Elderly Woman Dies After Nurse Refuses to Give Her CPR

[P_Instructor]

Per california law this type of facility was under no obligation to provide any level of medical care if I heard the story right. They dont even have to help you take an aspirin. This facility is an assisted living facility which helps with activities of daily living and emergency care is not in the purveyance of their care regimen.

And pinstructor if your family member acknowledged that no cpr would be given when you became a resident then NO you would not own the franchise.

And let us not lose sight of the fact that the family does not seem to have an issue with this...........yet. Since the mrdia got a hold of this story there might be dollar signs popping up on the horizon.

I quess I still haven't seen the fact that a document was signed for no CPR. Many are assuming. If so called document was signed, and P&P's were followed, so be it. I am not in tune with Cali-law, so probably am way off base here. Agree again that there is way to much info that needs to be brought out here.

Secondary thought.....if there were 'no code' documents, what did the paramedic crews do with the patient? We know they transported to the hospital. What were their protocol concerning this? Did they ALS or BLS the patient? Just wondering to get better insight.

[WolfmanHarris]

I'm finding this story difficult to comment on in a way that's relevant to this case. The differences between retirement homes and nursing homes here vs California and DNR's here vs there may make that impossible. So I'll keep my input more general:

Ethically I take issue with a facility making a general policy to exclude CPR on all residents and to make residents agree to that, especially if this is common practice (which it sounds like it might be). Regardless of our stance on the futility of resuscitation for a patient that elderly, the decision to withhold resuscitation should be the patient's and not a product of corporate policy. While it could be argued that the patient has the right to seek residence elsewhere, if this practice is common than the reality is their consent is not freely obtained.

If I'm understanding some of what's been said correctly, in California you cannot obtain a DNR without a terminal illness? Here any patient can have a DNR, we even have a Ministry of Health and Ontario Association of Fire Chiefs approved confirmation form that is supposed to make honoring a patient's wishes by first responders even easier. Anyone can obtain one and it can be signed by an MD or RN. Patient's right to informed consent should extend to preemptively stating which resuscitative efforts they do not want.

[Just Plain Ruff]

Needless to say, we did not put our Aunt in a facility that would not begin lifesaving treatment on her. If she coded we wanted them to at least do something.

These facilities were in the jurisdiction where I would be the responding medic and I wanted the facility to know that I was not pleased with their policy but they said it went all the way to their corporate offices.

I also told them that there would be times that both our ambulances would be out on calls and the normal 2-3 minute response times would be extended to upwards of 20 and 30 minutes and that fell on deaf ears.

When people asked me at the ER where I worked what nursing home I recommended in town I never gave a thumbs up or down but I did let them know that there were some facilities in town that would not do CPR on their family member. Made sure that people knew this.

So let's not ask for this nurses or facilities head.

How many of you are truly 100% willing to give up your livelihood to go against policy and lose your job with EMT or medic jobs being so hard to come by? Are you really willing to have to take unemployment to break a policy?

I'm not sure that I would be if jobs were very very scarce or if like in California nurses are a dime a dozen and you can't spit without hitting a nurse or someone who would gladly take your place.

[triemal04]

I quess I still haven't seen the fact that a document was signed for no CPR. Many are assuming. If so called document was signed, and P&P's were followed, so be it. I am not in tune with Cali-law, so probably am way off base here. Agree again that there is way to much info that needs to be brought out here.

Secondary thought.....if there were 'no code' documents, what did the paramedic crews do with the patient? We know they transported to the hospital. What were their protocol concerning this? Did they ALS or BLS the patient? Just wondering to get better insight.

There doesn't have to be. (I'm only guessing, but I don't think that California law is that screwy yet). While I'd very much like to know as it would clear up pretty much everything, just because a DNR or advance directives were not there does not automatically mean the nurse was obligated to render emergency care. The ethics and morals can be argued all day long (and allready are by the douches in the media it would seem) but legally speaking I highly doubt there was a requirement. This is one of those cases where you have to seperate your personal values from what is actually legally correct, and what in fact may have been in the best interests of the patient.

If the fire department has any sense we won't know. While this may blow over, it also has the potential to be a PR nightmare, and if they're smart they won't give out anymore than a basic, generic statement, and only then if pressed. But, depending on what documents may/may not have been there and what was actually wrong with the patient (it's not 100% clear that she was actually in cardiac arrest at the time of the call) they very well may have done nothing.

