Let's all say it together now: Death panels.

Cousin Dave says "Death Panels".

Teh Won says: "bending the cost curve down".

QEffin'D

I don't what is worse: that they let that poor woman die, or that her family is not outraged by this. What a sad tale and we will be hearing more of these stories in the near future.

No, I didn't follow the link. What else do we know about this woman and her family?

Was it time for her to die? Was she living in severe pain? Was she still sane? Could she still pursue interests, conversations and relationships?

Remember Christopher Hitchens? He's dead now. But when he was still alive, he said something really great: "This ends badly."

It proved true in his case, and it will probably prove true in your and mine. We have to be careful before firing off judgments about places like an "assisted living home, Glenwood Gardens."

Are we certain there wasn't a DNR on file for this person? Was she planning on going to the prom this summer with her old High School boyfriend to dance the Charleston?

Are we even certain the family isn't merely silent during consultation with attorneys?

Someday I too will follow links to emotionally manipulative news videos. But not yet, Dear Lord, not yet.

The most confusing part is in the last 20 seconds. The woman who died had a daughter who is a nurse, and the daughter is fine with the care her mother received?
Did she get some big inheritance?

I understand the facility warning residents that they don't employ nurses, and staff may not be trained, but if a nurse was there, don't nurses have similar rules as doctors, that whole "do no harm" thing?
I don't know the law specifically, especially in CA, but when I was trained as a lifeguard in MN, I was told that if I was on site during an incident, since I was trained, it was illegal for me to refuse to perform CPR on someone.

I also can't get over how devoid of emotion the woman who called sounds. The operator is panicked and worried, as any reasonable person would be, and the caller is just robotic in saying, no, I won't save this woman's life.

OK, power-scanned the blog post.

Friends, 87 is NOT a spring chicken.

you put a loved one in a assisted living place THAT SPECIFICALLY DOESN'T DO CPR.

For a REASON. That is an explicit Do NOT Resuscitate.

I have it in my will and so does my Mom.

A very good frined of mine had a hospital ignore her mom's explicit , legal DNR TWICE, and her mom was dying from lung cancer... all because a DIFFERENT family member, with no legal standing, didn't agree with the DNR.

Not only did it prolong the mom's agony, it made the daughter's agony worse.

Oh, and guess who got stuck with the BILL.

The daughter will be paying for that fiasco for years.

Do NOT pretend that there is always a reason to save someone, becasue sometimes it doesn't do anything but bring sorrow for everyone.

Also, this is a blog post about a blog post about a newspaper story about a report from a UHF television station in a smallish-market over the weekend.

I've worked in UHF television stations in smallish markets on weekends. I directed the evening news for years.

I recommend we not get too cranked about this.

My grandmother has a DNR order pegged directly above her bed, just in case and one she carries on her person at all times.

She's almost 90 and she is ready to go to see "grandpa" when the time comes.

Just sayin.

Of course, now the LAT wants a bite of the sandwich.

Seekers, please.... This is not a "No Humanity" policy problem.

Wrong Link. I feel bad about the error.

... I'd also not want to be present in the room if by some chance grandmother "came to" after someone had deliberately not followed her DNR orders... She would not be kind.

There was a blanket DNR policy at the facility. Period. It's actually not uncommon. If you move in there, you and your family know it up front and are okay with it. 911 call is to cover their asses legally. This is just in the press because it's shocking without all of the pertinent info. If they performed CPR on her, the legal repercussions would be very very bad. I'm seeing this now at one of the facilities where I visit patients. A new facility RN did not know that one of the residents was a DNR. Resident coded in the commons area, the RN performed CPR on her. Now, if you're gonna do CPR right, you're definitely gonna break some ribs. So 89 years old, three broken ribs, one punctured lung, she died in horrifying pain three days later. Family devastated by her suffering. Facility will most certainly be sued, absolutely fined by the state, and the RN will probably be disciplined or even lose her license.

