She was in the hospital with multiple medical problems. She was having difficulty swallowing. Her doctors decided she would be better off with a feeding tube.
For the first week and a half the feeding tube worked beautifully. Then one of the doctors came in and said the feeding tube was clogged, needed to be removed and cleaned and then reinserted. And that's exactly what they did.
They removed the feeding tube, cleaned it out and then reinserted it. After taking an x-ray and believing that the feeding tube was in the correct position they started the nutritional feeds again.
The problem was that the feeding tube was not in the correct place. That meant that all the nutrition that was supposed to go into her stomach was instead going into her abdomen.
She became acutely septic and infected and died shortly afterward.
An autopsy, which examines the patient's cause of death, revealed that the feeding tube was clearly in the wrong place. Had the feeding tube been put into the correct position, this patient would not have become septic and would not have died.
This case settled a few months after a lawsuit was started since it became obvious to all involved that this never should have happened and was a clear violation of the standard of good medical practice.
