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On the NBC Nightly News last night (Sunday) I heard a story that disturbed me.  The basic facts seem to be:
1 – An 87 year-old resident in an independent living facility called Glenwood Gardens in Bakersfield, California was having trouble breathing.
2 -  A staff member, who is a nurse, followed company policy by calling 911.
3 – The 911 dispatcher informed the staff member / nurse that there was not enough time to wait for emergency responders.  The resident needed immediate CPR.  The dispatcher repeatedly beseeched the staff member to either administer CPR or turn the telephone over to someone who was willing to administer CPR.  The dispatcher said she would instruct that person on how to administer CPR and there would be no liability to the staff member or the independent living facility.  The staff member refused, citing company policy.
4 – The emergency responders arrived, took the resident to the hospital, where she was declared dead on arrival.
5 – A spokesman for the independent living facility verified the staff member followed company policy and that all residents and their families were informed about this policy before they moved in.
6 – Family members of the resident stated they were comfortable with the level of care she received from the facility.
Below are a couple of links with this story
http://www.huffingtonpost.com/...
http://www.nbcnews.com/...

In the NBC report they played portions of the dispatch tape and the staff member is obviously controlled.  Despite anything the dispatcher says, she keeps refusing to do more than call 911 citing company policy.  My first reaction was what kind of monster is this woman.  She is a nurse, she should have done CPR.  In those moments the case seemed black and white.  

Then I started thinking.  What would this woman say to herself as she headed home?  “It was a good day today, I followed company policy.”  Although that sounds snarky, it was not intended to be.  One assumption I made was that this woman, who identified herself as a nurse to the dispatcher, must have wanted to help people at some time in her life.  Nursing is not known as a highly-paid or easy profession, so most people who become nurses do it because they want to be part of a helping profession.

What, I wondered, would change her to a person who would put following this company policy over saving a life?  Is she a single parent who desperately needs this job?  Does she see this job as the difference between the life and death of her family? Has she become an uncaring automon who finds it easier to do as she is told rather than provide compassionate care?  How will she process this and what toll will it take on her?  If someone died because of my inaction I would be devastated.  It would destroy all my believes about myself as a human being.

And what about the company and its policy?  Does the policy mean staff cannot provide compression to a bleeding wound, ice to a twisted ankle, or an aspirin for a headache?  Why would any company instruct their staff not to provide common first aid?  Liability if the patient dies?  Liability if the patient accuses them of providing unwanted care in extending life by artificial means?  Convenience for their staff?  Lack of appropriate medical facilities?  One story cited above mentions that this policy is only applicable to their independent living facility, not to their assisted care facilities.  Clearly, in my mind, the policy itself has as much to condemn it as the actions of the staff member.

This reminded me of a book I read a while ago entitled The Reader by Bernhard Schlink (Link to synopses at Amazon) http://www.amazon.com/...

I have not seen the movie that was made from the book.  I found the book thought provoking is some ways, and deeply disturbing in others.  

Basically the book was set in the time soon after WWII in Germany.  There are two main characters, a teenage boy who, in the story, grows to be a young man and a woman who is currently a minor civil servant, however we later find out, she was a guard in a concentration camp during WWII.  The book begins with an encounter between the teenager and the woman that turns into a love affair.  They lose track of each other and time passes.

He later encounters her during a war crimes trial.  (Spoiler Alert)  During the war, she and her fellow guards were given the task of escorting women and children prisoners from one concentration camp to another.  Of course, their main duty is to make sure no one escapes.  The train breaks down, so the guards commandeer a public building in the town, move all the prisoners into the building and lock it.  During the night a fire starts in the building.  The consensus of the guards is that their main purpose is to ensure no prisoners escape, therefore they cannot unlock the doors as there are not enough guards to ensure no one escapes.  The townspeople protest, but the prisoners all perish.  

At the trial the woman seems to not understand why she is being condemned.  After all, she did her job.  Her attitude is that the fact that the prisoners perished was unfortunate, but not her responsibility.  I have read other information about the trials of prison guards at Nuremburg.  Many of them were shocked that they were being held accountable for their actions when “all they were doing was their job; they were just following the orders of their superiors.”

Which brings me back to the incident in California.  Do I think the two situations are completely analogous?  No, the residents at Glenwood Gardens are not prisoners; they can come and go, have visitors, and live there because they have chosen to live there.  The staff members are not prison guards; they do not have the power of life and death over the residents.  

