'60 Minutes' ace's death echoes his own investigations

In July 2003, Trevor Nelson was 34, happily married, a father of two, and an award-winning producer tagged as a rising star and future executive of CBS's critically acclaimed news show “60 Minutes.” He was in the prime of life — and in that rare position of being aware of it.

So, on July 23, 2003, when Nelson arrived at the prestigious Massachusetts General Hospital to check on a persistent headache, fever and uncharacteristic lethargy, there was every expectation that he would soon be resuming his charmed existence.

Yet nine hours after he was admitted to Mass General, Nelson was brain-dead.

Mass General doctors had diagnosed Nelson's symptoms as viral meningitis, a painful but typically harmless disease that, according to the Centers for Disease Control and Prevention, commonly affects children and young adults and is known to clear up, untreated, within a week to 10 days.

Hospital records show, however, that Nelson received a potentially deadly mix of prescription-strength drugs — given with dangerous frequency. Over the course of 15 hours, staffers administered more than a dozen doses of potent narcotics and, Nelson's family alleges, left him largely unmonitored throughout.

Mass General's staff then attempted to cover up the mistake, according to the lawsuit now being brought by Nelson's family, by not referring the case to an independent medical examiner and by wrongfully attributing Nelson's death to viral meningitis.

In Massachusetts, which has long been a center of medical innovation and reform, all licensed hospitals are required to report, as of 2008, 28 types of serious adverse events to the state Department of Public Health, which then issues a public, hospital-specific summary. Massachusetts hospitals reported a total of 338 adverse events last year, including 12 medication errors.

The number is surprisingly low, considering the Institute of Medicine has estimated that as many as 1.5 million preventable medication errors occur annually in the U.S. and as many as 7,000 result in death.

Failure to report an adverse event can cost a Massachusetts hospital up to $1,000 per day per violation, but according to Jennifer Manley of the DPH, “the provision is there, but it is rarely used.”

Accurate reporting is at the crux of the lawsuit now pending in Massachusetts, in which the Nelson family is attempting to use the hospital's own records to show that Nelson's untimely death was caused by oversedation — not, as the hospital's discharge summary reads, by viral meningitis.

Filed at the Suffolk County Superior Court, the complaint alleges that nurses Steven Grondell and Maryse Alexandre, as well as Dr. Andrew Yee, who completed his residency a month before Nelson checked into Mass General, were responsible for Nelson's receipt of the lethal combination of painkillers and sedatives.

The hospital and its personnel deny any wrongdoing. “We are going to defend it aggressively,” said defense attorney William Dailey Jr. of the Boston law firm Sloane and Walsh. “We think the care provided was entirely appropriate.”

The Nelson case is being handled by Michael Mone Sr., the Boston attorney who litigated the wrongful death case of Betsy Lehman, the 39-year-old health reporter for the Boston Globe who died of a chemotherapy overdose at the Dana-Farber Cancer Institute in 1994. Lehman's death was among several egregious errors that prompted the Institute of Medicine's “To Err is Human” report and the establishment of the Betsy Lehman Center for Patient Safety and Medical Error Reduction in Massachusetts. Mone declined comment, citing the pending case.

If the family's claims are true, the muddled circumstances of Nelson's death are exactly the kind of thing he would have helped expose. As one of the youngest people ever to become a full producer at “60 Minutes,” Nelson worked on projects that routinely unearthed instances of fraud and misconduct, including an Emmy-winning piece on then-Attorney General Eliot Spitzer's Wall Street crackdowns, a segment on the conviction of Timothy McVeigh and a report on the aftermath of the 9/11 attacks.

“He was the best young producer I've ever had,” said Steve Kroft, a “60 Minutes” correspondent who worked extensively with Nelson. “His potential was unlimited.”

Nelson was vacationing in Manchester-by-the-Sea with his two young sons, George and Conrad, and his wife, Maggie, who said in an interview that her husband began feeling achy and sluggish toward the end of their stay. An occasional marathoner, a skilled kayaker and an avid skier, he considered cutting his vacation short and returning home to New York but opted instead for a visit to nearby Beverly Hospital on July 20, 2003.

When a spinal tap and routine tests showed nothing out of the ordinary, Trevor Nelson was diagnosed with a “possible viral syndrome,” prescribed painkillers for his headache and released within a few hours.

