California nurse refuses to give CPR to dying woman

California nurse refuses to give CPR to dying woman

A nurse's refusal to perform cardiopulmonary resuscitation on a dying 87-year-old woman in California despite desperate pleas on the telephone from an emergency dispatcher has prompted outrage and spawned a criminal investigation.

Loraine Bayless collapsed in the dining room of a retirement home in Bakersfield which state officials said was an independent living complex and did not need a licence.

The harrowing seven-minute, 16-second telephone call also raised concerns that policies at living facilities for elderly people could prevent staff from intervening in medical emergencies and prompted calls on Monday for legislation to prevent a repeat of what happened on 26 February.

During the call, an unidentified woman asked for paramedics to be sent to help Bayless. Later, a woman who identified herself as the nurse got on the phone and told dispatcher Tracey Halvorson she was not permitted to do CPR on Bayless.

Halvorson urged the nurse to start CPR, warning the consequences could be dire if no one tried to revive Bayless, who had been laid out on the floor on her instructions.

"I understand if your boss is telling you you can't do it," the dispatcher said. "But … as a human being … you know, is there anybody that's willing to help this lady and not let her die?"

"Not at this time," the nurse answered.

Halvorson assured the nurse that the home, Glenwood Gardens, could not be sued if anything went wrong in attempts to resuscitate the resident, saying the local emergency medical system "takes the liability for this call".

Later in the call, Halvorson asked: "Is there a gardener? Any staff, anyone who doesn't work for you? Anywhere? Can we flag someone down in the street and get them to help this lady? Can we flag a stranger down? I bet a stranger would help her.

"I understand if your facility is not willing to do that. Give the phone to a passerby. This woman is not breathing enough. She is going to die if we don't get this started, do you understand?"

The woman reportedly had no pulse and had stopped breathing by the time fire crews arrived.

Sergeant Jason Matson of the Bakersfield police department said its investigation had not revealed criminal wrongdoing, but inquiries were continuing.

State officials did not know on Monday whether the woman who talked to the emergency dispatcher was a nurse, or just identified herself as one during the call. She said one of the home's policies prevented her from doing CPR, according to an audio recording of the call.

"The consensus is if they are a nurse and if they are at work as a nurse, then they should be offering the appropriate medical care," said Russ Heimerich, spokesman for the California board of registered nursing, which licenses healthcare providers.

The executive director of Glenwood Gardens, Jeffrey Toomer, defended the nurse in a written statement, saying she had followed the facility's policy.

"In the event of a health emergency at this independent living community, our practice is to immediately call emergency medical personnel for assistance and to wait with the individual needing attention until such personnel arrives," Toomer said. "That is the protocol we followed."

Independent living facilities "should not have a policy that says you can stand there and watch somebody die", said Pat McGinnis, founder of California Advocates for Nursing Home Reform. "How a nurse can do that is beyond comprehension."

McGinnis added: "This was so horrifying. I've never seen this happen before."

http://www.guardian.co.uk/world/2013/mar/05/california-nurse-cpr-dying-woman

Was there a drs order DNR? Is

Was there a drs order DNR?
Is this place a hospice? Was the woman terminaly ill?
I don't think we've gotten the whole story, and may never get it due to HIPPAA laws

Example from: http://www.caregiver.org/caregiver/jsp/content_node.jsp?nodeid=397

©Family Caregiver Alliance

Introduction
Big issues—and big decisions—confront us when we think about the imminent death of a terminally ill loved one in our care. Among the emotional, legal and financial considerations are also questions regarding the type of medical assistance your loved one should receive as the end of life approaches. For example, if your loved one suddenly has difficulty breathing, will you allow a paramedic or an emergency room technician to administer CPR? And if CPR revives your loved one, yet he or she still can no longer breathe on his or her own, should you allow a machine—a respirator—to breathe for him or her?

