In Rockville, Maryland, the death of 63-year-old Adela Urbina at Shady Grove Adventist Hospital unfolded as part of a larger, disturbing pattern of neglect. Urbina, a female patient hospitalized with pneumonia, experienced a significant drop in blood pressure. The intensive care nurse assigned to her, Coleen M. Thompson, failed to notify a doctor of this critical change in her condition. This inaction was a key factor in the events that followed.
Subsequent investigations into a series of
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