Elderly Woman Dies After Nurse Refuses to Give Her CPR

[chbare]

I'm not sure what is to be gained with the liberal use of pejorative statements about other people?

[Just Plain Ruff]

Ok, this story has made headlines in my city, KC MO area.

The local news went to the local nursing homes and retirement communities owned by the one in story and maybe this will put some light on this whole thing.

The policy of the locally owned facilities is that they are to call 911 and then it is up to the facility and it's staff members to do what they feel comfortable doing.

So my suspicion is that if that is the policy of the local facilities then that is the policy of the national headquarters. I bet that what will come out is that this particular nursing home's policy is that they do not want their staff doing CPR but as a overall policy for the company it's left to the local facility to make their own policy on just this scenario.

But as a side note, I'm really pissed at this nurse. She sounds so disconnected to the whole situation. She sounds like she just doesn't give a shit and she couldn't care less about the resident. She doesn't sound stressed, doesn't sound like any nursing home/retirement center's nurse that I've taken 911 calls from because she doesn't sound freaked out enough. I'm not pissed at her actions of not doing CPR but I'm pissed because she just sounds like she doesn't give a shit.

The actions of the dispatcher although in the arena of trying to save this ladies life were rude, condescending and you can't say she didn't try everything in her bag of tricks to get this nurse to do something.

But the dispatcher releasing the tape or the 911 center releasing the tape when the family members had not a single issue with the care their family member received is terrible and bad bad form. If I was the overseer of this 911 call center I'd be cracking heads.

Edited March 5, 2013 by Captain ToHellWithItAll

[MikeEMT]

I will probably get flamed for this, but oh well such is life. Anyway, I don't see why people are getting worked up. We all know how truthful the media is.

First of all let us understand that this was an Assisted Living Facility and NOT a Skilled Nursing Facility. The caller, according to statements by the company, was NOT a nurse but was in fact a manager. Assisted Living Facilities are not required to provide medical staff on site. An Assisted Living Facility is NOT the same a Skilled Nursing Facility. They're different laws and rules to abide by. Its a completely different licensing process.

Second, we have all responded to calls at these facilities. What is one thing that most of our patients have in common at these facilities? They almost always have Advanced DIrectives. I have yet to see anyone ask the facility if there was an advanced directive in effect. Media has not made any attempt to ask and the company hasn't been forthcoming which is to be expected since the facility would probably claim it falls under HIPAA.

I am in no way defending the facility or the 911 caller. However, keep in mind that there is more to be considered than what the media is saying. How many times have you read in the paper or seen on the news a story where you responded only to see they botched everything? I wasn't there, I don't know all the facts therefore I am not going to villify someone based solely on news reports.

[triemal04]

I'm not sure what is to be gained with the liberal use of pejorative statements about other people?

Well...the way this is being hyped and misunderstood is very annoying to me, and since I'm a very simple person...it makes me feel better.

That and the dispatcher does not come across as the best, or smartest person for that job.

But as a side note, I'm really pissed at this nurse. She sounds so disconnected to the whole situation. She sounds like she just doesn't give a shit and she couldn't care less about the resident. She doesn't sound stressed, doesn't sound like any nursing home/retirement center's nurse that I've taken 911 calls from because she doesn't sound freaked out enough. I'm not pissed at her actions of not doing CPR but I'm pissed because she just sounds like she doesn't give a shit.

I have to ask...so? One, just because someone doesn't sound upset and/or panicky does not mean that they aren't aware of the situation. Two, if this person was a nurse (or had some type of medical background) maybe they are used to people being dead around them; after 11 years I've gotta say that when I'm talking on the phone, radio or to other people in person about a routine event (and yes, an 87-year old dying is a routine event) I don't get worked up about it. Three, this is an 87-year old that was dead...as I said, it's pretty routine, and NORMAL for an 87-year old to die. Why get stressed about it?

[Just Plain Ruff]

What I was saying is that the caller didn't sound like any caller from a nursing home that I've ever taken a 911 call from. You do have a good point Triemal but she was just so detached, that's what I can't get past. But maybe she has made hundreds of these calls and she is an expert at it.

