US Facility defends nurse who refused to perform CPR

[ledboots]

A DNR is not something the daughter can just make up. A doctor's order is needed.

Maybe in Florida a doctor's order is needed, but in the states with which I'm familiar, it's a decision made by an individual while s/he is of sound mind, which is then set out on a legal document, signed by the individual in question.

There is a difference between living wills and dnrs. From wiki:

DNR compared with advance directive and living will

Advance directives and living wills are documents written by individuals themselves, so as to state their wishes for care, if they are no longer able to speak for themselves.

In contrast, it is a physician or hospital staff member who writes a DNR "physician's order," based upon the wishes previously expressed by the individual in his or her advance directive or living will. Similarly, at a time when the individual is unable to express his wishes, but has previously used an advance directive to appoint an agent, then a physician can write such a DNR "physician's order" at the request of that individual's agent.

These various situations are clearly enumerated in the "sample" DNR order presented on this page.

It should be stressed that, in the United States, an advance directive or living will is not sufficient to ensure a patient is treated under the DNR protocol, even if it is his wish, as neither an advance directive nor a living will is a legally binding document. It is also the case that the wishes expressed in an advance directive or living will are not binding. But also see the legal discussion presented in the next section." http://en.m.wikipedia.org/wiki/Do_n...mpared_with_advance_directive_and_living_will

 

[ledboots]

I don't understand the problem. It says people are informed that part of the facility does not do CPR before they sign up and move in. The daughter is satisfied with their actions. I don't see how the mother could have been ignorant of the fact that she would not be getting CPR. Seems like the newspaper is just making up a story where none exists.

My Dad would have this if he were to end up in a nursing home. He and my step-mom both have instructions not to put them on life support should they end up in a coma or something else renders them unable to live with being hooked up to a machine and not likely to regain consciousness. I told him it was a good thing he made these provisions because if there were no instructions I for one would be incapable of making the decision to let him die. I know no one lives forever but I would find it impossible to be the one to tell the hospital to take him off life support. So it's not outside the realm of reality that an 87 year old woman in a nursing home would be fine with not receiving CPR if she should end up collapsing.

My parents both had living wills from the time they were in their fifties. My father had a DNR after his leukemia diagnosis and was under hospice care, and they still ignored it and tried to resuscitate once. He was so angry.

 

[mlp]

A DNR is not something the daughter can just make up. A doctor's order is needed.

Maybe in Florida a doctor's order is needed, but in the states with which I'm familiar, it's a decision made by an individual while s/he is of sound mind, which is then set out on a legal document, signed by the individual in question.

There is a difference between living wills and dnrs. From wiki:

DNR compared with advance directive and living will

Advance directives and living wills are documents written by individuals themselves, so as to state their wishes for care, if they are no longer able to speak for themselves.

In contrast, it is a physician or hospital staff member who writes a DNR "physician's order," based upon the wishes previously expressed by the individual in his or her advance directive or living will. Similarly, at a time when the individual is unable to express his wishes, but has previously used an advance directive to appoint an agent, then a physician can write such a DNR "physician's order" at the request of that individual's agent.

These various situations are clearly enumerated in the "sample" DNR order presented on this page.

It should be stressed that, in the United States, an advance directive or living will is not sufficient to ensure a patient is treated under the DNR protocol, even if it is his wish, as neither an advance directive nor a living will is a legally binding document. It is also the case that the wishes expressed in an advance directive or living will are not binding. But also see the legal discussion presented in the next section." http://en.m.wikipedia.org/wiki/Do_n...mpared_with_advance_directive_and_living_will

Which is why I said "DNR directive" - that's the document the patient signs. Yes, there's a difference between a DNR directive and a living will - I don't think I said or implied differently. A DNR directive deals specifically with resuscitation. That can be included in a living will (which deals broadly with what should/should not be done if a patient is in a coma, persistent vegetative state, etc.), but is generally set out in a separate document dealing specifically with resuscitation, since there's no time to read a long document when deciding whether CPR should or should not be performed.

And while a doctor or hospital may not be legally obligated to abide by a DNR directive (just as they are not necessarily obligated to abide by the wishes of a conscious patient, since their professional responsibility theoretically can trump patient wishes of a conscious patient), they generally do - for one, the argument could validly be made that any steps taken contrary to a DNR directive are against the patient's express wishes, and that therefore the patient (or his estate) are under no obligation to pay for the services.

