Elderly Woman Dies After Nurse Refuses To Give CPR

[Sarah in SC]

And just a quick plug not to forget the Heath Care Power of Attorney for your state of residence, which can have far more impact on your care and can be used to help guide your caregivers to the right decisions if you are not able to make them. The HCPOA is important to have, and you should have an alternate named in case your primary is not able to perform. I have chosen my DH as primary and a good friend who is a no-nonsense oncology RN with lots of experience as my alternate.

 

[HFWR]

You would think CBS and CNN would have their facts straight before reporting anything, clearly at least one does not (and I'm naive). Who knows...

 

[Meadbh]

If there had been clear communication from the get-go, this would never have been an issue.

 

[Midpack]

If there had been clear communication from the get-go, this would never have been an issue.

Do we know yet? FWIW "17 News contacted the family of Lorraine Bayless. Her daughter said she has no problem with the care her mother received at Glenwood Gardens."

 

[Brat]

Oregon has a document called a POLST (Physician Orders for Life-Sustaining Treatment) which the physician and the patient sign when the patient is seriously ill/at the end of life. When 911 is called and EMT's dispatched this document is on their computers, hospital computers and a copy should be filed with nursing home/care givers. This is above and beyond a health care directive, it is in force even if the persons with the power of attorney for health care are unavailable and it cannot be usurped by others.

The document was the result of an elderly lady who did not want resuscitation being put in intensive care when the persons who could invoke the health care directive were out of the country. The woman's heirs funded the development of the POLST.

 

[jclarksnakes]

If she had a DNR on file with the facility that would be one thing, but if she doesn't it seems as if the facility has a moral obligation to try to save her life by administering CPR. I'll bet the facility policy is based on liability issues. Seems stupid though.

IMO the moral obligation is to not perform CPR on someone in their 80s.

 

[antmary]

At the other end of the DNR process - passing over: I believe that there needs to be a "birthing to the other side" procedure. Our culture is sorely lacking in some instances (nursing homes) in easing e.g. panic on the part of the patient as he/she goes. At least, I think it is a conversation that would be welcome by many patients and families.

When Mom (at 89 years old) was in the hospital at the end of her life (she had COPD, and had trouble breathing) I made sure that the nurses followed her doctors orders. She was to be given a shot of morphine every few hours so she would not panic at not being able to catch her breath. Thus, her passing was relatively 'stress-free' for all of us.

If I were in the process of dying, I would certainly appreciate a smoother ride than having to white-knuckle dying.

If there is a DNR order, it seems to me that nursing homes can at least give the patients a shot of appropriate medication to ease the transition.

 

[Brat]

My maternal Grandmother preferred Jack Daniels.

 

[obgyn65]

I may have missed something, but why assuming that there may have been no clear communication from the get-go? The only question IMO is : were protocols and policies followed ?

If there had been clear communication from the get-go, this would never have been an issue.

 

[obgyn65]

Good point. Had the RN not followed protocols, had performed CPR and had broken one of the patient's ribs, she could have been sued because she did not follow protocols. At the very least, she could have been reported to her Board and some people could have claimed she abused the patient. Sad.

Interestingly, USA Today this morning says that it seems that all residents have been informed of the non-CPR policy and have agreed to it when they moved in.

I recently completed a CPR certification course. We practiced performing CPR on specially-equipped dummies that light up to show you whether the compressions are done correctly (hard enough). Most of us were pretty surprised at how hard we had to work (using both hands) to get it right. We were told that 80% of adults will suffer from broken ribs if the CPR is performed correctly.

 

[audreyh1]

If there had been clear communication from the get-go, this would never have been an issue.

Sounds to me like the media has the miscommunication issue. Big surprise that! (NOT!)

 

[Meadbh]

I may have missed something, but why assuming that there may have been no clear communication from the get-go? The only question IMO is : were protocols and policies followed ?

It appears that the patient and her family had communicated their wishes with the staff of the home. But why did the nurse dial 911 if the resident had a DNR? Did she not know, or was it CYA? And having made the call, why did the nurse not make it clear to the dispatcher that the patient had a DNR? Why did the dispatcher not ask? Clearly they had different mental models of the situation and were not communicating. Finally, who took it upon him/herself to share this with the media, under the misapprehension that CPR was the right thing to do? Too much communication again.

The best that could come out of this is improved public and professional awareness of the importance of documenting ones wishes and understanding what that means you won't do when there is a DNR.

 

[Tigger]

IMO the moral obligation is to not perform CPR on someone in their 80s.

Some people in their 80s are very happy to be alive.

My mother nearly died of a cardiac problem around that age, but was saved by surgery and is now leading a happy life, taking care of her granddaughters very often, etc. And I'm very glad she's still around.

I'll be turning 45 soon and can't imagine that I would ever want a DNR order, UNLESS my quality of life would become particularly bad. You can't deduce from someone's age that that person doesn't want to be alive as much as you anymore.