However, I find one commonality of both situations chilling.  The staff member at Glenwood Gardens was just doing her job.  Unlike the dispatcher, she seemed to give no thought to the consequences of her actions.  Listening to the portions of the dispatch call televised by NBC News, it seemed she had the attitude that she was doing her job, she was following company policy.  The fact that the woman may die (and later did die) was unfortunate, but not her responsibility.

Update:  11:00 am AST
Several comments have made the point that you never initiate heart massage if there is a pulse.  (note:  from my days of teaching CPR I was taught that perfect CPR is only 70% as effective as the heart beating at all, which is why if you feel a pulse at the neck, even if you can't feel it at the wrist you DO NOT initiate heart massage.)  They also made the point that when a patient is breathing you don't initiate CPR, also true.

Following is a link to the whole 911 call as well as a link to the incident report by the Fire Department.

The link to a copy of the incident report by the Bakersfield Fire Department.
http://media.turnto23.com/...

The report states, in part (last paragraph)

E15 was dispatched to a medical aid for a patient in apparent cardiac arrest.  While enroute, E15 was contacted by ECC via radio and advised the facility was refusing to intiate CPR.  E15 arrived on scene simultaneously with Hall Ambulance.  E15 personnel proceeded to the dining room and found a female patient to be pulseless, non breathing and lying supine on the floor. ...
There is also a recording of the 911 call.  In it you can here the dispatcher ascertain that the patient was not breathing adequately, then asking anyone to initiate CPR.  Note:  When I learned CPR , the term could also mean just breathing for the patient if there is a pulse.

http://www.turnto23.com/...

           

Update 2 – 3/5/2013 10:30 am AST

I came home after doing errands yesterday to find I was in the Community Spotlight.  I’m still new to this site so I’m not sure who or how the mechanisms work to put diaries on the Community Spotlight; so to whoever or whatever, thank you – I’m honored.

I’d also like to thank everyone who commented as well as sunka who wrote a companion diary.  I’m fascinated by sunka’s concept of a DNR that also refuses to pay any financial costs not explicitly authorized.  After reading many of the comments I realized that 1)  this is an extremely timely topic that enables important discussion, and 2) there were some of my thoughts I needed to clarify.  Instead of responding to individual comments, I thought this approach would be more coherent.

Before I clarify my thoughts, I want to apologize.  Several people were offended by my comparison of the staff member’s actions with a novel based in Nazi Germany.  I would like to clarify those remarks in context (below), but I want to assure everyone that I do not think the staff member /  nurse is a secret skinhead with a swastika tattooed on her bum.  Nor do I think she is guilty of murder,  manslaughter, negligence, or any other crime.  I apologize for any pain I caused with my lack of clarity.

As I said, there were several very important topics introduced in the comments.   While important, these topics aren’t germane to the points I wish to make so I wish to separate them out now.

DNR – As I stated in a comment I made, a while back my mother and I went through the process of filling out the paperwork for a living will and filing it with the local hospital.  I absolutely believe in patients’ having the final say in how they will be cared for and what measures will be taken, or not taken, to prolong life.  As I listened to the original 911 call (link in update 1) a DNR was never mentioned.  Whether it was not known at the time, I do not know; but the reason for refusing to perform CPR was clearly stated as being against company policy.  At one point in the tape there is a background conversation and the staff member comes back to the dispatcher and states that her boss has just confirmed that it is against company policy to perform CPR.  Staff members are to call 911 and wait with the resident.

Hospice – I have never been directly involved with Hospice, although several relatives and relatives of friends have used Hospice services in several different states.  It is amazing to me that I have never heard one bad word about hospice; not even a tiny horror story.   I have the utmost respect for Hospice workers, I recognize the wisdom and comfort they bring in the final days of life to both the patient and the patient’s family.  I know that should it become necessary for me or my family, I would welcome the help and support they bring to the end of life.

Credentials of Staff Member – When the staff member identified herself as a nurse it was in response to the Dispatcher asking if she understood the consequences of not initiating CPR; that’s when the staff member stated she was a nurse who understood the consequences.  Several people questioned whether she was credentialed as an RN or LPN or not.  I know a person who is an accounting clerk who routinely self-identifies as an accountant, so this is an important point.  However, what I believe is more important to this discussion is the staff member acknowledgement that there are consequences to this decision, no matter what her level of credentials.