ETA: If someone has a DNR directive, it's good practice to update it at least annually - that way, there is no question about it being outdated, that the person may well have changed his/her mind. The same thing for healthcare powers of attorney.

 

[mlp]

My father had a DNR after his leukemia diagnosis and was under hospice care, and they still ignored it and tried to resuscitate once. He was so angry.

That's very poor hospice care. I'm sorry.

My experience with hospice care has been very positive.

 

[Amy SF]

I think it's awfully tolerant of the daughter to concur that the facility's non CPR policy was followed. Either that, or she was waiting for her mother to die. Somehow one expects her to angrily file a big-*** lawsuit over the whole thing.

Had I been the nurse in question, I would have broken the rule and administered CPR, even if it cost me my job. I think the family would have preferred it that way in the end, had it saved the woman's life.

In any case, Bakersfield PD is looking into the case to determine if anything unethical or illegal occurred.

 

[mlp]

I think it's awfully tolerant of the daughter to concur that the facility's non CPR policy was followed. Either that, or she was waiting for her mother to die. Somehow one expects her to angrily file a big-*** lawsuit over the whole thing.

It could also be that she was aware that her mother would not have wanted to live if she couldn't live relatively independently. Of course, in that case, one would expect the mother to have signed a DNR directive and/or a living will. My mother was very adamant about the conditions under which she was willing to go on living, and had a directive, a living will, and a durable healthcare power of attorney in place many years in advance of her death.

 

[mlp]

There's a link to the 911 call at the bottom of the page: http://healthland.time.com/2013/03/04/listen-nurse-refuses-to-give-cpr-to-dying-woman/

After listening to this, I have to say it was a major cluster**** on the part of the facility. I also have to say that this nurse is not someone I would want within 100 feet of anyone I care about.

 

[mlp]

In any case, Bakersfield PD is looking into the case to determine if anything unethical or illegal occurred.

The police don't do anything about *unethical* - they only have authority if a crime occurred.

There's no crime here - calling 911 covered them in that regard.

 

[beancounter]

In any case, Bakersfield PD is looking into the case to determine if anything unethical or illegal occurred.

The police don't do anything about *unethical* - they only have authority if a crime occurred.

There's no crime here - calling 911 covered them in that regard.

That's what confuses me. If they have a DNR policy, then why bother calling 911?
Unless they think that the ambulance had warp drive, it would be extremely unlikely that they could get there in time to save her.
Knowing that, it seems almost cyncical for them to call, because the 911 operator is expecting the caller to want to help. Isn't that why most people call 911?

 

[mlp]

Well, there's no legal obligation for anyone to even call 911 unless they have a special responsibility to the person. For instance, a passerby can walk right past someone collapsed on the sidewalk without incurring any legal liability. But if someone collapses at a restaurant, for example, and the restaurant workers just leave the person lying there, they could/would incur legal liability, because the collapsed person has the status of an "invitee" under the law. Same thing, perhaps more so, in this case, where the woman was a tenant of the independent living section and eating in the cafeteria when she collapsed. So, while they don't have a legal duty to do CPR, they have a duty to call for help - hence the 911 call.

ETA: That's also one of the reasons underlying the difference in this facility's policy regarding CPR for residents of the independent living portion versus the assisted living and the skilled nursing portions - the facility has assumed some responsibility for medical care in the case of the assisted living residents, and even more responsibility in the case of the skilled nursing residents, so their refusal to perform CPR would constitute neglect, possibly at the level of a crime, depending on the state statutes and regulations governing those two types of facilities. An independent living facility, OTOH, is pretty much like any landlord/tenant relationship, subject to few regulations other than financial ones. (It's not unusual for upscale independent living facilities to charge a considerable upfront fee that guarantees that the resident will be given priority admission to the assisted living and/or skilled nursing facility when that becomes necessary, and those prepaid deposits are subject to financial regulation in some/many states.)

 

[Pickle Juice]

Still not understanding this.

...residents of the home's independent living community are informed of the "no-CPR" policy and agree to it when they move in.

So why would anyone need a DNR order if they had already agreed to this policy before moving in? And why, if residents must be informed and must agree to this before they move in, should the facility be held accountable? It hardly profits the facility to deceive its residents, or refuse to give them CPR in the hope that they will die, since then they will lose income from said resident.