A better understanding of cardiopulmonary resuscitation, or CPR, can be helpful when it comes to making this difficult choice before a crisis occurs. This Fact Sheet specifically addresses the process of CPR and describes the DNR (Do Not Resuscitate) form, the legal document used to indicate to medical professionals your—or your loved one’s—wishes. (For a more detailed discussion of the other issues involved in planning for the end of life, see the Family Caregiver Alliance Fact Sheet on End-of-Life Decision Making.)

CPR (Cardiopulmonary Resuscitation)
Consider the following scenario:

Nancy’s husband has had Alzheimer’s disease for eight years, and is now in the final stages of the illness. After a discussion of end-of-life issues with her family, Nancy has decided to “let nature take its course” if anything of an urgent medical nature happens to her husband — in other words, she does not want him to be put on life support. She has told her doctor of this decision, and he has concurred.

One night, Nancy wakes up to find her husband having trouble breathing. Reflexively, without thinking, she calls 911. By the time the paramedics arrive, her husband has stopped breathing completely. The paramedics leap to do their job: they immediately administer CPR and take him to the hospital. By the time Nancy arrives at the hospital, her husband is connected to a ventilator and numerous IVs. Unfortunately, this is exactly what she did not want for him.

Definition
Fully understanding Nancy’s scenario requires a deeper understanding of cardiopulmonary resuscitation. Simply put, CPR is the process of restarting the heartbeat and breathing after one or both has stopped. The first step involves creating an artificial heartbeat by pushing on the chest, and attempting to restore breathing by blowing into the person's mouth. A medical professional will then insert a tube through the mouth and down the airway to make the artificial breathing more efficient. Electric shocks may be given to the heart, and various drugs may be given through an intravenous line. If the heartbeat starts again but breathing is still not adequate, a machine called a ventilator may be employed to move air in and out of the person's lungs indefinitely.

On television, CPR is often depicted as the ultimate life-saving technique. However, television does not show this process quite accurately—in real life the process is more brutal. Pushing the center of the chest down about one and one-half inches, 100 times a minute for several minutes, causes pain, and may even break ribs, damage the liver, or create other significant problems. CPR produces a barely adequate heartbeat, and doing it more gently is not sufficient to circulate enough blood. Electric shocks and a tube in the throat are also harsh treatments, but may be essential to resuscitate someone.

CPR frequently can save a person's life, particularly in the case of some kinds of heart attacks and accidents an otherwise healthy person may experience. CPR is also most successful when the failure of heartbeat and breathing occurs in the hospital, in the Cardiac Care Unit (CCU). Nurses in the unit will instantly recognize the problem and begin sophisticated care.

However, when a person is in failing health from a serious and progressive illness, the heart and breathing will ultimately fail as a result of that illness. In such a circumstance, there is little chance that CPR will succeed at all. Any success will be temporary at best, because the person's weakened condition will soon cause the heartbeat and breathing to fail again.

Another possibility is that CPR may be only partially successful. If the heartbeat is restored but a person is still too weak to breathe on his or her own and remains too weak to do so, he or she may be on a ventilator for days, weeks, months or longer. Moreover, when breathing or heartbeat fails, the brain is rapidly deprived of oxygen. As a result, within seconds, the brain begins to fail (one loses consciousness), and within a very few minutes permanent damage to the brain occurs. If it takes more than those very few minutes to start effective CPR, the person will not fully recover. The brain damage may mean anything from some mental slowing and loss of memory to complete and permanent unconsciousness and dependency on a ventilator and sophisticated medical life support.

The Role of Emergency Help (Calling 911)
A call to 911 is a request for emergency help; the goal of those who respond to 911 calls is to protect life and property, and the people who respond expect to go to work doing what they are trained to do to accomplish that goal. If your house is on fire, the firefighters don't ask for permission to cut a hole in your roof and spray water all over your living room—they just do what is necessary to stop the fire from destroying your home.

Similarly, when a person's heartbeat and breathing have failed, the 911 responders are not prepared to have a long talk with you about the person's condition and what you think might be best to do. They know that any delay could mean brain damage, so they immediately start CPR and then take the person to the hospital. With one exception, which we will discuss in the next section, their rules require this, and it makes sense if you think about the purpose of the 911 system.