In much of the developed world people are living longer than in the past and staying healthy longer. And with medical progress that will hopefully improve even more in the future. I certainly hope people taking care of me in my old age won't assume I'm cool with dying and will do everything they can to keep me alive until I decide I myself that I want to die.

 

[donheff]

The incident has fired up a lot of discussion about death issues. As I speak, the Diane Rehm show is discussing a proposed Montana law that would put docs in jail for 10 years for helping old folks off themselves. I saw some talking heads yesterday who breached the subject of excessive spending in the last days of old folks lives. I hope the talk leads to more improvments (as I see them) like the compassion in death laws in Oregon and Vermont.

If the 911 agent had succeeded in intimidating the aide into letting a visitor give CPR the probable outcome if the CPR worked would be that the old lady would have burned up $250K or so lingering a few months longer in a hospital with broken ribs and a broken spirit. For the religious among us who always call for hands off, it strikes me that CPR in such a case is an attempt to stay God's hand.

 

[REWahoo]

For the religious among us who always call for hands off, it strikes me that CPR in such a case is an attempt to stay God's hand.

I agree it is a difficult question - but to your quoted point, couldn't you say the same thing with regard to vaccines, antibiotics, or chemotherapy? Where do you draw the line?

 

[donheff]

I agree it is a difficult question - but to your quoted point, couldn't you say the same thing with regard to vaccines, antibiotics, or chemotherapy? Where do you draw the line?

You are right. Not an easy question. I don't draw the line. I'm just pointing out another way to look at it. A few religions take the position that we should never intervene (vaccines, CPR, surgery, whatever). But the more common religious argument I hear raised is that life should be extended in all cases (e.g. Terru Schiavo). It just strikes me that they push intervention beyond what their theologies would really counsel if they studied them deeply. By the way, I would not push my views on any old folks who desire intervention in all cases (and a fair number exist). I just think the default ought not be to engage in heroic efforts. That should be something people are given an opportunity to elect in end of life directives rather than the reverse as is the case today. Yeah, I know -- easier said than rationally done.

 

[JoeWras]

It appears that the patient and her family had communicated their wishes with the staff of the home. But why did the nurse dial 911 if the resident had a DNR? Did she not know, or was it CYA? And having made the call, why did the nurse not make it clear to the dispatcher that the patient had a DNR? Why did the dispatcher not ask?

We don't have enough info to answer all these questions.

I've been reading this with great interest, since my dad is in independent living in a different facility by the same company. I've read his documents and can't find any "no CPR" policy in writing to the residents.

However, they make it clear that when in independent living, you are essentially an apartment dweller. This is not a licensed nursing facility. They do provide extra services by licensed contracted groups, but that is more of a one-on-one contract if you sign up for it. Perhaps this nurse was in the area attending someone else and came by to help or ran into the situation.

So what if you fall on your sidewalk at your apartment complex. What does someone do? Call 911. Similarly, they call 911 in these facilities for all emergencies. They don't call a "code blue" over the intercom and have every nurse within reach come running. That's not how it works. I don't know who called 911. Maybe the front desk. Maybe the lady pulled the panic cord. Not enough information.

With litigation these days, I can actually understand the policy they have for independent living. This is being portrayed as some heartless act. After all, on TV, Dr. House saves everyone. Surely, in a senior residence they should know how to save everyone, no? (I say that sarcastically.)

We need to get a handle on end of life issues. My dad has a DNR. Yet that doesn't mean we don't want him to have any medical treatment. He had life-saving surgery last year for something that had a good degree of success. He recovered. But if he were to have a heart attack at near 90? I don't think so. He's OK with it. My siblings and I are OK with it. He should not get CPR. Please give him comfort first. We've all already gone through the mourning process of where he's at. We're just happy he's with us right now and savor every moment. I know that at any time I could get "that call" ...

 

[Midpack]

YMMV

It appears that the patient and her family had communicated their wishes with the staff of the home. But why did the nurse dial 911 if the resident had a DNR? Did she not know, or was it CYA?

From post #18...

The executive director of Glenwood Gardens, Jeffrey Toomer, defended the nurse's actions in a statement, saying she did indeed follow policy.

"In the event of a health emergency at this independent living community our practice is to immediately call emergency medical personnel for assistance and to wait with the individual needing attention until such personnel arrives," Toomer said in a written statement. "That is the protocol we followed."

Toomer offered condolences to the woman's family and said a "thorough internal review" of the incident would be conducted.

He told KGET-TV that residents of the home's independent living community are informed of the policy and agree to it when they move in. He said the policy does not apply at the adjacent assisted living and skilled nursing facilities.