Maybe this woman accepted this policy as an alternative to paying a lawyer to get a DNR order. Seems to me that if loads of children were conning their parents into choosing a facility with a policy like this because they were in hopes that the parents would not be revived, and thus they would inherit that much sooner, that the facility wouldn't just allow it without question. Too much room for lawsuits if the parents get put there without full disclosure, and without signing whatever admission papers need signing before they move in, or are not of sound mind when they are informed of the no CPR policy and asked to sign.

I would hardly think that if I chose to move into a facility with a no CPR clause in the resident agreement, and I collapsed and was not given CPR, it would be either a legal or moral issue. I'm there because I want to be, and I chose that facility because I didn't want CPR should I collapse. There may be many people who would choose to live in a facility with a policy like that, so I don't understand why one of the people quoted in the article was "appalled", and I don't understand why anyone working there would have a moral obligation to save a person who clearly indicates by agreeing to their no CPR policy that they don't want CPR.

 

[Freesia]

I remember once I was walking up a city street and a homeless man had collapsed and wasnt breathing. He was drunk so had likely drank too much. But there was a woman holding him and crying, she was a passerby who had discovered him and it was like she was in shock and couldnt do anything. So I got my cellphone out and called emergency services and they got there very quickly and put him in the ambulance. The workers said he would be ok, was just too drunk.

 

[Calliegirl]

Well, there's no legal obligation for anyone to even call 911 unless they have a special responsibility to the person. For instance, a passerby can walk right past someone collapsed on the sidewalk without incurring any legal liability.

When I was 15 and out shopping with a friend we saw this happen. There was an unconscious man with blood on his head laying in the parking lot. People were walking by and ignoring him which had us really confused as to why no one was helping him. We called 911 and the paramedics came out, examined him and took him to the hospital. That really bothered us that none of the adults were willing to help him.

 

[mlp]

I'm there because I want to be, and I chose that facility because I didn't want CPR should I collapse. There may be many people who would choose to live in a facility with a policy like that, so I don't understand why one of the people quoted in the article was "appalled", and I don't understand why anyone working there would have a moral obligation to save a person who clearly indicates by agreeing to their no CPR policy that they don't want CPR.

I think there's a big difference between not focusing on the fact that CPR might be an issue in the future and the assumption (a really huge assumption) that people chose the facility because they don't want CPR.

It's sort of like people who don't have a pet at the time leasing an apartment where pets aren't allowed - they generally lease in that location out of a combination of factors (liking the looks of the place, convenience of location, the rent is in their price range). It's seldom, if ever, an affirmative decision of "I don't want a pet, ever", witness the fact of how many people try to sneak pets later, or bemoan how much they want a pet, but their lease doesn't allow it.

And a DNR directive doesn't cost oodles to have prepared - one can be printed off the internet. Every elderly person I've accompanied to the hospital in the past decade or so has been asked whether they have one, and if they don't, whether they want one - hospitals have the forms handy. I would be very surprised if this facility doesn't have the forms available for residents, should they want one, and I'd be amazed if the nurse-daughter couldn't lay her hands on one in really short order, at no cost.

 

[mlp]

In this particular case, though, the family says that the woman did not want CPR or any other life prolonging treatment: http://www.chron.com/news/medical/a...denied-CPR-wanted-no-intervention-4326960.php

I'm still surprised she hadn't signed any kind of directive in that case. This is not an inexpensive facility, and if she had the money to live there, she certainly had the resources to get a directive.

 

[Pickle Juice]

I think there's a big difference between not focusing on the fact that CPR might be an issue in the future and the assumption (a really huge assumption) that people chose the facility because they don't want CPR.

It's sort of like people who don't have a pet at the time leasing an apartment where pets aren't allowed - they generally lease in that location out of a combination of factors (liking the looks of the place, convenience of location, the rent is in their price range). It's seldom, if ever, an affirmative decision of "I don't want a pet, ever", witness the fact of how many people try to sneak pets later, or bemoan how much they want a pet, but their lease doesn't allow it.

