drank alcohol, he became upset with himself, and on Aug. 2, 2011, he went to Mayo Clinic Health System in Eau Claire (formerly known as Luther Hospital). According to hospital records, Trenton told a social worker that "he felt the urge to use narcotics again" and wanted a prescription for Suboxone, which, like methadone, is used to treat opioid dependency.

Even though he apparently hadn't been abusing drugs recently, within days Trenton resumed methadone therapy -- although he didn't tell his parents.

As he had in the past, Nusbaum sought help through the Eau Claire Metro Treatment Center, 2000 Oxford Ave., Building 2, one of 15 opioid treatment programs in the state. Nusbaum went to the clinic daily to receive his dose of methadone.

The clinic is one of 57 nationwide owned by Orlando, Fla.-based Colonial Management Group. Officials at the clinic didn't return telephone messages seeking comment for this story.

Turn for the worse

On Saturday, Aug. 6, 2011, Phillip Nusbaum became aware his son was sick. Trenton was red-faced and complained of dehydration, constipation, and insomnia, and he was hiccuping nonstop. The next day he had terrible heartburn, and he was breathing hard and sweating profusely after taking a half-hour walk with his father.

Finally, Trenton told his father he was taking methadone again, and his father urged him to go to the hospital. Trenton went to the Mayo emergency room, where he complained of his pain and other symptoms. At one point he left the hospital in agitation and called his mother by cellphone.

"He said, 'I'm in so much pain, Mom. I can't stand it,' " she recalled.

Eventually, Trenton returned to the hospital. He was diagnosed with a hiatal hernia and treated for his pain, and he returned to his father's house in the early hours of Aug. 8.

Later that morning, Phillip Nusbaum drove his son to the clinic for his daily dose of methadone. The visit took longer than usual -- at one point, Trenton came out and told his father, who was waiting in his car, that the clinic was trying to reach the hospital. After Trenton took the methadone the two returned home at about 9:30 a.m., and Phillip Nusbaum, who worked a night shift, went to bed.

Early that afternoon, he arose to check on his son. Trenton was dead.

Within hours, Trenton's skin turned black and blue -- so dark that his casket was closed at the funeral.

What happened?

Trenton's death left his parents distraught, angry and looking for answers.

They obtained medical records from the hospital and confronted the staff at the methadone clinic, who told them they weren't aware Trenton had been at the hospital the night before his last dose of methadone.

Later, Phillip Nusbaum found something that contradicted this claim: a reminder card for an appointment at the clinic on Aug. 9, 2011 -- the day after Trenton died -- with the words "bring Luther ER paperwork" written on it.

The Nusbaums believe the clinic staff should have been on the lookout for symptoms of an overdose when their son came for his medication.

"I blame the methadone clinic. Because this is what they do, they give out methadone," Penny Nusbaum said.

"It shouldn't have happened. But it's like, 'Oh well,' " she added.

After her son's death Penny Nusbaum began to research methadone poisoning on the Internet. She learned that the symptoms her son had exhibited in the days before his death -- including dizziness, fatigue, slow breathing and constipation -- were all signs of a methadone overdose.

She also learned methadone carries many risks. According to the U.S. Centers for Disease Control and Prevention, it can build up in the body and cause adverse reactions when mixed with tranquilizers or other painkillers. The difference between an appropriate dose and a dangerous dose is small, the CDC says.

Penny Nusbaum wonders if the fact her son hadn't been abusing oxycodone recently had lowered his drug tolerance and therefore made the methadone more dangerous to him.

Long wait

When Trenton's death certificate was signed on Aug. 10, 2011 -- just two days after his death -- deputy medical examiner Mark D. Anderson listed the manner of death as "pending." It wasn't until May 29 -- nearly a year later -- that Anderson updated the death certificate with specifics. The immediate cause of death was determined to be aspiration pneumonia with sepsis (widespread infection). This was listed as being caused by respiratory depression, which in turn had been caused by methadone toxicity brought on by the initiation of methadone treatment four days earlier.

Anderson, who didn't return several telephone messages seeking comment, completed the death certificate after receiving medical documents from the Eau Claire Metro Treatment Center. Those documents were only handed over after Rich White, then the Eau Claire County district attorney, obtained a subpoena ordering the clinic to release them, Sheriff Ron Cramer said.

While there have been other methadone-related deaths in the county in the past, they occurred when people abused methadone that had been prescribed to others, Cramer said. In this case, Cramer said, investigators didn't know if Trenton Nusbaum had abused other drugs at the same time he was taking methadone.

However, according to the Nusbaum family, a toxicology report obtained by the medical examiner found that the only drugs in their son's system were the ones he had been prescribed.

While recent months brought some clarity to Trenton's parents, they also brought disappointment. The Eau Claire County Sheriff's Department conducted an investigation of their son's death and forwarded the reports to Eau Claire County District Attorney Brian Wright. However, Wright decided not to file criminal charges against the treatment center. In a July 10 letter from the district attorney's office, victim witness coordinator Jodi Voegeli noted that "the fact that no criminal charge is filed does not prevent you from seeking damages through a civil suit."

However, because a civil suit is impossible in the case, Penny Nusbaum is pursuing other avenues. She's contacted lawmakers, asking them to change state law; she's talked to media organizations and other groups.

She remains frustrated, angry and sad - even more than she felt when her daughter, 23-year-old Shanda, died in a one-vehicle car accident in 2000.

"If she had to die, she died. I was so glad there wasn't somebody else (at fault), because I think I would blame and have that hate in me forever," Penny Nusbaum said. "And now with Trent it feels like -- it's awful. ... Just to know that someone could have prevented it by a little phone call."

Giffey can be reached at 715-833-9205, 800-236-7077 or tom.giffey@ecpc.com.

About Methadone

What is it?

Methadone is a synthetic drug used to treat people addicted to opioids such as heroin or prescription painkillers. It is also used for pain management.

How does it work?

Methadone occupies the same receptors in the brain impacted by other opiates. It blocks the effects of those opiates, diminishes cravings for the other drugs and, when used properly, doesn't cause intoxication, allowing patients to lead more normal lives.

Who prescribes it?

Methadone is typically used as part of opioid treatment programs. There are about 1,200 such programs in the U.S., 15 of them in Wisconsin, according to the U.S. Government Accountability Office. However, in recent years, it has become a more popular drug to treat pain, which authorities say has led to an increase in abuse of the drug.

How many deaths are methadone-related?

According to the National Vital Statistics System, part of the U.S. Centers for Disease Control, methadone-related deaths in the U.S. grew from 826 in 1999 to 5,692 in 2007, a 589 percent increase.

Sources: U.S. Centers for Disease Control and Prevention; U.S. Government Accountability Office.

(c)2012 the Leader-Telegram (Eau Claire, Wis.)

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