Not everybody wants to live/die slowly wasting away. I'm only 41 and I'm already a DNR. So are >90% of MD's. Ever wonder why? Go to these homes sometime.

> Go to these homes sometime.

Thanks much for that comment, Juliana.

Is it somewhere in the links that the woman had a DNR, or that a DNR was implicit in choosing the home? I didn't go through all the links, but the video made it sound as though it wasn't an implicit DNR, just that there weren't nurses on staff, and the normal staff wouldn't be required to perform CPR as part of their employment.

As far as everyone's points about DNR, yes, if the woman had a DNR, that should be respected. The video made it sound as though she did not, and should have been resuscitated if possible.

Swiss & Feeb too.

I have a senior woman in my life, and she's tiny and brittle and beloved. I think about these scenarios a LOT.

A very good frined of mine had a hospital ignore her mom's explicit , legal DNR TWICE, and her mom was dying from lung cancer... all because a DIFFERENT family member, with no legal standing, didn't agree with the DNR.

Not only did it prolong the mom's agony, it made the daughter's agony worse.

This possible scenario scares the hell out of my husband. My mother-in-law was just released from a medical living facility where she did rehab after her open heart surgery. She's home now and fine (relatively speaking) but the hospital and facility was aware there was a DNR for her so if she's arrested on the table, or in rehab, they would not have performed CPR, either. But, there is one family member in particular who likes to butt in and had she been there if it happened, I can imagine this exact scenario.

I gotta side with the mercy killers here. My Mom has been in an Alzheimer's coma for over three years, and truly the costs are staggering. She was a wonderful Mom and a treasure of a woman, but this is not humanity. I wouldn't let my dogs go through this.

PS- I imagine the care home has legal reasons that are well thought out in advance.

Sorry, but doesn't DNR mean not using extraordinary means to keep somebody alive over time -- as opposed to doing CPR on them when they pass out?

"No CPR" is generally a default setting of a DNR, as far as I understand. CPR can be considered "extraordinary" means, as it is quite invasive and brutal, especially if the person is frail to begin with.

This woman's daughter has confirmed that her mom did NOT have a DNR, which makes this situation all a bit more complicated.

I think the sad part is the lack of understanding of how rules can and should be bent during an emergency. I understand the policy that in general staff should not try to treat a resident and should call 911. That is a seperate issue of following emergency responders instruction once they have been informed.

My money's with the people who want to kill, kill, kill... OK?

Because I believe very strongly in "No Humanity Policies."

And I think you should, too.

I think most DNR's are pretty specific as to what kind of procedures or protocall should be followed, aren't they? My MIL was very specific about her treatment, or lackthereof.

However, that there wasn't one, according to this report, does gray it up a bit. I have to wonder if the family was aware of the facilities policy. If so, then there really isn't anything they can do. Or, was this one of those situations where the employee felt that they were damned if they do, and damned if they don't. Follow procedure and lose her job, or don't follow procedure and risk getting sued. Tough call. It's the coldness in her voice that gets me. I wonder if she's been down this road before and is just numb to it at this point. So many unanswered questions...

Sorry.. I meant, her choices were: follow procedure or lose her job or don't follow procedure and risk getting sued.

I imagine it is a policy because of legal issues.

When I took a First Aid class in college (Yes it was a long time ago) the instructor noted we should consult with our lawyer as to when we should provide aid -- there are times when you may not want to. There was little legal protection for a private citizen providing first aid. CPR was one of the big ones to avoid. I did talk to lawyer friend and he confirmed what they said. There was no legal requirement for you to provide aid - well basically all you have to say is that you though you would likely do more harm than good.

To qualify for the legal protection, if sued you had to show you had a legal First Aid trained card or some other way and that the person would have most likely died before a firefighter/police/medic unit could have arrived.

I imagine that has changed over the years, but I was shocked.

Heart massage is about chest compression. If the bones are going to break, professional skill will not help.

Seekers, 87 year old women often die.