And having made the call, why did the nurse not make it clear to the dispatcher that the patient had a DNR? Why did the dispatcher not ask? Clearly they had different mental models of the situation and were not communicating. Finally, who took it upon him/herself to share this with the media, under the misapprehension that CPR was the right thing to do? Too much communication again.

The best that could come out of this is improved public and professional awareness of the importance of documenting ones wishes and understanding what that means you won't do when there is a DNR.

Right or wrong, my take on it based on the recording, they were both doing their jobs (very professionally IMO), with cross-purposes. I don't fault either one at all...someone doesn't have to be at fault every time something bad happens.

 

[JoeWras]

Midpack: good info, and pretty much our understanding. This is one reason that the assisted living is in a different wing.

We're all OK with this policy. As mentioned, what dad would want is "comfort" in an emergency. Having someone be there with him while waiting is really all we ask at this stage of life. And hopefully, they can pass along his DNR wishes.

Which reminds me. We were supposed to put something in his freezer (a standard location) which has the paperwork. I'm not sure we did that or not. Time to call the siblings and find out.

 

[Texas Proud]

It appears that the patient and her family had communicated their wishes with the staff of the home. But why did the nurse dial 911 if the resident had a DNR? Did she not know, or was it CYA? And having made the call, why did the nurse not make it clear to the dispatcher that the patient had a DNR? Why did the dispatcher not ask? Clearly they had different mental models of the situation and were not communicating. Finally, who took it upon him/herself to share this with the media, under the misapprehension that CPR was the right thing to do? Too much communication again.

The best that could come out of this is improved public and professional awareness of the importance of documenting ones wishes and understanding what that means you won't do when there is a DNR.

+1 on this...

It was what I was going to write... if there was a DNR, then no call should have been made at all...


I would want to know if there were other medical problems or not... she seemed to be in the independant living section and not the SNF that I heard reported early on... if she was in the SNF, I would have thought they would have done CPR unless a DNR order was there...

 

[JoeWras]

It was what I was going to write... if there was a DNR, then no call should have been made at all...

Not enough information. Perhaps she called 911. Perhaps a neighbor. Perhaps she called the front desk or hit the panic and said, "I'm having trouble breathing." In that case, they'll call 911.

They are not going do a medical evaluation and make a call on DNR. Doesn't work that way in independent living. They leave that up to the EMS. So, yeah, you are right. If this was SNF, it would be a whole different story.

The fact that it was a nurse who encountered the lady is the confusion. They send someone to look after a panic situation, but that could just as easily be someone completely unskilled in medical treatment (for independent living).

 

[JOHNNIE36]

I've read so much and heard so much about this situation that I'm not sure what to think. One thing that caught my ear is that CPR is not considered resusitation. It's not a "violation" of DNR. I also heard that if you perform CPR on someone and something happens like breakiing a rib or similar harm, that you cannot be sued for harming that person. It was also stated that is the case in "most" states. Well what is the truth? This begs for further discussion, disclosure and facts printed for the world to see. I'm confused.

 

[Midpack]

It was what I was going to write... if there was a DNR, then no call should have been made at all...

Except that would violate the published agreement they have with all their residents and presumably their families...

 

[easysurfer]

IMO, the situation in the independent facility was more clear cut than other situations. With both the 911 dispatcher and facility nurse doing their jobs. If either of them did things differently, they could lose their jobs. Plus, even though there was not a DNR, the daughter's view sounds like that was her opinion.

That said, I think that how a nurse is trained to handle things in a hospital vs a nurse from an independent living facility or nursing home is different. I might be wrong, but I wouldn't imagine at a hospital setting, if someone who didn't have a DNR needed a code blue, that they wouldn't try.

 

[Midpack]

I've read so much and heard so much about this situation that I'm not sure what to think. I also heard that if you perform CPR on someone and something happens like breakiing a rib or similar harm, that you cannot be sued for harming that person. It was also stated that is the case in "most" states. Well what is the truth? This begs for further discussion, disclosure and facts printed for the world to see. I'm confused.

No one can stop you from bringing a lawsuit against you, but if you Google/Bing you'll find:

Good Samaritan laws protect people who "gratuitously and in good faith" give CPR or use an AED. There has never been a successful lawsuit in the United States against a person providing first aid/CPR in good faith.

Q. Can I be sued for providing CPR or First Aid?

A. You are protected by the Good Samaritan Law as long as you do what a normal prudent person would do in an emergency situation. This means: Don't go weird and try to perform invasive procedures, such as cutting open the throat and sticking in a straw to help someone breathe or doing compressions over the throat. Unfortunately you can be sued, but not successfully, as long as you only do what is within your scope of training.

Remember, if some one is not in your care, you must ask permission of the responsive victim if you can help. If they are unresponsive, you have implied consent.

CPR Rescuers, the National Safety and Health Institute (ASHI), the National Safety Council, the American Heart Association and the American Red Cross will all stand behind you if you follow these guidelines.