President Trump’s former National Security Advisor, General H.R. McMaster, lost his father recently to a death being investigated as “suspicious.” Though published accounts indicate the tragic event was deemed by the Department of Health to be due to “blunt impact head trauma” and “ruled an accident,” Philadelphia police in cooperation with the Pennsylvania attorney general’s office are, for not entirely known reasons, in the beginning phases of scrutinizing the incident.
H.R. McMaster Sr. was a resident of a senior living facility in Philadelphia that provides a host of supportive services – it has been reported that he was receiving care there after enduring a stroke. According to local ABC affiliate,
“The allegations are that McMaster Sr. fell, hit his head, was put in a chair and then died. He allegedly did not receive proper care. Investigators are probing information from some staff members who informed the McMaster family that records were falsified pertaining to this death.”
How can a death be accidental and suspicious?
When a medical examiner deems the manner of death to be accidental, that may or may not be the entire story. So, though a person might sustain an unintentional fall, for example, that causes a head trauma, further questioning and examination of the scene and circumstances are essential to determining the complete picture.
A litany of findings need to be ruled out to affirm there was no negligence or malicious intent that led to or exacerbated the catastrophic event, including but not limited to the following: Was proper care delayed (e.g. patient ignored or not monitored appropriately, misdiagnosed, staff lacking sufficient expertise or with perverse incentives)? Were there egregious measures in place that facilitated such an injury (e.g. faulty outdated equipment)? Does the manner of death make sense in terms of the timeline of actual demise? Is there evidence of elder abuse?
Can “blunt impact head trauma” just happen for no nefarious reason?
Yes. If the reporting is accurate, then strokes can definitely place someone at a greater risk of falling - so it is especially important in this population to make sure precautions are strictly implemented. The level of risk depends on the extent of the disability in conjunction with a person’s underlying clinical status, existing conditions and medications.
In my article Leonard Cohen's Death By Falling Among Top 5 Leading Causes, I address the 2016 Centers for Disease Control and Prevention (CDC) estimates of preventable deaths from the five leading causes with unintentional injuries surging 23% —mainly due to drug poisoning and falls. As I wrote then
“Falls are an enormous cause of catastrophic injury and death. They impact millions of those over 65 as 1 in 4 older people fall per year with less than 50% informing their physician. Happening once is a risk factor for recurrence. Fear of falling becomes a very real symptom that limits daily activity. The more immobile a person is, the more at risk they are of other disease sequelae…The CDC estimates fall injuries prompt $31 billion of direct medical costs.
As I always say with respect to trauma, it is location, location, location that determines the outcome. High real estate pays the ultimate price. Head injury is a very dangerous one with falls being the #1 cause of traumatic brain injury. One in five falls triggers such serious consequences that also include hip fractures and broken bones. Fall injuries account for over 800,000 hospitalizations.”
To read about bleeding in the brain, see here.
This investigation is important
For so many reasons, discerning whether elder abuse, negligence or intentional injury factored into the equation is a worthwhile endeavor. Among them, providing a family peace of mind, being able to avoid recurrences and making certain a facility doesn’t engage in an untoward pattern of behavior.
Elder abuse can present in many forms (e.g. physical, financial), occurring at home or in a specialized center. Our aging population is growing and more susceptible to being vulnerable on a number of fronts (see Why Florida Nursing Home Death Counts Were So High After Hurricane Irma).
Fortunately, there are ways to assess whether something was well outside of the standard of care or not, so as this story unfolds more information will be revealed. That won’t necessarily rid loved ones of suffering, but, hopefully, the determinations won’t compound it.