Balko once made a joke.

So...

Bayless' daughter told KGET that she was a nurse and was satisfied with her mother's care at Glenwood Gardens, the station reported.

So it is now a crime to not be hysterical when an 87 year old woman dies?

My mother is 87 and the last thing she wants is someone breaking her ribs so she can spend a few days or weeks in pain before she finally expires. DNRs exist for a reason, to prevent this kind of lawyer driven idiocy.

Live shots all over local news here. The "No Humanity" crowd is being roundly stoked...

The homes in and of themselves can actually be quite lovely, especially the ones that successfully cover the smell of urine. Makes the younger generations feel less guilty about putting them there. The residents often are despairing of their very existence. They all have the diagnosis of terminal waiting. It's a very rare lady or gentleman who goes about daily with an upbeat demeanor and a gleam in their eye. They know full well how they've declined, no matter how interesting the social coordinator tries to make their days. Many of them are on antidepressants.

Crid, you're 100% spot on about chest compression. It will typically kill the geriatric patient, especially with osteoporosis. Very ugly, especially when there's an audience that loves the patient and shares three squares a day plus mah jongg every Tuesday.

Oh, and guess who got stuck with the BILL.

The daughter will be paying for that fiasco for years.

The daughter aught to sue the family member and the hospital.

At that age (87), if you find me after I've checked out, go out get some lunch, wash the car, take in a movie, THEN call 911. I'll be fine, I promise!

Freakshow at the ending, freakshow at the beginning.

Twas ever thus.

http://www.cnn.com/2013/03/04/health/surrogacy-kelley-legal-battle/index.html?hpt=hp_c1

According to CNN:

"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."

DNR status is something I hold very close to my heart. I'm 33, and I'm what's called a modified code. For me, there are certain cases where I would want CPR, and others where I would not. My family knows my wishes and I also have a living will stating them.

As an RN, I've had some heartbreaking cases where an older patient, before losing mental faculties, has made themselves DNR, and then had their family come in, freak out, and override the patient's wishes. It has made me sick to my stomach to code these people, but I have to follow what the family says. Like someone else said, if my family did that to me, I would make sure to haunt them for decades. I've also had cases where the patient was 90+ years old and still full code of their own choosing. I will gladly perform compressions as long as needed on these patients and respect their wishes.

My hospital has wonderful palliative care providers who explain very well what the choices of code status are and don't pressure patients one way or another, but I don't know what it's like everywhere. We have recently started a policy where if a patient meets certain criteria, based on age, prognosis, and other factors, that will trigger a consult with someone from palliative care just to discuss code status and get the code status in order. By default at my facility, if we don't have an order otherwise, everyone is full code.

I don't know exactly what happened in this case, but it seems weird to me that, barring a DNR status, a company would prohibit someone trained in CPR from doing it as a blanket policy. I'm certain that it is to limit liability, but if that's the case, why even hire people who are certified at all? At least then, you'd have a better excuse for not performing CPR if the case warranted.

While obviously more important in older/sicker patients, if you take anything from reading this article, please, at the very minimum, make your wishes known to your family members. I'm so glad that my father had made his decisions before he died and didn't leave my mother and I to decide what should be done. I've done my best to keep my loved ones out of that position if something were to happen to me.

To answer Amy's question about code status, at least in my state, you're full code, which means we do everything we can to keep you alive, unless otherwise stated. You can be modified code, which can be specified as to what you want done. The most common I've seen was "CPR but no intubation." I've seen modified codes that range from that to "no CPR, no intubation, but use all emergency cardiac medications," or in the case of a patient with some pretty severe but potentially reversible lung issues, "intubate, but no CPR." Lastly, there's DNR/DNI, which means no CPR, no intubation, all we'll do is comfort measures, like pain medications or turning up the O2 levels.

"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."

When people die, those around them get weird. Lawyers media are weird anyway.

An 87-year-old woman died and it's not in my heart to be too spooked.

