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
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.RICHARD LAM / PNG
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.