Woman Dies After Nurse Refuses to do CPR

[MNlady]

But if that is the case, why call 911? 911 is to ask for help for emergencies. Why not just call the doctor, family and mortuary? Why tie up emergency resources that may be needed elsewhere?

IMO, because most people don't know who to call, they just want someone to be there, and your first instinct is to call 911.

It's really frustrating to take care of someone at home who has a DNR and when bad things start to happen and you feel so helpless, hospital and doctor won't take your call because of the DNR. Because they can't help either. I took care of a friend with a DNR. The night he passed away, he was very restless. I was so very tired that I laid down in my room for a half hour to an hour (I was suppose to work the next day too-hospice would come) and he passed away while I was not with him. I called hospice who came to 'pronounce' and then called his brother who called funeral home. So frustrating for the caregiver, but I still wanted and have a DNR for myself. (Which states that IF I can't not be brought back to 'quality of life' to let me go.)

 

[HMSHood]

I don't fault the 911 dispatcher, she was doing her job. If this woman truly had a DNR, why was 911 called to begin with? It was useless and stressful for the dispatcher. What was the point???

That is what I am wondering too. Why waste the 911 dispatcher's time.

 

[Donjeta]

This person wasn't a nurse, despite what's been reported.

"The staffer was identified today as a resident services director, not a nurse as previously reported. The woman repeatedly rebuffed pleas from the 911 dispatcher during a seven minute call on Feb. 26 to give the woman CPR or to ask someone else to do it."
http://abcnews.go.com/Health/staff-refuse-cpr-elderly-woman-facility/story?id=18648941

Why does the caller say she's a nurse in the 911 call?
http://abcnews.go.com/Health/staff-refuse-cpr-elderly-woman-facility/story?id=18648941
(In the video)

I suppose she would likely have died anyway and if no CPR was what she wanted then it was perfectly fine but I'm not sure if the patient's desire to have no life prolonging measures was any kind of factor in the decision making here. Wouldn't the caller have told the 911 dispatcher (and the paramedics) that the patient had a DNR order instead of the argument if that was the reasoning behind the unwillingness?

 

[Donjeta]

IMO, because most people don't know who to call, they just want someone to be there, and your first instinct is to call 911.

It's really frustrating to take care of someone at home who has a DNR and when bad things start to happen and you feel so helpless, hospital and doctor won't take your call because of the DNR. Because they can't help either. I took care of a friend with a DNR. The night he passed away, he was very restless. I was so very tired that I laid down in my room for a half hour to an hour (I was suppose to work the next day too-hospice would come) and he passed away while I was not with him. I called hospice who came to 'pronounce' and then called his brother who called funeral home. So frustrating for the caregiver, but I still wanted and have a DNR for myself. (Which states that IF I can't not be brought back to 'quality of life' to let me go.)

It works if there is a known existing disease with a known prognosis but it would be a decision making nightmare in an unexpected emergency situation IMO. If you suddenly collapse and stop breathing how is anybody to know, without doing proper medical tests, whether it's something that will pass and can still leave you with a reasonable quality of life or a massive stroke or some such thing that will leave you seriously challenged in terms of QOL, and you would need resuscitation to keep you alive until the medical tests can be done.

 

[badhorsie]

Most people of 87 don't want CPR, at least in my experience. I have been a nurse for over 30 years. Where I work, we have about 60 residents and fewer than 5 wish to be
resuscitated. They have signed legal papers stating this in their charts. We are bound to honor their final request. The elderly are often tired. They are ready to go and speak easily of passing, without fear, and with a yearning for it in many cases. I would not feel good about doing CPR on a very elderly person, but if it is her wish, I certainly would. However, to allow them to die in their own bed, with staff that know and care about them, and adequate medication for anxiety and/or pain, is a wonderful way to end life. Last week we cared for just such a lady. Her husband had been a musician, and she in burlesque. We played soft jazz in her room, gave her lots of care, though she was largely unaware of us, helped her sons, and it was a blessing for all involved.

:goodpost:

 

[oh_gal]

It has been reported on my local news (Fox 8 Cleveland), that the nurse, or whatever she was, "misunderstood" the facility's rule regarding CPR.

No, I don't have a link to the story, because I heard it in passing, but I'm sure it was carried on other local stations.

Apparently, the "nurse" or whatever she was, is now on "voluntary" leave from her position while this is being investigated.

