Let’s Live…FOREVER!

 

“Harrowing” and “Horrifying”

The Associated Press reported yesterday that an 87-year-old Bakersfield, CA, woman collapsed at the dining hall of her assisted living facility and that staff refused to perform cardio-pulmonary resuscitation (CPR).  She died.

Now, all hell is breaking loose.

Never-mind that the “residents of the facility are informed of the policy (no CPR) and agree to it when they move in.”

A nurse is being vilified by the ignorant media, politicians and others needing to score points as she was simply doing her job and adhering to policy.  The policy is not a “do not resuscitate” but rather a “will not resuscitate.”  No difference, just they are telling you instead of the other way around.

This situation highlights the fact that apparently healthy people, especially the elderly,  can die of natural causes and not need or want resuscitation.  This potential eventuality had been explicitly addressed without the need for the “DNR” order.  There are many ways to skin the cat.

We westerners think we will live forever and that every sentient being should go to the great Walmart in the sky with four broken ribs, a lacerated liver and a tube jammed down our throat.

From California Advocates for Nursing Home Reform: “Independent living facilities should not have a policy that says you can stand there and watch somebody die…How a nurse can do that is beyond comprehension.”

From the California Board of Registered Nursing: “The consensus is if they are a nurse and if they are at work as a nurse, then they should be offering the appropriate medical care.”

And this bon mot from Assemblywoman Mariko Yamada, chair of the California Assembly Aging and Long-term Care Committee, “This is a wake-up call.”  (Not so much.)

This is shaping up as another example of the “Hot McDonald’s coffee/I’m stupid so i’ll sue you”  world we inhabit.  Frankly, it’s 2013, if you are in any facility and they lack one or more Automatic External Defibrillators (AEDs), they aren’t serious about “sudden death” lifesaving regardless of what they say or who knows or will administer CPR.

If I defy the odds and live to be eighty-seven and am in the dining hall and go into cardiac arrest, I’ll sue all right.

I’ll sue whoever dares to touch me.

 

 

29 Comments

  • R. Ingram says:

    While I think it’s perfectly fine for a person to make whatever life decision that they want, and I will respect that, there is a legal problem with this. Company / Facility policy should never be able to over ride the simple “Duty to Act” clause that comes with a state issued medical provider license. If this person was a state licensed RN/LPN/whatever, without a written DNR for the patient, they have a “Duty to Act” and thus preform to the level of care that they are trained, and safely able to perform at the time.

  • Smitty says:

    I understand, but I don’t think it’s quite that simple, Eric. Why call 911? The job of emergency responders is to try to keep the patient alive. One could argue the nurse put herself in that situation by making the call.

    Further, I would question the legality of withholding CPR. Just because someone needs CPR doesn’t mean he or she is in a persistent, vegetative state or would otherwise have no hope of survival, which is the case when a DNR is enforced. Would they have withheld CPR if the patient had fallen into a swimming pool and was drowning?

    I don’t think it’s as simple as trying to deny death. Those of us who have enforced a true DNR for our loved ones know that the moment of decision is not what we had anticipated it would be because death doesn’t come at the point of decision. For some, loved ones can linger for weeks.

    So, pardon my ramblings on the subject, but if you’ve got a policy that says no CPR, save yourself, your families, and your institution a lot of aggravation and don’t call 911. …but before you even get that far, make sure that you really want to withhold CPR as opposed to enforcing a DNR.

  • Jim A. says:

    The point i would like brought out in this debate is that the refusal to act goes against the nurses code of ethics and probably the state nurses practice act and the good samaritan laws as well. In Florida the law states medics and nurses HAVE to act to preserve life. refusing to do, or allow, CPR to be done would result in immediate repercussions against that nurse or medic’s license/certificate.

  • Duane says:

    “KGET-TV says Bayless’ daughter told the station she is a nurse and was “satisfied with Glenwood’s handling of the situation” USA today article

    I run into the same problem with my grandmother who is in a nursing home and does have a DNR. The Medical Staff always want to more and threaten to report to thier “higher ups” when we as a family do not agree or want the treatment they are suggesting.

