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CREVE COEUR — Kat Dunkus was doing better. She had moved in with her niece after completing an alcoholic treatment program two years ago. The program helped her learn better ways to cope with her schizophrenia and trauma.

“She was trying to find her way back to more stability. She was trying to find happiness for herself,” said her niece Rachael Benns, 31, of Creve Coeur. “She kept saying, ‘I’m finally in a safe place.’”

That was until April 21, when a schizophrenic episode landed Dunkus, 48, in the emergency room at Mercy ӣ����Ƶ in Creve Coeur. Once inside, she was taken to the emergency department’s behavioral health unit for patients in a mental health crisis.

The unit is locked and separated from the rest of the emergency department. Little to no medical care is provided there, as patients wait, often for several hours, for an open bed in a psychiatric facility.

At 7 a.m. the next day, Dunkus was found dead. An autopsy released June 12 revealed she died of complications related to long-term alcohol abuse. Her heart had failed.

Hospital workers directly involved with the care of patients in Mercy’s emergency behavioral health units say how Dunkus was treated exemplifies the poor conditions inside these units.

“It was not a matter of if this would happen. It was a matter of when,” said one worker.

The worker was one of four, including a nurse, who spoke on background to the Post-Dispatch, citing concerns about losing their jobs if they were named.

Dunkus’ family members say they have been given few answers from the hospital. Her medical records, copies of which her family provided to the Post-Dispatch, indicate numerous medical concerns, leaving them with more questions.

The records show Dunkus had dangerously low potassium — an electrolyte that can affect the heart’s electrical signals. An electrocardiogram (EKG) showed she had a concerning heart rhythm. Her blood pressure was high.

Benns said she also told doctors about her aunt’s history of alcohol abuse and how she had been complaining of chest pains.

Yet Dunkus was kept in the behavioral health unit with no heart monitoring, her records show. The only treatment she received was intravenous fluid containing potassium and magnesium. No or were used that could help regulate her heart.

“That wasn’t the appropriate place for her to be,” said her sister Cheryl Ketter, 56, of Ferguson. “You can’t just shove them into a corner somewhere and think that they are OK.”

The autopsy report notes that Dunkus was last seen alive at 11 p.m. — eight hours before her dead body was discovered. From a central nurses’ station, she was supposedly observed every 15 minutes via a video camera.

“All they did was just leave her in a room,” said her niece Rose Taylor, 25, of Mehlville.

Mercy officials say federal privacy laws prevent them from speaking about Dunkus’ death. In response to allegations about the quality of care provided by its emergency departments, hospital officials only released a general statement.

Officials insisted that all patients coming into a Mercy emergency department are appropriately screened to rule out emergency medical conditions and to determine if any tests or procedures are needed.

Patients are safe, they say, despite higher numbers they are having to care with behavioral health issues.

“Patients are monitored by nursing and other personnel throughout the ED visit to ensure their safety,” the statement read. “Increasingly, due to lack of access to mental health resources across the U.S., high-volume emergency departments such as Mercy have become a regular source of care for patients who are often in crisis situations.”

A difficult life

It was important to Dunkus to be at the births of every one of her 11 nieces and nephews. She babysat any time she could and hosted sleepovers.

“She was always that aunt that was there for a lot of us,” Benns said.

Dunkus was one of five siblings who grew up in the ӣ����Ƶ area. As children, they ended up in foster care after their mother left and their father couldn’t take care of them on his own, though he remained close with them.

Dunkus’ medical record shows her father also had , a serious mental illness that typically manifests in early adulthood and can cause hallucinations, delusions and extremely disordered thinking.

The five children were split up in foster care. Dunkus stayed with Benns’ and Taylor’s mother as well as their uncle. Life was difficult, Taylor said, “but they had each other.”

Their mom learned about her sister’s schizophrenia and helped keep the symptoms at bay. Benns and Taylor said they rarely saw their aunt experience delusions.

Dunkus earned a degree in human resource management, Benns said. She worked various customer service jobs, where she enjoyed helping people. She loved photography. She was proud of her Native American heritage on her mother’s side and was a registered member of the .

But Dunkus also struggled with alcoholism, which with schizophrenia as a way to cope with the symptoms. It contributed to ending her 15-year marriage around 2016 and strained family relationships.

In 2010, Dunkus’ sister — Benns and Taylor’s mother — died. That was followed by the death of her brother in 2018 and father in 2020.

“The deaths really took a toll on her,” Benns said. “She was trying to find her way back to more stability.”

Two years ago, Benns agreed to let Dunkus move in with her after she completed an alcohol treatment program. Dunkus came out healthy and hopeful, Benns said.

Benns and Taylor said they had watched their mother gradually get sicker as she was in and out of the hospital. It was different with their aunt.