There isn't a "'No Humanity' Policy" at work in the care of American elders.

There isn't a "'No Humanity' Policy" at work in the care of American elders. --Crid

I absolutely agree. I've read a few different articles about this from different sources, and it seems like there's a lot more to this case than we know at this point, and some inconsistencies in what's being reported. That's all I meant to point out by posting that comment. I'm with you--87 years is more than most, and I'm not too spooked about it either.

I mean, that's a weird comment to give to CNN in a time like this. She's up to something.

> if my family did that to me, I would make
> sure to haunt them for decades.

A long time ago I told my niece that no matter what happened I was going to show up in her dreams on the night before the services to kiss her on the forehead and thank her for doing the right thing. I figger it's more likely to happen if she anticipates it for a few decades.


> I'm only 41 and I'm already a DNR. So are >90% of MD's.

Not to pester you with a morbid topic, but 41 is young indeed. You obviously have some hard-won clarity for this stuff. Care to share any more?

> Ever wonder why? Go to these homes sometime.

I cared for a loved one for a couple of years as dementia blossomed. The quiet in that house was what got me in the habit of picking fights on this blog at the computer a few years ago. And having that experience in retrospect renewed my enthusiasm for wine, eggs and a few social risks that I'd thought best to avoid in earlier times. Getting old and frail is NOT what this is about, even if you have the money.

And regarding that, Holy Fuck…

Eric (above) isn't kidding.

My job has me working with software to support nursing homes.

The general breakout for nursing homes:

• Alzheimer units
• Hospice units
• Recovery units (post-surgery for aged/loners)
• Nursing home (long term care for the aged)
• Assisted Living (very grand hotels)
• Independent Living (some assistance depending on needs.)

The Alzheimer and Hospice units are generally all DNR.
The recovery units are generally try to resuscitate.
Nursing home are generally DNR, but it is not strict.

The Assisted Living (AL) and Independent Living (IL) are usually not a DNR situation. Many of the residents are there because of a tie to another resident that is further along.

That a facility declares the staff can't give CPR to a resident in the AL/IL area just is not acceptable to me. AL/IL means that the resident is generally has coherent thought and generally decent health. Giving CPR should be acceptable. For that matter that it happened in the dining room, she could have been dying from choking and and the Heimlich maneuver might have been the answer.

I just can't find it acceptable.

It's starting to get all Schiavo in here.

It's starting to get all Schiavo in here. -- Crid [CridComment at gmail] at March 4, 2013 8:05 PM

No it isn't. You are trying to equate permanent vegetative state/coma with someone sitting in a restaurant and falls out of a chair unexpectedly.

No, I'm comparing the last time we spent years arguing about the value of the last moments of life with the next time we'll spend years arguing about the value of the last moments of life.

No, I'm comparing the last time we spent years arguing about the value of the last moments of life with the next time we'll spend years arguing about the value of the last moments of life. -- Crid [CridComment at Gmail] at March 4, 2013 8:42 PM

I can only hope you fall out of a chair at a restaurant. I hope no one does shit for you.

I am with Crid.

Healthy people do not just fall out of a chair, and stop breathing.

The Heimlich maneuver would kill or seriously injure most Octogenarians.

There is a lot of magical thinking going on here. I suspect people watch too many medical TV shows where CPR works. It usually doesn't. It is a brutal dangerous procedure that is done only as a last resort, and then, only by professionals. It is not for people who have merely passed out.
Contrary to popular belief, when your heart and your breathing stops, it is almost always because something has gone seriously wrong in your brain, your heart or your lungs. In short you are dead or dying, and CPR will do almost nothing to fix a major malfunction. CPR has been pushed for political reasons. Makes people feel empowered, and keeps passengers on a plane with a heart attack victim secure in their delusion that the guy is actually "still alive"

> I can only hope you fall out of a chair
> at a restaurant.

Harsh! Have you ever disagreed with someone before? You seem new to it.