But I do have to disagree that an 87 dying is a routine event, sure it's a routine event all over the world but at that facility if it was a routine event to the point where this person was able to talk about it so calmly and detached, then they must have a lot of 87 year olds dying and a lot of vacancies opening up.

But I digress, her demeanor is what pissed me off, I'm not upset whatsoever that she didn't do CPR, nope not a dang bit upset.

As for MikeEmt, I've been saying all along that there is more to this story and that the media SUCKS big donkey balls and they report whatever the hell they want to report and don't really care who they hurt. The media has blown this way out of proportion and I'm actually sickened at the amount of coverage it has gotten when there are hundreds if not thousands of facilities with the same policy all over the country. I would bet if you called the nursing facilities in your catchment area you would get across the board differences in how they treat and respond to patients in cardiac arrest, I'll bet you that for every 10 facilities you call you will get 10 different answers.

I agree Mike and I've said it throughout, we do not have all the information and crucifying the nurse isn't productive in this.

[triemal04]

What I was saying is that the caller didn't sound like any caller from a nursing home that I've ever taken a 911 call from. You do have a good point Triemal but she was just so detached, that's what I can't get past. But maybe she has made hundreds of these calls and she is an expert at it.

But I do have to disagree that an 87 dying is a routine event, sure it's a routine event all over the world but at that facility if it was a routine event to the point where this person was able to talk about it so calmly and detached, then they must have a lot of 87 year olds dying and a lot of vacancies opening up.

But I digress, her demeanor is what pissed me off, I'm not upset whatsoever that she didn't do CPR, nope not a dang bit upset.

As for MikeEmt, I've been saying all along that there is more to this story and that the media SUCKS big donkey balls and they report whatever the hell they want to report and don't really care who they hurt. The media has blown this way out of proportion and I'm actually sickened at the amount of coverage it has gotten when there are hundreds if not thousands of facilities with the same policy all over the country. I would bet if you called the nursing facilities in your catchment area you would get across the board differences in how they treat and respond to patients in cardiac arrest, I'll bet you that for every 10 facilities you call you will get 10 different answers.

I agree Mike and I've said it throughout, we do not have all the information and crucifying the nurse isn't productive in this.

I see where you're coming from, I just disagree with it. Really, who's to say that she hasn't made hundreds of calls like that? Or worked in a branch of healthcare for long enough that she's been exposed to death enough that it isn't a big deal? Or that she is just very unemotional? Or who knows...maybe's she's just a sociopath and you're right. Either way, like I said earlier, this is a case, like so many others, where you have to lay aside emotion and personal beliefs for awhile.

Far as 87 being a routine age...I think I answered that above, but just in case... 87 is a normal age for someone to die at. If it is a facility, independant living or otherwise, that houses people who are in their 70-80's or older...they will have people dying on a regular basis...because it's normal. And as I said, the nurse/staff may have had a large amount of experience with it elsewhere.

Either way, I get where you are coming from, I just strongly disagree.

You've got a good point with the rest though; as far as the BS that independant living facilities/assisted living facilities/nursing homes/skilled nursing homes do, this is small potatoes. As in, it shouldn't even come up on the radar. The only good thing I can see coming from this is either the importance of having advance directives, awareness of, and acceptance that they are appropriate becomes mainstream, or the lay public actually starts becoming aware of the crap that happens in places like that.

[Just Plain Ruff]

I see where you're coming from, I just disagree with it. Really, who's to say that she hasn't made hundreds of calls like that? Or worked in a branch of healthcare for long enough that she's been exposed to death enough that it isn't a big deal? Or that she is just very unemotional? Or who knows...maybe's she's just a sociopath and you're right. Either way, like I said earlier, this is a case, like so many others, where you have to lay aside emotion and personal beliefs for awhile.

Far as 87 being a routine age...I think I answered that above, but just in case... 87 is a normal age for someone to die at. If it is a facility, independant living or otherwise, that houses people who are in their 70-80's or older...they will have people dying on a regular basis...because it's normal. And as I said, the nurse/staff may have had a large amount of experience with it elsewhere.

Either way, I get where you are coming from, I just strongly disagree.

