Monday, October 17, 2016

4 Comments Sort by Top Add a comment... Also post on Facebook Post Julie Ali · University of Alberta The lack of interest of all concerned in the medical system with reference to do not resuscitate orders is clear to me. The system is designed to ensure that patients who have a poor prognosis in the eyes of medical professionals are not treated and die prematurely. In this case, the doctor backed down from his unilateral decision when family objected but it was too late for the patient. In my severely handicapped sister’s case at the Grey Nuns Hospital in Edmonton, Alberta, repeated orders to do not resuscitate (DNR), do not intubate and no ICU were placed on her file in the belief that she was a non-compliant patient with a poor outcome who would cost the system money. In Alberta, apparently if the doctor decides, he can prematurely terminate a patient based on his beliefs rather than appropriate medical investigation and review. In my handicapped sister’s case, no one did the required respiratory investigation to determine what the problems were. I did the investigation that the entire medical profession in Alberta did not do which was a year long review of her respiratory care at the Good Samaritan Extended Care at Millwoods. I found out that professional staff failed to turn on her BIPAP machine on two occasions. The failure to turn on her BIPAP machine resulted in adverse events that required hospital transfer with associated do not resuscitate orders being emphasized. These abuses were confirmed by the Protection for Persons in Care Office at Alberta Health. In the case of trying to overturn the do not resuscitate orders, three health ministers were contacted--Mr. Horne, Mr. Mandel and Ms. Hoffman. None of them did anything to help the family. They all passed the buck to Alberta Health Services (AHS). Nothing has been done about the matter of premature termination of severely handicapped patients lacking insight in my opinion. You can be prematurely terminated even when these patients like my sister have a personal directive indicating full resuscitation. This raises the question of why even bother to have legal documents specifying your wishes if doctors can decide to withhold life saving measures at any time? What this means for every family is that they need to confirm that are no orders for premature termination on file. Families can find out what the medical staff have ordered on an ongoing basis by requesting medical information continously. They need to challenge these orders before it is too late. They need to go to court if necessary to protect their handicapped and frail family members who cannot advocate for themselves. They need to go public because this is an issue that needs review in the public arena. It is not right that the rationale for this type of decision is that there is no benefit for the patient or that there are costs for the system. Why is it that the society can repeatedly resuscitate citizens who overdose on drugs but with handicapped citizens or seniors there is no such similar consideration? Why did my family have to fight it out for three years with Alberta Health Service, Covenant Health and Alberta Health to protect and affirm the rights of a severely handicapped woman in Alberta? Why are some citizens seen as disposable in this way despite their disabilities and inability to advocate for themselves? If doctors can terminate in this fashion why is it that we even need the legislation for doctor assisted death? And why is it that Alberta Health and the health authority in Alberta are more interested in protecting the rights of doctors to decide death in these cases, than the rights of citizens to choose life over death? Handicapped citizens and seniors have rights that are being ignored because it is economically beneficial for the system to do this. In addition, there seems to be discrimination involved. There is an entrenched perception that some citizens have less worth than others. In my opinion, the system is biased against handicapped citizens and seniors and without strong advocates such citizens are at risk. Seniors are at risk simply because they are seen as having lived their lives and so, no extraordinary efforts are made to keep them alive. Why all concerned have such a mysterious belief that extreme age and sickness means no CPR is beyond me. You can still have a certain quality of life that is worth living even while you are very sick. I mean folks with cancer are not denied life saving treatment so why deny folks CPR when they are in acute situations? Handicapped citizens are at risk at any point in their lives with the medical system as it is. The best way for families to handle these DNR situations is to go public and ask for the help of national organizations such as the Not Dead Yet disability rights group. http://notdeadyet.org/ Typically the health authority and the government will be of no help to the families in these situations and only public exposure of these problems will result in change. Like · Reply · Just now