I begin this day resolved never to fall out of a chair again. It's not like I was ever worried about falling out of chairs, but you're being a tremendous ninny, and it'll be fun to break your ninny heart.



> There is a lot of magical thinking
> going on here.

It happens with guns, too. There are people who think guns are evil... But when the time comes to use one, they think the average policeman on the beat should be able to shoot the gun from the bank robber's hand, bloodlessly, with a sidearm, from two blocks away into the sun and through a crosswind, neatly missing the three dozen mentally retarded (but photogenic) schoolgirls who closely surround the bad guy as he makes his way to his escape car. Because they saw Don Johnson do that once on TV, and Don Johnson looks great.

Any other outcome is police brutality.

I exaggerate, but only a little. When this went down in LA a few years ago, I was appalled that a casual friend, a man with a child of his own, had expected so much more of the police.

Friend, sometimes bad things happen. Policy is not the problem.

"No Humanity" policies especially are not the problem.

Also, the three dozen mentally retarded (but photogenic) schoolgirls are all virgins.

I meant Matlock! Or that girl from Seinfeld, she's great with handguns.

Jim. I think you are taking this a bit to personal. Not all cases are the same. Seeing as none of us were actually there, none of us really know what the woman's health was, and the reports we are getting are inconsistant (Imagine that...inconsistant reporting on the news! *GASP*), all we have is speculation. And, I speculate that the home had the policy for a reason, and the family had to be aware of it. I cannot believe otherwise. Does the call send a chill up my spine? Just a bit. I am very sensitive to vocal tone and her coolness does bother me but not necassarily because I disagree with her actions. Like I said before, she has probably been down that road many times before, considering her occupation and she's numbed herself to it.
The fact that the woman was in the facility to begin with already provides evidence that she was not in the condition to care for herself. She's 87. Her death is not exactly shocking and now, she's not also suffering from a broken rib cage thus adding to her decline. Morbid as it sounds, I'd be willing to bet that she'd express gratitude for being allowed to move on if she was alive to speak for herself.

Jim:

That a facility declares the staff can't give CPR to a resident in the AL/IL area just is not acceptable to me.

Hope you like caring for your frail relatives.

Cause there's a lot of facilities with exactly those rules, for a lot of reasons, but most importantly, without them, they'll go out of business with lawsuits.

So, declare it's not acceptable to do that, and guess what you'll find? Less coverage and less homes with any support structure. (Then we'll decry how greedy those CEOs are.)

CPR on an 87 year old woman? Nah, I can't say that's normal, that's going to break a lot of ribs, and if they were up front with their policy, I can't see a problem here.

Giving CPR should be acceptable.

And it was, just not from that facility, from all reports. Any one of the EMS people could have shattered her ribs in a likely futile effort to gain her a bit of time.

Just because someone is a 911 dispatcher, does not make them an expert on police matters, profiling, or medicine. (Or kidnapping, per a Halle Berry movie promo I saw the other night.)

Halle's Berries.

"...keeps passengers on a plane with a heart attack victim secure in their delusion that the guy is actually 'still alive'"

There's a saying in the airline industry that "no one ever dies on a plane", meaning that airline crews do not ever decide that a person onboard is dead. If the onboard AED is unsuccessful, they may decide that the unfortunate needs "rest". There are several reasons for that, pax uncomfortableness being one. But the more important reason is that a zillion complications come into play if you declare the person dead: exactly what state's or nation's airspace was the plane in at the moment of death? Which laws apply and which political entity has jurisdiction? Much simpler to keep the person "alive" until the plane lands, and then let the authorities on the ground handle it.

> There's a saying in the airline industry that
> "no one ever dies on a plane"

Rainier was 'sustained' on life support so as not to be distracting attention from the death of Jean Paul II.

See, Gog_Magog_Carpet_Reclaimers, this is why IFV should not be allowed and eugenics supported

At this hour, the longest backdate I've heard on Chavez' death is December 20.