“Looking back on my mom, you could see it coming,” Taylor said. “But with Kat, she was doing so much better.”

‘Eight hours?’

Two days before ending up in the emergency room, Dunkus began feeling paranoid, Benns said. The next day, she was hearing voices. Dunkus thought people were recording her. She was scared someone was coming to take her to prison. She accused Benns and her boyfriend of drugging her.

Benns said Dunkus admitted she had gone to a bar and was drinking again. Benns scheduled a doctor appointment for the following day.

The morning of the appointment, however, Dunkus left the apartment and ended up nearby at the Jewish Community Center, where an employee called police at 10:46 a.m., according to the police call log. Officers arrived a minute later to find Dunkus sitting in an office.

Police called Benns. The officer had called for an ambulance, which Benns followed to the hospital.

No police report was written, but Benns said part of the reason why police called for an ambulance was because her aunt said she had chest pain. Dunkus’ medical records show she arrived at Mercy ӣ����Ƶ at 11:44 a.m. for “psychological evaluation.”

Benns said Dunkus was taken straight to the locked behavioral health unit within the emergency department.

Benns found her aunt getting her blood drawn and in what her nurse called a — she was making tense, unusual movements, such as holding up her leg or her mouth open.

Benns said she talked to a doctor about her aunt’s chest pains. The doctor told her he would order an EKG of her heart and a CT scan of her organs.

Dunkus’ bloodwork revealed she had no alcohol or drugs in her system, according to the medical records, but her potassium level — 2.7 — placing her at higher risk of cardiac arrhythmia (irregular heart rhythm). Normal is 3.5 to 5.2. Anything lower than 3 is considered “severe.”

Dunkus refused to take pills or eat, so she was given an intravenous bag of fluids to raise the level, which requires continuous monitoring, , to ensure safety.

Benns and Taylor stayed with her for several hours. The EKG machine was brought into the room, they said. To go to her CT scan, Dunkus had to be lifted into a wheelchair. She was quiet.

“She was slightly responsive, or she wouldn’t talk,” Taylor said.

Benns and Taylor said the only concern staff shared with them was her potassium level was low, and the goal was to raise the level so she could be admitted to an in-patient psychiatric facility.

Dunkus eventually wanted her nieces to leave, thinking they were trying to hurt her, they said. They didn’t want to scare her, so around 7 p.m., the two left the hospital.

“I love you, and I hope you know we just want you to be safe and happy,” Taylor said she told her.

Benns, the main contact, was expecting to get updates throughout the night. Instead, Taylor got a got a call from a chaplain at 7 a.m. the next morning saying her aunt had died.

At the hospital, Taylor said a doctor and a nurse told her that her aunt was last checked on at 11 p.m.

“In my head, I’m like, ‘Eight hours? Is that normal?’” she recalled. “That is the only thing that stuck in my head, them telling me eight hours. They couldn’t even tell me when she died.”

Complications

The hospital reported the death to the ӣ����Ƶ County Medical Examiner’s office, in cases where the cause of death cannot be established. The office decided an autopsy was needed.

The examination concluded that the cause of death was complications from chronic alcohol abuse. The years of drinking had caused the .

When that happens, explained ӣ����Ƶ County Assistant Medical Examiner Dr. Joshua Akers, the electrical impulses that travel through the heart “kind of get lost” or travel slower.

“That can create a cardiac arrhythmia, and a serious arrhythmia can be fatal,” Akers said. The body is starved of blood and oxygen.

Death can occur in less than five minutes, he said.

One of the first signs of a severe arrhythmia would be losing consciousness, Akers said. If a person was sleeping, there might not be any signs.

After Dunkus’ lifeless body was discovered, CPR was administered along with two doses of epinephrine, records show. No heart activity was ever detected. She was pronounced dead at 7:07 a.m.

A doctor called to the bedside wrote “no recent vital signs available.” The doctor also described the body as “gray, cold to touch, had swelling on her back,” medical records show.

Akers said such descriptions can be subjective and there’s no way of knowing the time of death.

The workers say Dunkus should not have been kept in the behavioral health unit.

After her arrival, Dunkus’ blood pressure was 140/100 and heart rate was 110 beats per minute — both high. Lab results came quickly, revealing the dangerously low potassium.

An EKG was completed within about two hours. The test showed a QTc interval — the time it takes for the heart to contract and recover — of 492. The interval is considered prolonged if greater than 460 in women, , and 500 predicts an “increased risk of life-threatening cardiac events.”

Dunkus’ long-term and recent alcohol use were noted in the medical records, and the CT scan results showed liver disease consistent with chronic alcohol use.

No observations were noted after 2:18 p.m., when Dunkus was marked as “stable.” Her last vital signs were taken at 1:04 p.m. Her blood pressure was still 142/92.