Woman says dad died after resuscitation order she didn't approve

KIM PEMBERTON(Vancouver Sun)
Published: October 15, 2016
Updated: October 16, 2016 8:48 PM
Filed Under:
The Province > Health > Local Health
Lori Wang, the only child of 84-year-old Zaixing Wang, poses for a photo with a picture of her dad who died last year in Richmond, BC, October, 12, 2016.
Lori Wang, the only child of 84-year-old Zaixing Wang, poses for a photo with a picture of her dad who died last year in Richmond, BC, October, 12, 2016.RICHARD LAM / PNG
101316-PNG1012N-resuscitation_order-02-230769548-PNG1012N-resuscitation_order-02-W.jpg
Lori Wang said she wasn't consulted by a doctor at Richmond General Hospital before a Do Not Resuscitate order was written on her 84-year-old father's medical chart. When he went into cardiac arrest in front of her, nurses refused to revive him, she said.RICHARD LAM / VANCOUVER SUN
Lori Wang will never forget the image of her 84-year-old father gasping and choking on his own blood while in cardiac arrest, and her desperate attempts to get staff at Richmond General Hospital to help him.
But she said nurses refused to do cardiopulmonary resuscitation on Zaixing Wang because a doctor had written a Do Not Resuscitate order on his medical chart after assessing him in the emergency department on Sept. 21, 2015.
“The blood was pouring out of his mouth and I pressed the red button, but no one came so I ran into the corridor shouting for help. This is when I learned they wouldn’t resuscitate him. The nurses were just wiping his blood away,” she said.
“He choked on his own blood from the lungs, when resuscitation needs to be conducted immediately without delay. And yet, standing by his bed watching him gasping for air and turning blue, the nurses refused, even at my repeated and desperate request, to lay a finger to help him.
“Instead, the assigned attending nurse spent those critical few minutes debating with me why my dad would ‘not make it,’ that he was a ‘no code,’ and asked me to contact my mom to deliver the bad news.
“I simply could not fathom how this could happen in the hospital when medical professionals were in arm’s reach.”
After pleading with the nurses to help save her father, Dr. Edgar Lau, the internist and respirologist who had placed the Do Not Resuscitate order on Zaixing Wang’s medical chart, was called.
Wang said her father was revived with CPR around 10 minutes after he went into cardiac arrested. However, he never regained consciousness and died on Sept. 29.
Lau would later tell two review panels looking into the case that he had explained his treatment plan to the family, which would have included putting a DNR order on Wang’s chart in the event of “acute cardiopulmonary deterioration,” given his “poor pulmonary reserve.”
In the recently completed reviews, both the College of Physicians and Surgeons and Vancouver Coastal Health Authority’s Patient Care Quality Office accepted Lau’s statement that the doctor had that conversation with the family.
But Wang said the doctor never told the family a Do Not Resuscitate order was being placed on her father’s medical chart, and “now it’s his word against mine.”
According to the review by the College of Physicians and Surgeons, the signature of the patient or substitute decision maker is optional for a DNR form.
Coastal Health spokeswoman Anna Marie D’Angelo said a physician doesn’t require a family’s consent for a Do Not Resuscitate order for someone who is very ill with complex conditions.
“They need to discuss it with the family, certainly, but it’s not a consent decision,” said D’Angelo. “If you don’t agree (to having a Do Not Resuscitate order), there’s a dispute process to get a second opinion.
“The focus is always the care and comfort of the patient, what treatments can be tolerated by a severely ill person with complex medical challenges, and whether a treatment will be beneficial. This information, including the patient’s and family’s responses, are documented in a patient’s chart. It is generally accepted in Canadian health care that medical doctors need not offer interventions that they do not consider will benefit a patient.”