And a DNR directive doesn't cost oodles to have prepared - one can be printed off the internet. Every elderly person I've accompanied to the hospital in the past decade or so has been asked whether they have one, and if they don't, whether they want one - hospitals have the forms handy. I would be very surprised if this facility doesn't have the forms available for residents, should they want one, and I'd be amazed if the nurse-daughter couldn't lay her hands on one in really short order, at no cost.

I don't see it as a huge assumption if, as the person who was interviewed stated, people are informed of this option before they sign up and agree to it when they accept. It wouldn't serve the facility financially to keep this from them or spring it on them after the fact without giving them the chance to change their arrangements or leave. I think the huge assumption was made by the newspaper for making a sensational article based on a lot of claims that weren't backed up with any evidence.

Unless we are to assume the people running the facility are blatant liars and con-artists, the people who are living there without the option for CPR are surely living there with full knowledge that CPR won't be given should they collapse. Now that the news has broken out I'd expect a huge outcry from the rest of the residents in a follow-up article if they are truly unaware of what they have signed up for. Though the lack of outcry from those residents who must have witnessed the event tells me they are probably fully cognizant of this policy, and in agreement with it.

 

[mlp]

Oh, I suspect that the facility is at this very moment doing a lot of damage control with the residents of its independent living apartments.

The press wouldn't have ready access to the rest of the residents, BTW - the facility as a whole is private property, and they have no obligation to let the press in.

I'm sure that the no medical services provided clause shows up in the paperwork - my point is that I doubt that most people focus on that, much less make a decision based on that. How many people actually thoroughly read the leases that they sign?

 

[Pickle Juice]

They wouldn't need to let the press in. The people who witnessed the woman's collapse, and the refusal to give CPR, are free to go to complain to the press if they wish. I would think that if they were there under the false assumption that CPR would be given they would have been as shocked and appalled as everyone else to find otherwise and would have created an uproar.

 

[mlp]

They wouldn't need to let the press in. The people who witnessed the woman's collapse, and the refusal to give CPR, are free to go to complain to the press if they wish. I would think that if they were there under the false assumption that CPR would be given they would have been as shocked and appalled as everyone else to find otherwise and would have created an uproar.

You don't know they haven't created an uproar - all you know is that they haven't gone to the press.

My firm used to represent a nonprofit that, among other ventures, owned and operated retirement communities much like this one throughout the country. I can tell you from experience that there were plenty of uproars, none of which entailed press coverage until/if lawsuits were filed. The initial reaction of people of a certain age is not to immediately go to the press.

 

[mlp]

The owner of the facility is now doing some backpedalling:

The home's parent company, Brookdale Senior Living, later said, "This incident resulted from a complete misunderstanding of our practice with regards to emergency medical care for our residents. Glenwood Gardens is conducting a full internal investigation." The company said the employee was on voluntary leave during the process.

Read more: [URL='http://www.sfgate.com/news/medical/article/Family-Woman-denied-CPR-wanted-no-intervention-4326960.php#ixzz2MjMIX7P0[/QUOTE']http://www.sfgate.com/news/medical/article/Family-Woman-denied-CPR-wanted-no-intervention-4326960.php#ixzz2MjMIX7P0[/URL]

And:

The nation's largest trade group for senior living facilities has called for its members to review policies that employees might interpret as edicts to not cooperate with emergency responders.
"It was a complete tragedy," said Maribeth Bersani, senior vice president of the Assisted Living Federation of America. "Our members are now looking at their policies to make sure they are clear. Whether they have one to initiate (CPR) or not, they should be responsive to what the 911 person tells them to do."


Read more: [URL='http://www.sfgate.com/news/medical/article/Family-Woman-denied-CPR-wanted-no-intervention-4326960.php#ixzz2MjMk68av[/QUOTE']http://www.sfgate.com/news/medical/article/Family-Woman-denied-CPR-wanted-no-intervention-4326960.php#ixzz2MjMk68av[/URL]

And:

The California Board of Registered Nursing is concerned that the woman who spoke to the 911 dispatcher did not respond to requests to provide aid or to find someone who might want to help.
"If she's not engaged in the practice of nursing, there's no obligation (to help)," agency spokesman Russ Heimerich said. "What complicates this further is the idea that she wouldn't hand the phone over either. So that's why we want to look into it."


Read more: http://www.sfgate.com/news/medical/article/Family-Woman-denied-CPR-wanted-no-intervention-4326960.php#ixzz2MjN1sry6