ETA: Here is a link to another news source carrying the story:
http://www.wsmv.com/story/21537423/death-at-ca-facility-after-no-cpr-has-some-reviewing-policies

 

[jjenny]

Why does the caller say she's a nurse in the 911 call?
http://abcnews.go.com/Health/staff-refuse-cpr-elderly-woman-facility/story?id=18648941
(In the video)

I suppose she would likely have died anyway and if no CPR was what she wanted then it was perfectly fine but I'm not sure if the patient's desire to have no life prolonging measures was any kind of factor in the decision making here. Wouldn't the caller have told the 911 dispatcher (and the paramedics) that the patient had a DNR order instead of the argument if that was the reasoning behind the unwillingness?

I have no idea why she said she was a nurse. Her position wasn't a nurse.
People who signed up for that facility appear to be aware of the policy. The one thing this facility should do better is to document the wishes of residents in writing.
The woman family says she was aware and that is what she wanted.
At least she was able to die naturally rather than attached to some machine. I don't think this 87 year old woman was going to come back after a massive stroke either way.

 

[jjenny]

"A thorough review was conducted of all the facts surrounding the case. The investigation revealed that no criminal statutes had been violated. As of Wednesday March 6, 2013, the Bakersfield Police Department has concluded its investigation and will not be filing any criminal charges against any of the individuals involved in the case.""

http://www.turnto23.com/news/local-news/bpd-nothing-criminal-in-glenwood-gardens-incident

 

[txsvicki]

What if the woman didn't have a massive stroke but heart attack and could have been revived? The lady refusing didn't know. Those kinds of apts. Won't let people live there if not getting around well. I'm trying to get my age 87 year old mom to go to one and she has nothing wrong with her except mild age related emphysema and her people lived really long lives up to 90's or 100. I know now to check because she would be furious to be allowed to die by some clerk or nuses aide. We would make the decision AFTER word by a medical doctor on what to do next. For myself, I plan to do nothing much if I get ill even in my fifties.

 

[LinasK]

Most people of 87 don't want CPR, at least in my experience. I have been a nurse for over 30 years. Where I work, we have about 60 residents and fewer than 5 wish to be
resuscitated. They have signed legal papers stating this in their charts. We are bound to honor their final request.

I strongly disagree! That may be your experience, it certaintly hasn't been mine! It's like the attitude of euthanizing them just because they are old. Age has nothing to do with health, mental health, attitude, or quality of life!!!

 

[rosesfromangels]

This incident has sparked a very important discussion about quality of life, the elderly, and our moral responsibilities as human beings. This type of dialogue is very important and good.

First, I don't know all the facts, but I will say this. If the woman wasn't in a "nursing home" but an assisted living residence, it would be alarming that she didn't receive CPR *unless* she specifically had a "DNR" order. This would be despite her age. Her age is meaningless in the discussion, at least to me.

On the other hand, if she were in a nursing home and terminally ill or aged and infirmed and had a "DNR" order, her wishes should prevail. As a young woman I worked in nursing homes to put myself through college, and those experiences changed my life forever. Lot's of life lessons learned there. I saw the best of humanity, and the worst of it. I saw elders who still had reasonable quality of life ignored to hasten their demise, and I saw family members keep suffering elders alive because they couldn't let go of them.

In this particular case, because the woman was in a residential setting and she did not have a DNR, I have to believe the nurse in question did not act with the best judgement. And that being said, it was the facilities policy *not* to resuscitate/perform CPR, and that was known to the elder and her family.

This incident will be remembered as the case that caused us to question our view of the elderly, their worth, and our moral conscience. While sad, it's an important debate to have. No easy answers.

 

[jjenny]

I strongly disagree! That may be your experience, it certaintly hasn't been mine! It's like the attitude of euthanizing them just because they are old. Age has nothing to do with health, mental health, attitude, or quality of life!!!

Not doing CPR does not equal euthanasia.
And if an elderly person does not want CPR, they shouldn't be subjected to it.

 

[oh_gal]

Not doing CPR does not equal euthanasia.
And if an elderly person does not want CPR, they shouldn't be subjected to it.

I don't think anyone is saying they should...and I also don't think LinasK was saying that. LinasK was responding to the comment from another poster that most elderly people just want to die, and don't want extraordinary means performed on them.

 

[Donjeta]

I think if an elderly person (or anybody else) does not want CPR they should have a signed DNR order.

Did the paramedics do CPR when the ambulance arrived?
The hospital staff at the emergency unit?

Even if the people who call 911 refuse to do CPR for one reason or another, it is not a guarantee that you'll die quickly enough not to end up dying in the hospital attached to tubes and machines.