  • Chris says:

    I agree with Jim A. It seems to me that the policy is in conflict with the nursing license. The argument of “just doing her job” is intellectually lazy because the “job” of a nurse (paramedic, EMT, firefighter, police officer, etc) goes well beyond written policy. In other words, when is a nurse NOT a nurse?

    I suspect the policy exists solely to create a differentiation among the levels of care offered in the various different parts of that facility. I’m not so sure the owners will agree that the policy is a very good business model right now.

    I get the importance of allowing people dignity and a choice as to how they wish to be treated in a life-ending event like this. But if it is THAT important to you, get a DNR.

    And, Eric. If you collapse in front of me and you HAVE no DNR, I am going to be on your chest and you can sue me if you like, but you will not win.

    Get…A…DNR…and this would never be an issue.

  • Victoria Huckenpahler says:

    It’s a knotty problem, Eric, but it’s a fact that sometimes these institutions err on the side of life-saving against the odds — presumably to evade lawsuits. I remember that when my father-in-law was dying, even though he had a DNR that had been signed only 4 mos. before, the hospital called us, agitating about whether we/father-in-law still wanted them not to intervene. At the same time, they were trying to withhold morphine from him, which he needed to avoid discomfort! We flew out of the house and ran to that hospital to make sure that my father-in-law had what he needed for comfort, but that the DNR was respected. That’s why it’s always good to have a patient advocate at hand, no matter what docs. have been signed.

  • teri miller says:

    Appropriate advance directives are the legal way to avoid CPR. A facility that does not advise there customers of the legal way to control their medical care is negligent in my mind. Having a blanket policy to withhold care, (especially with a nurse present), is suspect in my mind. the problem with these directives is they address the patients wishes and not necessarily the family’s if the patient is of sound mind. These are emotional decisions….people assume if you want CPR at 87, (or disabled), years old that you are not of sound mind and want to make that decision for you. by placing you parent in a facility with this kind of policy I believe you are bypassing your parents right to make this decision for themselves. I have been helping my mother in law wade through these decisions, and it does seem the case workers try to push her decision to match their own personal beliefs on these end of life issues. Maybe there is a reason there was no DNR on this woman…maybe it was because she refused to sign it and was legally able to refuse but not quite savy enough to understand the facility policy. No facility should have the right to bypass the states requirements for advance directives….these are laws designed to protect in individuals right to decide their own medical care. Not many ambulances can get there in time for CPR to be effective. That is why dispatchers are trained to coach. Regardless of whether or not the family was advised of the policies do not make those policies legal. I would not want to live in a state that supported these facilities in bypassing laws designed to protect an individual right to decide their own end of life care. I would be really surprised if the facility, (not the nurse), doesn’t face some charges for the illegality of this policy. And the family also needs to adhere to the law….otherwise inheritances may come prematurely.

  • Dennis says:

    Eric,

    Have a DNR tat placed strategically on your chest. Hopefully that should prevent some snot-nosed paramedic from crushing your chest, searing your skin a la ahi tuna, and making a pin cushion out of you. If I make it to 87, not much to bitch about if I don’t make it to 88.

  • Kathy Drawdy says:

    She collapsed in the dining hall, which makes me suspect aspiration, in which case timely intervention would have saved her. I agree with the previous poster, if she had fallen into a swimming pool, would they let her drown. I am willing to withhold judgment until further details are known, but it is very hard for me to picture a nurse with the ability to intervene choosing instead to let someone die.

  • Tim Walker says:

    “KGET-TV says Bayless’ daughter told the station she is a nurse and was “satisfied with Glenwood’s handling of the situation”…is the daughter the beneficiary on her mom’s insurance? Is she stuck paying the bill every month her mom is alive?

    “Get…A…DNR…and this would never be an issue.”…as long as you have the DNR where everyone can see it. And it’s the original. WITH all the required signatures.

    Are we all sure that there is a “Duty to Act” attached to a license in Kalifornia?

    If the facility’s policy is so airtight about not doing CPR, and everyone involved agrees, why does the policy include calling 911?

  • Steven Godbehere says:

    This situation is a nightmare. Every medical provider takes a hit when something like this goes public. It took some soul searching and some info beyond what the media provides, but I came to a conclusion. I have no problem with death, never have. We all will die and thus should be able to choose how we die. The problem here is figuring out how to protect ourselves from liability, the patient from actions beyond their wishes, and the public from the drama unfolding here.