Level of Care – In all articles I have seen, the facility is identified as an Independent Living facility.  My understanding is in such facilities residents are mobile, relatively free of debilitating chronic illness, and don’t require medical intervention or assistance.  One commenter spoke of his mother who was placed in an Independent Living facility whose condition deteriorated but was not moved to assisted care or a nursing home due to concerns about how a move would affect her.  I recognize there are exceptions, but I am assuming that most residents, including the patient we are discussing, are elderly but in decent health.  That may be one reason why the facility did not know about a DNR; it may not have been appropriate because this is not a health care facility.

So after separating those issues that are important but are not contributing to my deep concerns, I realize there are three issues that chill me to the bone.

One – I have worked with companies who encourage staff to learn first aid, CPR, using the defibrillator, etc.  They certainly do not require staff to take these classes nor do they penalize those who don’t.  It is an opportunity many staff take advantage of.  I have worked in other companies who have a standard first aid kit in the kitchen area, period.  However, I have never worked for a company that prohibits staff from administering first aid or CPR to other staff members or customers in an emergency.

Think for a moment, if you were the clerk at a department store.  A customer falls down grabbing her chest.  You know CPR, but due to the company policy all you can do is call 911 and hold her hand.  Or, imagine the guy in the cube next to you has what appears to be heart failure.  You know CPR but don’t dare use it because it might place your job in jeopardy.  I find it appalling that a non-medical facility can, or would, implement and enforce a policy prohibiting their staff from taking emergency action.  

Two – Before I could teach CPR for the Red Cross years ago I was required to take a “train the trainers” class.  One of the things they emphasized was that each class should end by discussing the legal and ethical issues surrounding performing CPR.  So, in the last ½ hour or so of the class I handed out our state’s Good Samaritan law, and we used that as a springboard to discuss issues such as “Is it OK not to perform CPR.” “Once you start, is it OK to stop?”  So how did I get from here to Germany?

Years ago when I learned world history, I learned that while the global depression was devastating around the world, it was much worse in Germany.  After WWI, the Allies required Germany to provide reparation to the Allies.  It left the German economy in worse shape than everyone else’s.  Today, we look back at Hitler through the lens of what we know happened.   At the time, the German people saw Hitler as a charismatic, principled, and prescient leader.  They were sure he knew how to lead them from economic desperation back to their place as a leader among nations.  Sure, many knew the Jews were rounded up and shipped out of town to the country; but most Germans at that time did not know about the genocide.

In order to survive many Germans adopted an attitude of heads down, eyes forward, and do what you’re told to ensure a bright tomorrow.  I’m seeing the same attitude, to a lesser extent, today.  It is exemplified by the staff member at Glenwood Gardens.  On Daily Kos we have criticized, justifiably in my opinion, Citizens United, corporate lobbying, the NRA, the banking industry, etc. all as large corporate organizations shaping government and the world to their needs and wants.  However, if we as individuals abdicate our responsibility to make ethical decisions and instead toe the company line, are we not putting ourselves into the same position the German people did almost a century ago?  This is what chills me, not whether the staff member did, or should, have performed CPR.

Three – There seems to be a barely spoken attitude that the age of the patient changes the value of that person’s life.  What if an elementary school aged child fell from a playground apparatus during recess and his heart was knocked into arrhythmia.  The playground monitor had the ability to perform CPR but chose not to due to school district policy.  Would there be more outrage?  Several people have said that at 87, they would not want to be revived.  OK, that is your decision for yourself; but can any of us make the decision for someone else based only on their age?  I find this implied lack of value for this woman because of her age to be chilling as well.

Thank you for taking the time to read my comments.

Originally posted to Debis Diatribes on Mon Mar 04, 2013 at 09:34 AM PST.

Also republished by Community Spotlight.

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Comment Preferences

  •  I commented on another diary (67+ / 0-)

    there were more facts brought out there, including that the woman was apparently breathing, if a person is breathing then CPR would be inappropriate in any event,  plus a lot of discussion about whether DNR orders were in place, the low rate of survival of elderly patients who are revived, the damage that CPR can cause, etc., that made it clear this might not be the clear cut choice the new media is making it out to be.  Further, the woman's family had a daughter who spoke publicly and said she was satisifed with the care given her mother.