But three days later his headache continued unabated, and on the urging of some of his family members, he went to the emergency room at Mass General on July 23.

Maggie Nelson left the ER that night to take care of the couple's children. She would not see her husband alive again.

“They assured me everything would be fine and that I should go,” she recalled of the hospital staff. “‘He's fine,' they kept saying.

“‘He's fine, he's fine, he's fine.'”

Hospital records obtained by the family and included in the court filings suggest that between 2 and 10 p.m., while Trevor Nelson was still in the emergency room, the hospital's medical staff administered, in addition to a regimen of antibiotics, the painkillers Vicodin, Fioricet and morphine.

Trevor Nelson then received two doses of the powerful opiate Dilaudid — at 11 p.m. and midnight. Next, he was given a dose of Tylenol No. 3, which includes the narcotic drug codeine, at 1 a.m. He received Ativan, a sedative, at 2 a.m. and, finally, a concurrent dose of 1 mg of Ativan and 2 mg of Dilaudid at 5 a.m.

The combination of the last two is known to cause respiratory and cardiac depression and necessitates careful monitoring. Both Ativan and Dilaudid are included on the list of products most frequently involved in medication errors compiled by MEDMARX, a national database maintained by the nonprofit U.S. Pharmacopeia and used by health care facilities to track adverse drug reactions.

Trevor Nelson was apparently not seen by any Mass General staff members between 5:30 and 6:45 a.m., when he was found facedown, with no pulse and not breathing in his hospital bed, according to the plaintiff's case file.

His family agreed to take him off life support at 9:50 p.m. July 24.

Maggie Nelson did not accept that her husband was dead, she said, until five minutes before he was taken off life support.

“I didn't want to believe that anything had gone wrong with Trevor. I didn't want to believe that his death was a mistake,” she said. “I wanted to believe — and I did believe — that something was wrong with his heart, something was wrong with his brain or his lungs and that we were just really lucky to have him for the time that we had him.

“But then it became clear that his body was in perfect condition,” she said. “And his death was not because of something wrong with his body.”

Massachusetts law requires that an independent state medical examiner conduct an inquiry into the cause of death of patients who die within 24 hours of admission to a hospital or who die suddenly while in apparent good health, both of which seemed to have applied to Trevor Nelson.

In his case, however, no such inquiry was ordered. Instead, the hospital itself handled the autopsy, records show. The autopsy performed on-site at Mass General did not reveal an anatomic cause of death, but made special note of the fact that he did not have encephalitis, or inflammation of the brain due to infection. According to expert medical testimony submitted by the plaintiff, the lack of encephalitis was just one of the reasons why attributing his rapid demise to meningitis was questionable. Nevertheless, Trevor Nelson's death certificate states as his immediate cause of death: “consistant (sic) with viral meningitis.”

“The autopsy report was not compatible with death from viral meningitis at all,” said Dr. Edward Colt, Trevor Nelson's stepfather and a New York endocrinologist.

Colt, who drove to Massachusetts when he heard that his stepson was found unresponsive, expressly requested an independent autopsy after he was declared brain-dead. Colt said Mass General staff told him the medical examiner declined the case because Trevor Nelson had been at the hospital longer than 24 hours and that the family had no choice but to consent to an in-house autopsy. The hospital's records state that Trevor Nelson's case “was not a Medical Examiner case as he had been in the hospital greater than 24 hours.”

Its records also show, however, that he was admitted at 9:56 p.m. July 23 and pronounced dead at 9:50 p.m. July 24 — just under 24 hours.

“One way or another, they were covering up,” Colt said.

The hospital and its personnel deny any cover-up.

The first time Maggie Nelson began having doubts about the hospital's conduct was on July 26, two days after her husband's death. She was back at Mass General's emergency room, this time with her 3-year-old son, Conrad. The doctors had diagnosed him with viral meningitis.

She was panic-stricken, she said, until she was approached by a Mass General doctor who had tried to save her husband after he was found unresponsive.

“He said to me, ‘Mrs. Nelson, you understand that your husband didn't die from viral meningitis,'” Maggie Nelson said. “And I said, ‘… No.' And he said, ‘He didn't.'”

She was assured by other doctors in the ER that her son would be fine — and he was.

“But I guess it was then that I realized,” Maggie Nelson said, “that something was horribly wrong.”