What is it that the person really wants? No resuscitation for no reason whatsoever? Maybe CPR while waiting to find out what's wrong and what the prognosis is but no breathing tubes, no respirators? No life prolonging measures whatsoever, not even if rehabilitation could possibly help you and you could get back home after a while? Does it include antibiotics and feeding tubes, chemotherapy, other drugs etc.?

 

[LinasK]

Respectfully, that's your choice. For some folks, a natural death is better than living with some of the sequelae of CPR and resusitation. It's a personal decision, and it really needs to stay that way - whether to get heroic measures or to let someone die is a very personal decisions, and need to be respected as such (as hard as it is...).

Best-
Herding Cats

This incident has sparked a very important discussion about quality of life, the elderly, and our moral responsibilities as human beings. This type of dialogue is very important and good.

First, I don't know all the facts, but I will say this. If the woman wasn't in a "nursing home" but an assisted living residence, it would be alarming that she didn't receive CPR *unless* she specifically had a "DNR" order. This would be despite her age. Her age is meaningless in the discussion, at least to me.

On the other hand, if she were in a nursing home and terminally ill or aged and infirmed and had a "DNR" order, her wishes should prevail. As a young woman I worked in nursing homes to put myself through college, and those experiences changed my life forever. Lot's of life lessons learned there. I saw the best of humanity, and the worst of it. I saw elders who still had reasonable quality of life ignored to hasten their demise, and I saw family members keep suffering elders alive because they couldn't let go of them.

In this particular case, because the woman was in a residential setting and she did not have a DNR, I have to believe the nurse in question did not act with the best judgement. And that being said, it was the facilities policy *not* to resuscitate/perform CPR, and that was known to the elder and her family.

This incident will be remembered as the case that caused us to question our view of the elderly, their worth, and our moral conscience. While sad, it's an important debate to have. No easy answers.

I absolutely agree with the bolded above. Just as Herding Cats said we have to honor DNR wishes, it's just as personal and must be respected when someone 87 or over wants to be Full Code "Heroic Measures", although I wouldn't call being a full code heroic. It's not extraordinary to me.

 

[LinasK]

She had a dnr, she did the right and just thing, for this patient.

Ummm, no the patient did NOT have a DNR on file, only what her family said.

 

[Perodicticus potto]

Did anyone else catch the recent Radiolab episode on this topic? I highly recommend it. Among the points made were:

- The vast majority of people who receive CPR die or are permanently severely disabled. Only about 3% will recover to the point where they can lead a normal life.
- CPR can cause severe injury and pain to the recipient.
- In a long-term survey of doctors, 90% said they would not want CPR if they went into cardiac arrest.
- Nonetheless, there is a widespread public perception (aided by inaccurate portrayals in films and TV shows) that CPR is far more effective than it really is. So patients and relatives tend to insist on it, and hospitals comply so as not to seem negligent.

I find this case very interesting in light of the above information. Did the care home seem to be refusing to save a life? Obviously. Is that what they were actually doing? Debatable.

(P.S. I'm CPR trained myself and would perform it in an emergency. In the absence of other information, a 3% chance is better than no chance. But I don't work with elderly, sick or dying people, and don't have to think about these things as matters of policy.)

 

[jjenny]

This woman died from a massive stroke. I think it's a safe bet that the likelyhood of her recovering was close to 0, CPR or not.
And I have no reason whatsoever to doubt what her family says. They don't have any motive to lie. They were not involved in the decision on whether to carry out CPR or not.

 

[Donjeta]

This woman died from a massive stroke. I think it's a safe bet that the likelyhood of her recovering was close to 0, CPR or not.
And I have no reason whatsoever to doubt what her family says. They don't have any motive to lie. They were not involved in the decision on whether to carry out CPR or not.

Was any of that questioned?
I didn't see anyone saying that the family is lying about what her wishes were. Only that if your wish is to not to be resuscitated it is prudent to have it in writing.

 

[ohiogirl]

If my realtive was to enter a nursing home or assisted living facility, I would definitely make sure what they would and wouldn't do. The family is not disputing their relative's care. The only ones disputing it are those of us who read the media articles. Do we know more than the family? I highly doubt it. If not for the 911 recording that was released, no one would be questioning this.
It is good that this has created discussions regarding end of life care. Hopefully, all who are commenting are thinking long and hard about what they would want in this situation. It seems that the family is ok with what happened. We should honor that.
If it causes discussion in your own family regarding thsi issue, all the better, imo.