    From personal experience, my mom is in an independent living facility, she has a DNR, and many of the people there do.   Not everyone thinks death is the worst that can happen to them, and they make plans accordingly.  My mom has dementia and a progressive disease, I would be very disappointed if staff at her home ignored her DNR and revived her, possibly breaking her ribs and causing other damage so that she could hallucinate about people long dead visiting her, not remember her grandchildren or friends, etc. or even that she just ate dinner, for a few more months or years.

    •  Reportedly there was no DNR (14+ / 0-)
      CBS News has been told the elderly woman in this case did not have a "do not resuscitate" order on file.
      http://www.cbsnews.com/...

      "No one life is more important than another. No one voice is more valid than another. Each life is a treasure. Each voice deserves to be heard." Patriot Daily News Clearinghouse & Onomastic

      by Catte Nappe on Mon Mar 04, 2013 at 10:11:45 AM PST

      [ Parent ]

      •  It's now being reported that ... (42+ / 0-)

        there WAS a DNR, which sounds believable in that it never made sense that a nurse would refuse to perform CPR unless that was the case.  Especially given that the daughter is reported to have been "satisfied with the care her mother received".

        It was later revealed that Ms Bayless had signed a Do Not Resuscitate form, and it is against the policy of the retirement home to give CPR to residents against their wishes.
        It would have been nice, though, if the nurse had explained that to the dispatcher.  (sigh)

        "Two things are infinite: the universe and human stupidity, and I am not sure about the universe." -- Albert Einstein

        by Neuroptimalian on Mon Mar 04, 2013 at 02:45:12 PM PST

        [ Parent ]

        •  I'm not surprised to hear this. (26+ / 0-)

          Something sounded off about this story from the start. But still strange to call 911. We don't call 911 when we have a signed DNR.

          The daughter being a Nurse and being pleased with the care given should have been a tip-off that all the hysteria surrounding this story was unwarranted.

          WE NEVER FORGET Our Labor Martyrs. For Jan: Right-to-Work/Right-to-Live(?)

          by JayRaye on Mon Mar 04, 2013 at 02:52:14 PM PST

          [ Parent ]

        •  Why Then, ... (6+ / 0-)

          didn't the nurse on the phone just say there was a DNR? It would have avoided a lot of drama. I listened to as much of the 911 call as was played on the radio, and at no point did the nurse explain the situation other than saying, "It's not our policy."

          "Facts are meaningless. You could use facts to prove anything even remotely true." -- H. Simpson

          by midnight lurker on Mon Mar 04, 2013 at 05:20:32 PM PST

          [ Parent ]

          •  I was thinking the same thing (1+ / 0-)
            Recommended by:
            OldDragon

            Would disclosing the existence of a DNR violate HIPPA? If so, we need to change that.

          •  The nurse might simply have forgotten to say so (2+ / 0-)
            Recommended by:
            mrkvica, AllisonInSeattle

            Or maybe she thought she did say there was a DNR order.

            The discussion above certainly shows what a hodgepodge of rules and laws there are about CPR.  
            A nursing home doesn't have to call EMS, but an assisted facility has to.  
            Maybe HIPAA forbids the nurse from saying the patient is DNR?  I hope not, but I've heard of quirks in HIPAA that are just as silly.

            I have some experience as a hospice medical director.  I got to the point of wishing all hospice patients would have a framed copy of their DNR order hanging at the bedside.

            We're all pretty strange one way or another; some of us just hide it better. "Normal" is a dryer setting.

            by david78209 on Tue Mar 05, 2013 at 06:51:57 AM PST

            [ Parent ]

            •  or she may have had personal reservations (3+ / 0-)
              Recommended by:
              CayceP, OldDragon, david78209

              about the DNR which she had not disclosed in her job interview...

              or perhaps she was a temp worker and not made well aware of the DNR.

              Many of us who are approaching this stage of life have signed DNRs with the full knowledge of our children and other relatives.

              My Mother had a DNR, but the available nurse's aides doing home care would never have agreed to it. So basically her death was prolonged against her will when she was no longer able to care for herself.

              Good for the family in this situation which seemed quite on the same page about their wishes.