Dunkus’ blood was analyzed again, but the sample was damaged, possibly skewing the results that were released from the lab around 10:30 p.m., the records show.

Benns said after calling the hospital to try and learn more about how her aunt died, she was eventually told that Dunkus was watched via a video monitor and because she appeared to be sleeping, no one physically checked her because they didn’t want to wake her.

A travel emergency room nurse who has worked in hospital systems in the ӣ����Ƶ area says when she sees patients with a history of alcohol abuse in the behavioral unit, she is adamant they be moved to a medical bed because of how quickly they can deteriorate.

“If you have a patient who is an alcoholic, I absolutely will not take them on the behavioral health side. I will stomp my feet, throw a fit. No way,” she said. “They turn too quickly, they do.”

‘Just touch them’

The Mercy workers who spoke to the Post-Dispatch about Dunkus’ death described the behavioral health units at both Mercy ӣ����Ƶ and its sister hospital Mercy South.

At Mercy ӣ����Ƶ, workers say, the unit includes nine patient rooms. Some basic medical equipment is kept behind locked doors in rooms, as well as a toilet. Patients can receive intravenous fluids. The central nurses’ station sits behind a high counter.

Mercy South includes 10 rooms, four of which are in an overflow wing. The patients share a bathroom in the hallway. The nurses’ station sits in a closed room with windows. No medical equipment is kept in the rooms, and family members are not allowed.

Patients in the units wear scrubs. Beds are bolted to the floor. Nothing can be in the rooms that can be used to hurt themselves or others. Doors to patient rooms must remain unlocked.

The units are staffed with a nurse, one patient care technician (two if patients are in the overflow wing) and a security guard.

Patients coming into the emergency room are supposed to be medically screened first and have blood drawn to check for abnormalities and drugs in their system before being sent to the units, the workers say.

“I’ve had them come straight from EMS, straight back here, and I’m like ‘Look, nuh uh, this patient needs to go over there, medically should be over there,’ and they won’t take them back …,” said the nurse. “But we have open rooms — that’s how it’s looked at. The behavioral has open rooms, use them. And I’m like, ‘But I can’t monitor them.’”

Patients in the behavioral units should be able to walk, speak, use the bathroom “and have no medical needs,” she said, “meaning that for the most part, other than their mental health, they are healthy.”

But patients are sometimes sent there who are incontinent or in wheelchairs, the workers say. Some are not in mental crisis but emotional from grieving a death or an injury. Staff use the units as a way to reduce wait times, they say.

“There are times when a patient is highly agitated and being on a locked unit is the safest path for sure, and they need to get them over there quickly. We all understand that. But that is not how the unit is used,” one worker said.

That makes it harder for the one nurse staffing the unit to keep a watchful eye on all the patients, the nurse said. “I can’t chart, I can’t look at orders, I can’t get the meds, do all that, plus look at the monitors, make sure everybody is OK, make sure I order meals and get the meals up here to them. You are only one person, you can only do so much.”

Patients in mental crisis who also have medical needs, the workers say, are supposed to be cared for in a medical room with a sitter continually watching them and noting their condition every 15 minutes — such as sleeping, calm or agitated.

Routine in-person checks should also happen in the behavioral health units, but instead patients are observed via a screen from the nurses’ station or not at all, as workers say they have caught patient care technicians doing homework or searching the internet.

“How hard is it to get up every 15 minutes to do a safety check? It is their actual job, and they can’t get up to check?” said one worker.

The nurse says patients should have their vital signs taken at least every two hours. Patients can refuse to have them taken, but staff should continue to try. And if a patient hasn’t moved after an hour, she said, they need to be checked physically.

“I have to count a lot on the (patient care) techs,” she said, “and if they are like, ‘Oh, they are fine, they are sleeping,’ I’ll say, ‘When was the last time you went in there? I need you to be in there and just try to wake them up, just touch them, see if they move, whatever.’”

But, she said, she understands that dealing with patients in mental crisis can be extremely challenging, exhausting and dangerous. She and others have been attacked by patients.

Mercy officials, in their statement, encouraged workers to report concerns to Mercy’s internal safety event reporting system, used to address concerns related to patient care and workplace conditions:

“We rely on our co-workers, patients and visitors to be the eyes and ears to report events and give us the opportunity to address any issues and create a safer environment for all.”

Benns and Taylor said while at the hospital, staff never told them the results of their aunt’s EKG or CT scan. The severity of the low potassium was never explained. “We should have been given this information so that we could advocate for her care,” Taylor said.

They also don’t understand why Dunkus’ chest pains were not noted in her medical record.

“Their best solution for how to care for a catatonic patient with concerning health issues was to leave her in a room for eight hours,” Taylor said. “It really hurts us to know this is how someone we loved was treated.”

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