Saturday, April 15, 2017

The patients were saved. That’s why the families are suing.

What happened to Beatrice Weisman before dawn on Aug. 29, 2013, was not supposed to happen: The medical staff at Maryland General Hospital found her in cardiac arrest, resuscitated her and kept her alive.

The matriarch of a close-knit family on Maryland’s Eastern Shore, Ms. Weisman, then 83, had suffered a serious stroke in June and had spent weeks in two hospitals.

Fortunately, she and her husband had drafted advance directives; she named her husband, William, to make medical decisions if she became unable to.

In August, as her condition deteriorated, Mr. Weisman convened a wrenching family meeting at their Easton home. With the support of their four children, he authorized Medical Orders for Life-Sustaining Treatment, known as a Molst form, stating that if his wife’s heart or lungs failed, she should be allowed to die.

Yet when Ms. Weisman was discovered turning blue in her bed, staff members began to perform CPR, which caused broken ribs and collapsed lungs. They defibrillated her with electric shocks, injected epinephrine and succeeded in reviving her.

“My father was distraught,” said Christian Weisman, the couple’s eldest child.

He said his parents “had done everything the way they were supposed to — the wills, the advance directives, the Molst.” But when hospital personnel found their patient dying, “they still violated her wishes.”

Mr. Weisman has brought suit against Maryland General for its treatment of his mother, alleging assault, negligence, the “intentional infliction of emotional distress” and other claims…
Historically, the practice has been “if in doubt, err on the side of aggressive, life-sustaining treatment,” said Thaddeus Pope, who directs the Health Law Institute at Mitchell Hamline School of Law in St. Paul, Minn.

After all, resuscitated patients in intensive care can later be disconnected from ventilators, he pointed out, but “you can’t reverse death.” Courts have seemed unreceptive to what might be labeled wrongful-life cases.

Dr. Pope sees that changing, however, and has compiled several recent examples in the latest Journal of Clinical Ethics[See comment below].

“Courts increasingly accept that unwanted life is also a harm,” he said. “Families were showing up at plaintiffs’ attorneys offices in the past and getting turned away. Now, plaintiffs’ attorneys are taking these cases.”…

In Georgia, Jacqueline Alicea is suing both Doctors Hospital of Augusta and the surgeon who ordered her grandmother, Bucilla Stephenson, 91, placed on a ventilator in 2012. That contravened Ms. Alicea’s verbal instructions as her designated health care agent and Ms. Stephenson’s advance directive declining such life-prolonging procedures.

“It might as well have been in the garbage can, for all the good it did Ms. Stephenson,” said Harry Revell, Ms. Alicea’s lawyer. “They ignored and trampled the patient’s rights.”

A statement from Doctors Hospital expressed sympathy for the family but said “the care provided was appropriate and in the best interest of the patient.”

While Ms. Alicea was ready to let nature take its course, she initially hesitated to tell doctors to disconnect the machinery that was keeping her grandmother alive. After a week, however, she authorized removal from the ventilator and comfort care; her grandmother died three days later.
Ms. Alicea’s lawsuit, scheduled for a June trial, seeks approximately $200,000 in hospital and physician charges (which were largely paid by Medicare), plus punitive damages and lawyers’ fees.

A decision in the case last July by the Supreme Court of Georgia, however, may already have consequences for other plaintiffs. The justices denied the defendants’ immunity claims, saying pointedly “it is the will of the patient or her designated agent, and not the will of the health care provider, that controls.”…

Court clashes over advance directives hardly represent settled law. In these recent cases, “nobody’s gotten a check yet,” Dr. Pope noted.

And when cases get settled, as typically happens, the terms often remain confidential, so nobody knows the size of the check…

In Maryland, the Weisman case has a trial date in November. “I don’t want to suggest there’s evil afoot” by Maryland General, said the Weismans’ lawyer, Robert Schulte. “Her Molst form was right on the top of her chart. They just didn’t bother to look.”

William Weisman died about a year after his wife’s discharge, so their son, Christian, filed the lawsuit. It seeks $250,000 in hospital charges, plus the roughly $180,000 annual cost of her care from her resuscitation to her eventual death. The suit also insists that the hospital improve its procedures and training for D.N.R. orders.

A hospital spokeswoman said in an email that the staff members who resuscitated Ms. Weisman didn’t intentionally disregard her D.N.R. and that Maryland’s highest court has held that being granted life is not an injury.

She also noted that “Ms. Weisman has made a remarkable recovery.”

That’s true — thanks to intensive physical therapy and round-the-clock home care, all paid for out of pocket. Formerly an active bowler and bridge player, Ms. Weisman left Maryland General in November 2013, bedbound and relying on a feeding tube and catheters.
Now 86, she lives at home in Easton with revolving shifts of caregivers, eats meals, recognizes family members and is taken to church on Sundays. But dementia makes her confused and afraid, her son said.

“I’m happy to see my mother each day, but I’m also seeing her suffer each day,” Mr. Weisman said. “She asks why she’s still here. That’s a difficult thing to answer.”

Courtesy of Doximity

1 comment:

  1. Thaddeus Mason Pope, Legal Briefing: New Penalties for Ignoring Advance Directives and Do-Not-Resuscitate Orders. The Journal of Clinical Ethics 28, no. 1 (Spring 2017): 74-81.

    Patients in the United States have been subject to an ever-growing “avalanche” of unwanted medical treatment. This is economically, ethically, and legally wrong. As one advocacy campaign puts it: “Patients should receive the medical treatments they want. Nothing less. Nothing more.” First, unwanted medical treatment constitutes waste (and often fraud or abuse) of scarce healthcare resources. Second, it is a serious violation of patients’ autonomy and self-determination. Third, but for a few rare exceptions, administering unwanted medical treatment contravenes settled legal rules and principles. This “Legal Briefing” describes a central and growing role for the law. Specifically, courts and agencies have increasingly imposed penalties on healthcare providers who deliberately or negligently disregard advance directives and DNR (do-not-resuscitate) orders. I group these legal developments into the following five categories:
    1. Five Types of Unwanted Medical Treatment
    2. State and Federal Duties to Follow Advance Directives
    3. Doctors Hospital of Augusta v. Alicea
    4. Other Lawsuits for Ignoring Advance Directives
    5. Administrative Penalties for Ignoring Advance Directives