When Nancy called 911 in our scenario, the paramedics simply did what they are trained to do—they revived her husband. However, if Nancy and her doctor had completed a DNR form and kept it in the home, her husband would not have been resuscitated and/or connected to machines when he got to the hospital.

The Do Not Resuscitate (DNR) Form
The "Emergency Medical Systems Prehospital Do Not Resuscitate (DNR) Form" is a legal document that gives the 911 responders permission not to perform CPR. The DNR form is prepared in advance of any situation and kept at home. This prehospital DNR form lists the name of the person to whom it applies, and is signed by that person (or whoever represents that person if he or she is too ill to make medical decisions on his or her own behalf). It is also signed by the person’s doctor. Please note this is very important: the form is not valid until the doctor signs it.

The DNR is the only form that affects 911 responders; other documents, such as a Durable Power of Attorney for Health Care or some other Advanced Directives, do not.

If emergency personnel arrive to find a person whose heartbeat and breathing have failed or are failing, they will perform CPR unless they see a correctly completed DNR.

In light of this, the DNR form should be kept near the ill person's bed, perhaps on the wall, so it will be easy to find in case of emergency. When 911 responders see this form, they will still do anything they can to make the sick person comfortable, but they will not perform CPR. In the absence of a DNR form, they must do CPR. The DNR is the only form that gives you control over what they may do. (Note: A DNR may be reversed if you so desire.)

hydrangea wrote: Was there a

hydrangea wrote:

Was there a drs order DNR?
Is this place a hospice? Was the woman terminaly ill?
I don't think we've gotten the whole story, and may never get it due to HIPPAA laws

From: http://www.foxnews.com/us/2013/03/05/spokesman-says-woman-who-refused-to-give-cpr-to-dying-87-year-old-wasnt-nurse:

The family of an 87-year-old woman who died after an employee denied to give her CPR at a California independent living home says she chose to live in a facility without medical staff and wanted to pass away without life-prolonging intervention.

Lorraine Bayless' death last week at Glendale Gardens, a Bakersfield independent living facility, prompted outrage after a 7-minute recording of the 911 call was released. Brookdale Senior Living, which owns the facility, initially said its employee acted correctly by waiting until emergency personnel arrived. But late Tuesday, it issued a new statement saying the employee had misinterpreted the company's guidelines and was on voluntary leave while the case is investigated.

"This incident resulted from a complete misunderstanding of our practice with regards to emergency medical care for our residents," the Tennessee-based company said.

Sorry, I only meant to quote

Sorry, I only meant to quote an excerpt from the article...not the whole thing! It wouldn't let me edit.

Here is the statement from

Here is the statement from the family of 87-year-old Lorraine Bayless, who died last week of a heart attack after being denied CPR at a Bakersfield elder home:

Our mother and grandmother was a remarkable and intelligent woman who was blessed to have a great life of 87 years. It is the wish of our family to honor and celebrate her life at this personal time. Like so many Seniors, it was our mother's wish to live independently. She was fully-aware that Glenwood Gardens did not offer trained medical staff. Even so, she personally-selected the senior living community, and our family has come to know the staff and been very pleased with Glenwood Gardens as her home. It was our beloved mother and grandmother's wish to die naturally and without any kind of life-prolonging intervention. Our family respects the right of all people to make their own life choices in such cases.

We regret that this private and most personal time has been escalated by the media. Caregivers, nurses and other medical professionals have very difficult waters to tread in the legal and medical landscape of our country today. We understand that the 911 tape of this event has caused concern, but our family knows that mom had full knowledge of the limitations of Glenwood Gardens, and is at peace. We also have no desire, nor is it the nature of our family, to seek legal recourse or try to profit from what is a lesson we can all learn from.

We wish to focus on our family at this time, and this will be our final comment on this personal matter.

— The Bayless Family

http://www.bakersfieldnow.com/news/local/Statement-from-family-of-elderly-woman-denied-CPR-195476801.html#familystatement

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