Wang said her father’s diagnosis of bronchiectasis — a condition that leads to gradual deterioration of the lungs — was chronic but it wasn’t terminal.
“I feel they can basically sign someone’s life away,” she said. “The family needs to give clear, informed consent. I didn’t sign anything and my dad didn’t sign anything. Why would we even take him to hospital if it wasn’t to seek treatment?
“For any other tests my father needed I had to sign, but for something as serious as a DNR I didn’t have to sign. If this is truly the hospital’s policy not to require a family member’s signature on a DNR order, it’s really flawed.”
Wang said her father was admitted around 10:30 a.m. to Richmond Hospital after coughing up blood. His respiratory arrest happened after he had been transferred to a hospital ward around 5 p.m. and just an hour previously a nurse had seen him well enough to go to the washroom unassisted.
Wang questions why Lau failed to meet the family that day to directly spell out the full range of medical options and prognosis for recovery, which she felt would have been high if he was given CPR immediately in the event of a cardiac arrest.
She said the DNR order was made when she had left her father’s bedside to retrieve personal items for him. At that point, she said, she received a phone call from Lau, but she said the conversation was about his condition only, with no mention of a DNR order.
Lau’s statement to the College of Physicians and Surgeons conflicts with Wang’s recollection.
“Dr. Lau noted it would have been better to speak with Ms. Wang in person, but another important consideration is being able to reach a decision (on whether to place a DNR order) relatively early in the hospital course, before an emergency occurs. Dr. Lau noted he believes he had explained the process over the telephone to Ms. Wang in adequate detail, in plain words. Dr. Lau believed that Ms. Wang understood the indications of the order, although this appears to be incorrect,” according to the College’s review.
Wang said the DNR order was reversed after Lau was called during her father’s cardiac arrest and she told him directly she wanted her father to be saved. But by that time about 10 minutes had passed without any medical intervention for her father, she said.
Lau then initiated a “code blue” and supervised staff who administered CPR. Wang said although her father was revived, he suffered brain damage and died eight days later.
“It just feels my dad died when he could have been saved. He had been hospitalized before after coughing up blood and there was never a DNR on his chart, ever,” Wang said.
The College of Physicians and Surgeons review noted Lau “acted quickly and appropriately by telephoning his primary contact person, Ms. Wang, to discuss level of intervention and to complete the MOST (Medical Orders for Scope of Treatment — no CPR) form. The (review) Committee commented that the timing was reasonable, and commended Dr. Lau for initiating the conversation early in the patient’s hospitalization. The Committee accepted the statement of Dr. Lau: that he had no reason to doubt that Ms. Wang understood their discussion.”
Coastal Health’s Patient Care Quality Office review stated: “It is believed the decision to contact next of kin was appropriate and that a no code status was an appropriate decision based on the medical condition of your father.”
However, the review panel for Coastal Health did add that while the nurse was following the physician’s order, it was “inappropriate for engaging in a debate … during this time.”
Wang also filed a complaint with the College of Registered Nurses of B.C. regarding the nurses’ actions that day, but has not yet received a response.