[ChaseZ]

The ICN Code

• According to the ICN, a nurse’s

  primary responsibility is to patients, and she should treat them with

  respect for their rights, values, customs and beliefs. Personal

  information she learns about them should remain confidential. In addition,

  she should continue her learning because she is personally responsible and

  accountable for good nursing practice and she should take care of her own health so it doesn’t interfere with

  her ability to care for others. She should co-operate with her co-workers

  but, if a patient’s health or safety is threatened by others, she must

  take action to protect them.

The ANA Code

• Like the ICN, the American

  Nurses Association believes that a nurse’s first commitment is to her

  patient, and she should have compassion and respect for every individual

  no matter who they are, what kind of health problems they have, or what

  social and economic background they come from. A nurse also has a duty to

  establish, maintain, and improve health care environments and conditions of employment so that high quality

  health care can be provided. She should work to improve health

  care locally, nationally, and internationally, and she should also work

  through her professional associations to influence social policy

  concerning health care. Finally, she has a duty to maintain her own

  competence and to grow personally and professionally.

Types of Ethical Issues

• Registered nurses responding to

  a 2006 survey reported 21 different ethical issues they faced while caring

  for their patients. These issues included the use of restraints, pain

  management, determining best interest of the patient, organ

  donation, life-sustaining treatment and end of life care, reporting

  errors, dealing with impaired nurses, conflicts of interest, justice for

  people with disabilities, the ethics of research and the use of

  information technology and confidentiality.

Nurse Dissatisfaction

• In a study investigating the

  relationship between ethics and the intent of nurses and social workers to

  leave their profession, researcher Connie Ulrich, Ph.D., RN discovered

  that 25 percent of practicing nurses and social workers wanted to leave

  the field. More than 52 percent of those who responded said they were

  frustrated with the ethical issues they faced. Hospital workers reported

  more ethical stress than caregivers

  who worked in other settings. Nearly 40 percent of hospital workers

  reported they had no organizational resources to help them with their

  ethical concerns, while another 25 percent said they had never received

  any ethical training.

Quoting statements from the ICN and ANA means absolutely nothing. They are both professional organizations that do not represent all nurses nor do they prove any type of legal or ethical obligation aside from their members. As stated earlier many people identify themselves as nurses who are not RNs or even LPNs.

I personally would not throw away my job or my career for one patient, call me heartless.

It sounds like the nurse said "they don't want her resuscitated" meaning the family. I have encountered this a lot where the family will not make the patient a DNR because they are afraid it will lead to inadequate care or neglect but they do not actually want their family member resuscitated. It is a bad situation but it happens.

It also does not sound like the patient was ever in full arrest

Edited March 5, 2013 by ChaseZ

[BushyFromOz]

What i cant understand is that the family had knowingly placed their relative in a facility of any type who is presumably reasonably fit and a reasonable quality of life but knew should their family member drop thei bundle they would recieve no help? Where is the famlies morals in this?

The irony doesn;'t escape me that these people have paid money to an assisted living facility that provided no assistance for living... if she had have dropped dead i the street she would be better off. At least you can do that for free?

I would have thought that any health are facility would have had a legal obligation to provide basic first aid and care for any of their residents, and basic first aid includes CPR.

[ERDoc]

This isn't s healthcare facility, it's assisted living. They make it easier for elderly to live so that they can maintain their independence. Who said it was the family's decision? I would assume that this reasonable fit person made their own decision to enter the facility. If I'm 87 and I drop for whatever reason and one of you respond, promise me you will not do anything. If I am 87, I've lived a good life and would rather not have you beating on my frail, old fat ass. All I hope for is that my last though was of which nurse's ass I pinched last.

[BushyFromOz]

I don't know about the litigation. If they signed a form stating that CPR was not allowed, they knew the consequences. From what I have read, the family seems fine with what happened. It sounds like some dispatcher got her nose tweaked and wants to make a case out of it. The only ones that should have brought this to the media should have been the family.

Fair enough.... wouldn't want them as my family then, maybe there is a good inheritance involved

Assisted living facility or not. I cant understand how a health facility of any type can have policy of not providing basic first aid to its residents and it be "legal"

[ERDoc]

My mother worked at a nursing home and it was required that if you wanted to be a resident there you had to have a DNR. There were plenty of other facilities so it wasn't like they were being kept out of some place.

[triemal04]

Burn the witch! Burn the witch!

http://www.turnto23.com/news/local-news/911-call-regarding-a-senior-homes-refusal-to-give-cpr-spawns-legislature-concerns

While this adds a fair amount of info to the story, the utter idiocy contained in the first few paragraphs is scary. Scary...but not surprising. Hopefully it'll blow over in a few days like most sensationalized yet still unimportant news stories do.

But on a side note it does show yet again that the dispatcher was a fucking retard.