CBS 5 Investigates With Anna Werner

SAN FRANCISCO (CBS 5) ― For someone to die at a hospice isn't unusual, it's expected. But the daughter of an elderly San Francisco resident said her mother shouldn't have died there the way she did.

"There's no way to free myself from the memory of what I witnessed," said Sylvia Forsmann.

Forsmann said her nightmare started at the Coming Home Hospice, owned and operated by California Pacific Medical Center in San Francisco. It's where she brought her 81 year old mother Leah, who was dying of cancer.

"We came to the conclusion that hospice would be the next best step," said Forsmann.

Just two weeks after moving into the hospice, her mother began coughing. Forsmann said she was worried so she called the nurse on duty, vocational nurse Betsi Bilyck.

Forsmann said Bilyck retrieved medications and administered them. But Forsmann said she didn't know what drugs her mother was being given. "And I said, and that is for? And (Bilyck) just turned and looked at me and said, 'Don't worry, she'll rest now,'" Forsmann recalled.

But Forsmann said an hour later her mother sat up in her bed and was "struggling to breathe."

Forsmann said she asked the nurse to clear her mother's throat with suction but that the nurse refused and instead gave her mother more drugs. Forsmann insisted the drugs weren't helping her mother.

"She stood up and said I've been doing this for 20 years, I know what I'm doing. She stood up, stomped out of the room like a child and slammed the door," said Forsmann. "And I just sat there stunned in total disbelief of what I just witnessed."

Forsmann said she did the only thing she could think of.

"I told the nurse that I was calling 911. And she said if you call 911 I will lock them out of the building," said Forsmann.

That's when Forsmann said she had a chilling thought.

"I felt in my heart that this nurse was trying to kill my mother," said Forsmann.

Forsmann called 911 and paramedics came to the hospice but it was too late. Shortly after they arrived, Leah Forsmann died.

The next day, searching for answers, Sylvia Forsmann reviewed medical records filled out by the nurse and noticed "something odd."

"There were some dosages changed. There were some times changed," Forsmann said.

Forsmann hired a private pathologist to do an autopsy and find out just how much medication was in her mother's system, and says the results of his toxicology tests stunned her.

"Enough to kill seven horses is what the doctor told me," said Forsmann.

The private pathologist Forsmann hired ruled her mother's death a homicide.

An expert pathologist consulted by CBS 5 Investigates indicated that the level of one drug found in Leah Forsmann's blood, a drug called Atropine, was 10 times higher than that found in people who have died from atropine intoxication in case reports in the medical literature.

California Pacific Medical Center (CPMC) declined to do an interview or answer questions about the case. In a statement to CBS 5 Investigates, CPMC said that their employees, including nurse Betsi Bilyck, provided appropriate care for a patient who was dying.

Sylvia Forsmann disagrees. She has filed a lawsuit against CPMC and Coming Home Hospice, which is ongoing.

In depositions taken as part of that lawsuit, nurse Bilyck admitted she broke the law. Asked when, she said "when I gave more Atropine than was ordered."

Bilyck revealed she gave that drug Atropine to Leah Forsmann several times on the day Forsmann died, June 15, 2006.

Forsmann's lawyer, Chris Dolan, asked Bilyck: "Did you ever ask anybody, before you kept giving this Atropine, 'How much of this can I give before it kills somebody?'"

"I never talked to anybody," answered Bilyck.

Dolan asked, "You kept giving it on your own initiative, correct?"

"Yes" Bilyck answered.

Dolan asked, "In violation of the doctor's orders?"

"Yes," Bilyck answered.

And why? Bilyck claimed: "I was trying to alleviate…alleviate her suffering."

Dolan asked, "To alleviate her suffering…"

"Yes," Bilyck answered.

Dolan asked, "So that she would die in what you thought would be a peaceful death?"

"Yes," Bilyck answered.

David Magnus directs the Stanford Center for Biomedical Ethics. The medical ethics expert found the admissions "shocking."

CBS 5 Investiages asked Magnus, "When (Bilyck) says well, I was trying to alleviate suffering does that make it okay?"

"No", answered Magnus. "That's unethical, illegal, inappropriate, anything you can think of." Because Magnus said the law is clear: vocational nurses can't give drugs without the proper orders.

"It's practicing medicine without a license," said Magnus. "It's illegal."

Magnus said the deposition video is disturbing.

"I don't want to say this is what she is doing, but when you are watching this what it evokes is somebody who is engaging in what in their mind is mercy killing," he said.

Despite the nurse's admissions, CBS 5 Investigates found that as of June 8, Bilyck was still working at Coming Home Hospice.

Meanwhile, Sylvia Forsmann has regrets.

"I wish I would have acted sooner. I feel like, she didn't get that transition, you know, into another world, the way she deserved," she said.

Bilyck and her attorney did not respond to calls seeking comment.

Records show the San Francisco Medical Examiner's office, which also performed an autopsy, called the cause of death 'undetermined."

California Pacific Medical Center sent CBS 5 this statement:

"CPMC believes its employees acted appropriately in caring for a resident who was terminally ill, and it is unfortunate that this patient's family was dissatisfied with the care she received. Since the matter is in litigation, and out of respect for the patient's privacy rights, we cannot comment on the details of the case. However, Coming Home Hospice has provided end-of-life care in San Francisco for the past twenty-two years. It has an experienced team of caregivers dedicated to meeting the needs of terminally ill residents and their families. CPMC is proud of the compassionate and dignified care provided to our hospice clients."

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