You've got a good point with the rest though; as far as the BS that independant living facilities/assisted living facilities/nursing homes/skilled nursing homes do, this is small potatoes. As in, it shouldn't even come up on the radar. The only good thing I can see coming from this is either the importance of having advance directives, awareness of, and acceptance that they are appropriate becomes mainstream, or the lay public actually starts becoming aware of the crap that happens in places like that.

Actually I don't think we are really very far off in what we are trying to say. I do agree with you that she might have done this thousands of times before thus making her an expert but honestly I don't agree. Here's where I think we disagree and let me see if I can get it right. You think that she might be a pro at calling these things in. I see that and can understand that but she has no emotion in her voice and that's what got me. I mean there is no emotion in her voice that leads me to think that she cares about this lady. It's like she's an automaton and that's what's got me. I'm sure that she's was just doing her job which required her to make the phone call and deal with a very persistent and irritating dispatcher. I am NOT faulting her for doing her job, sticking to her guns on the no cpr policy. I've just not heard anyone on the phone like that with that level of tone in a very long time. The last time was a psych patient.

Again, I'm not faulting her, nor villifying her for doing her job, jsut the unemotional side of it. Does that make more sense?

[systemet]

So we have an 87 year old in an assisted living facility in cardiac arrest, probably as the end result of a chronic disease process, and likely with minimal physiological reserve. Likelihood of successful resuscitation = near zero. Likelihood of successful resuscitation with good neurological outcome = pretty much sitting in the middle of the circle that makes a zero.

The issue at hand here is whether the woman's wishes were met. It appears that there was no documentation signed that meets the legal requirements for a DNR / personal directive / advanced directive in this particular community. On the other hand, the family seems to be ok that the facility staff didn't begin resuscitation.

To me, as a paramedic, this seems like an appropriate medical decision given the likely futility of resuscitation. That being said, if this person wanted to be resuscitated, then there wishes must be followed. It would seem reasonable that living in an assisted facility, that states (presumably openly) that it won't provide CPR, would seem to suggest that its quite likely this person didn't want to be resuscitated.

Personally, I have a bit of venom for the facility itself, for putting its staff in this position without ensuring that the appropriate paperwork was in place. I have no love, as a first responder, for arriving to a cardiac arrest in an elderly patient with a bunch of family present saying "No, they wouldn't want to be resuscitated", without any valid documentation present. This usually ends up shifting the responsibility on to me to decide whether to start or not. For the record, if the family present seems unanimous in saying that the patient didn't want resuscitation, I will usually respect this. I realise that this places me in a position of legal risk, much like the staff member at this facility. I do sometimes diffuse this responsibility by calling and chatting with a physician. They're usually willing to provide some helpful guidance (and usually agree).

The general public doesn't understand the reality of advanced life support in an 87 year old who has come to the natural end of their life.

I don't blame the lady on the phone for not sounding panic. The sicker my patient is, the more clearly, slowly, and deliberately I speak. It's been my observation that many of us are like this. It doesn't mean that we don't care, just that we're controlling our emotions to prevent them from interfering with commmunication.

[ERDoc]

Ruff, I see where you are coming from. I hadn't had a chance to actually listen to the call (only read transcripts). She does sound detached but maybe she is just one of those people with a flat affect or an IQ south of 70. It also sounded like she was trying to keep quiet, like she didn't want others to overhear the conversation. Someone mentioned that we shouldn't crucify the nurse or anyone else in this case without all info and I agree but sometimes it is a good mental exercise to go through even without all of the facts. It gets us thinking and may help out one day if we find ourselves in a similar situation.

I think sysmet brings up a good point also (as usual). We have this Rescue 911-we-can-save-everyone mentality in the US. How would this go if it happened in Europe or one of the Asian cultures where death is respected and at times almost revered? I think it would have gone a lot differently.

[ERDoc]

So now I just read the following from the daughter:

"I never said I was fine with that," daughter Pamela Bayless told CNN Monday before hanging up the phone. "That was completely taken out of context, and I have no further comment." (http://www.cnn.com/2013/03/04/health/california-cpr-death/index.html?hpt=hp_t2)

Sounds like the lawyers started talking $$$ with the family.