4 Comments
Sort by
Add a comment...
Julie Ali ·
The lack of interest of all concerned in the medical system with reference to do not resuscitate orders is clear to me.

The system is designed to ensure that patients who have a poor prognosis in the eyes of medical professionals are not treated and die prematurely.

In this case, the doctor backed down from his unilateral decision when family objected but it was too late for the patient.

In my severely handicapped sister’s case at the Grey Nuns Hospital in Edmonton, Alberta, repeated orders to do not resuscitate (DNR), do not intubate and no ICU were placed on her file in the belief that she was a non-compliant patient with a poor outcome who would cost the system money. In Alberta, apparently if the doctor decides, he can prematurely terminate a patient based on his beliefs rather than appropriate medical investigation and review.

In my handicapped sister’s case, no one did the required respiratory investigation to determine what the problems were. I did the investigation that the entire medical profession in Alberta did not do which was a year long review of her respiratory care at the Good Samaritan Extended Care at Millwoods.

I found out that professional staff failed to turn on her BIPAP machine on two occasions. The failure to turn on her BIPAP machine resulted in adverse events that required hospital transfer with associated do not resuscitate orders being emphasized. These abuses were confirmed by the Protection for Persons in Care Office at Alberta Health.

In the case of trying to overturn the do not resuscitate orders, three health ministers were contacted--Mr. Horne, Mr. Mandel and Ms. Hoffman. None of them did anything to help the family. They all passed the buck to Alberta Health Services (AHS). Nothing has been done about the matter of premature termination of severely handicapped patients lacking insight in my opinion. You can be prematurely terminated even when these patients like my sister have a personal directive indicating full resuscitation. This raises the question of why even bother to have legal documents specifying your wishes if doctors can decide to withhold life saving measures at any time?

What this means for every family is that they need to confirm that are no orders for premature termination on file. Families can find out what the medical staff have ordered on an ongoing basis by requesting medical information continously. They need to challenge these orders before it is too late. They need to go to court if necessary to protect their handicapped and frail family members who cannot advocate for themselves. They need to go public because this is an issue that needs review in the public arena.

It is not right that the rationale for this type of decision is that there is no benefit for the patient or that there are costs for the system.

Why is it that the society can repeatedly resuscitate citizens who overdose on drugs but with handicapped citizens or seniors there is no such similar consideration?

Why did my family have to fight it out for three years with Alberta Health Service, Covenant Health and Alberta Health to protect and affirm the rights of a severely handicapped woman in Alberta? Why are some citizens seen as disposable in this way despite their disabilities and inability to advocate for themselves?

If doctors can terminate in this fashion why is it that we even need the legislation for doctor assisted death? And why is it that Alberta Health and the health authority in Alberta are more interested in protecting the rights of doctors to decide death in these cases, than the rights of citizens to choose life over death?

Handicapped citizens and seniors have rights that are being ignored because it is economically beneficial for the system to do this. In addition, there seems to be discrimination involved. There is an entrenched perception that some citizens have less worth than others. In my opinion, the system is biased against handicapped citizens and seniors and without strong advocates such citizens are at risk.

Seniors are at risk simply because they are seen as having lived their lives and so, no extraordinary efforts are made to keep them alive. Why all concerned have such a mysterious belief that extreme age and sickness means no CPR is beyond me. You can still have a certain quality of life that is worth living even while you are very sick. I mean folks with cancer are not denied life saving treatment so why deny folks CPR when they are in acute situations?

Handicapped citizens are at risk at any point in their lives with the medical system as it is. The best way for families to handle these DNR situations is to go public and ask for the help of national organizations such as the Not Dead Yet disability rights group. http://notdeadyet.org/ Typically the health authority and the government will be of no help to the families in these situations and only public exposure of these problems will result in change.
LikeReplyJust now
Vanessa Leigh
If a patient is not a candidate for CPR due to their health conditions the doctors and medical staff are doing a disservice to the patient by allowing the family to demand CPR. There is a big misconception that CPR is for everyone but this is not true, survival rates are very low even with the best trained staff and equipment immediately accessible. We should be providing appropriate symptom management and care to maintain comfort as best as possible for those not suitable for CPR. Being a DNR does not mean we do nothing. Based on the above description CPR would not have saved this man even if...See More
LikeReply23 hrs
Sunny Quinn ·
This man should have been given the chance at life. Considering a DNR was not discussed with the family, this dr should be sued. I have had enough experience with hospitals etc to know that this Dr is clearly lying. Why would this woman make this story up?? she just wanted her father saved, just be cause someone has the word Dr in front of their name doe not give them the right to choose life or death for someone. I'm sure if her father was resuscitated and kept alive by machines, she would obviously decide then and there. Typical of the College of Physicians and Surgeons to stand behind one of their own based on lies. I'm disgusted. I've heard nothing by negative feedback about Richmond General Hospital and now i know I would never step foot in there. This poor family needs support and not judgement.
LikeReply13 hrs
Joe Petrucci
I agree the doctor should be sued in this case. So should the college of physicians and surgeons who license him. Doctors have a routine of using willful ignorance to protect themselves from liability. They intentionally keep themselves unaware of the facts that would render themselves liable.
LikeReply1 hr
Terry Gillmore ·
Still need to allow a person to die with dignity and no pain. Our medical system has no bedside manners!
LikeReply14 hrs

No comments:

Post a Comment