    The daughter of the “victim” in this situation, also a nurse, stated that she was pleased with the care provided. That included doing nothing. I have great concern about the legal ramifications against the nurse who followed the company’s protocol. I also worry about the legal precedent that this may end with.

    Our medical licenses require us to act under these circumstances. A company protocol will not protect our licenses under that “failure to act.” We, as a community of medical professionals, need to ensure that there is no doubt or blame. We need a way to ensure 911 dispatchers, nurses or employees, patients and families, and the public understand that people have the right to die how they want; accidental, natural, or (where legal) at their own request.

    The best way would have been for that company to require residents to have an active DNR while at that facility. That simple piece of paperwork protects the facility from deaths on their premises, the nurse from “failure to act”, and the patient’s right to choose where to live and die. They have a distinct ability to display a choice to live there with a DNR or live elsewhere where they have staff, training, and equipment for live-saving capabilities. It protects everyone.

    What we do now is the most important. If you hear people discussing this case, talk to them about the facts. Become active instead of passive and overcome the media by providing truth. If you work in a facility with a No CPR/Resuscitation policy, advise your superiors of their legal predicament. Any discussions that we can have as medical professionals is better than complaining, joking about it, or doing nothing to remedy the problems!

  • Steven Godbehere says:

    (By the way, I understand them calling 911. It is the only way the public knows to activate the system of declaring death in a pre-hospital environment. There isn’t another publicized medical examiner/coroner phone line. I also think that the dispatcher did the correct thing based on her information. It is rather unbelievable that a licensed on-duty nurse wouldn’t do CPR when there isn’t a DNR in place. It is all about the communication.)

    • teri miller says:

      I did read somewhere that their policy was for EMS to provide medical care not them. That would be why they called 911…for medical care. they assert however that their employees will provide no medical care.

  • Karrie Boswell says:

    Brother Lamar I to reject the opinions of Jainism which holds that all matter is endowed with sentience. People should be allowed to die with grace. Clearly a dead woman only definitively possesses 1 of the 5 skandhas; form. Arguably she lacks the other aggregates of sensation, perception, mental formations, and consciousness. I give you my word if ever you are in my presence and you collapse I’ll shall have you immediately declared non-sentient and allow you to pass into the great Wal-Mart, blogisphere, union meeting (which ever you most closely identify with at that time) in the sky with your ribs in place and free of a tube. I make no promises about your liver because I think you drink too much merlot while blogging. On another note given your mention of western civilizations desire to prolong the life of all sentient beings shouldn’t the converse then also be given some consideration. Should we not be allowed to pass judgment on all those who lack form, sensation, perception, mental formations and consciousness? I’m not calling for death sentences however at the very least it shouldn’t be against the law to hit them in the head with a 2 x 4 at the first sign they are attempting to speak, write a book, get a reality show, host a radio show, run for office or post on Facebook? I know right!!!!

  • Anthony says:

    I agree with the above arguments. It would be so easy for the facility to say we will not admit you to our facility without a DNR. That keeps everyone out of trouble.

  • Linda says:

    Are we missing the point….. she was still breathing DNR or not you assist, maybe just opening her airway could have helped. DNR only comes into play if the are not breathing

  • Henry Lawrence says:

    I cannot there is even a debate at all about trying to preserve a life in the first instance.

  • Henry Lawrence says:

    Sorry, that should include the word “believe”.

  • CJ Ewell says:

    I agree- if the woman was informed of the policy and agreed to it, so be it. However, I belive that the lines are often blurred in assited living facilities. Whether or not the person on the phone was actually a nurse is a good question. Lots of non-nurses refer to themselves as nurses, especially in assisted living facilities. A DNR is the only legally clear way to make end of life choices known. Everyone should do this.

  • Dennis says:

    Karrie,

    Your 2×4 comment may be the most intelligent and funny comment ever uttered on this blog. DK

  • Glenn says:

    I wonder if the “we will not attempt to save you” policy statement was some of that number 6 font we often see at bottom margin of the contract. Face it there is never good news in small print.

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Eric Lamar

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