              "There's nothing serious about a plan that claims to reduce the deficit by spending a trillion dollars on tax cuts for millionaires and billionaires." - President Obama

              by fhcec on Tue Mar 05, 2013 at 08:35:01 AM PST

              [ Parent ]

          •  DNR vs 911 (0+ / 0-)

            Do you imagine that 911 would respond at all if they were told that an 87 year old woman was having medical problems, and that she was under a DNR order?  That too would be confusing, and 911 would probably hang up, since the DNR would prevent emergency personnel from giving aid when they arrived.

            •  But the Nurse Called 911 in the First Place (0+ / 0-)

              If you listen to the call, she seems very detached from the whole situation. When she was asked if the woman was lying flat on the floor, she couldn't answer because she wasn't in the same room. When she did get the woman lying down, she scarcely provided any usable information about the woman's condition.

              I'm hearing now that some facilities require a resident to have a DNR on file before they will accept them. Don't need no "death panel" there.

              "Facts are meaningless. You could use facts to prove anything even remotely true." -- H. Simpson

              by midnight lurker on Tue Mar 05, 2013 at 09:02:21 AM PST

              [ Parent ]

              •  That's true, but you also are choosing (1+ / 0-)
                Recommended by:
                AllisonInSeattle

                to live in that facility. Frankly, it's a choice many people would make, to not worry about heroic measures and just die.

                You said the air was singing / it's calling you, you don't believe / These things you've never seen / Never heard, never dreamed.

                by CayceP on Tue Mar 05, 2013 at 09:42:50 AM PST

                [ Parent ]

        •  IF this was the case- (0+ / 0-)

          they should NOT have called 911 and when they did they should have told the operator she was a DNR.  When a patient has a DNR you let them die and then call the family and MD but not the 911 which is for emergencies.

          "..if you keep the hope alive, then change is still possible." Van Jones

          by shanti2 on Tue Mar 05, 2013 at 06:38:55 AM PST

          [ Parent ]

        •  Head of facility explained policy-no mention DNR (0+ / 0-)

          The USA Today article has more information including The head of the facility explained the policy.  It seems he would have mentioned if a DNR was in place. Instead this seems to be the policy for the independent living part of the facility:

          The executive director of Glenwood Gardens, Jeffrey Toomer, defended the nurse's actions, saying she did indeed follow 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 in a written statement. "That is the protocol we followed."

          Toomer told KGET that residents of the home's independent living community are informed of the "no-CPR" policy and agree to it when they move in.

          The policy does not apply at the adjacent assisted living and skilled nursing facilities. Those residents would have received CPR in identical circumstances.

          This company operates facilities in 36 states.

          There's also this:

          Not all facilities have the same policy, however. At Erickson Living, an effort would have been made to save Bayless, says Dan Dunne, director of communications for the company, which has retirement facilities in nine states.

          "All of our communities have first responders who are trained to provide emergency care, including CPR whenever and wherever necessary," he says.

          Why might this happen -
          At many of the nation's retirement communities, the cost of the care is based on how much medical assistance is required. Both assisted living and skilled nursing care are more expensive than independent living.
    •   (14+ / 0-)

      Thank you for your comment.  I have a mother who will soon be 88.  Luckily she is still independent and is still in her own house, but we have had the conversation about DNR and filled out a living will together.  I am sorry your mother is not as lucky.

      It is my understanding that there is a difference between independent living facilities and assisted care facilities.  Before responding to your comment, I double checked to verify that most independent living facilities are designed for people who have no chronic health issues that need medical supervision.  In fact, I reference a comment made by the company in my diary that they have different first aid standards in their assisted living facilities.

      Having taught CPR in my past, I am aware that it should only be performed once no heartbeat is detectable.  I also know breaking rib bones is a danger especially in children and the elderly.  However, I also know that most 911 dispatchers are well trained.  I have not seen the complete transcript of the 911 call.  If the situation deteriorated it would explain why the dispatcher was urging the nurse to perform CPR.  It is also my understanding that by the time the fire department arrived, she was unresponsive.

      The nurse did not reference patient wishes or a DNR order when refusing to perform CPR, but rather a blanket corporate policy.  It seems that what guided the nurse in this situation was not what was communicated by the patient and their individual wishes, but what was communicated by the head office as a general policy.

      When my mother and I made decisions about her living will there were very specific questions.  Do you want CPR performed?  Do you want to be intubated?  etc.  It was a difficult conversation, as I'm sure you know from you discussions with your mother, and perhaps other family members.

      I agree there is a time to release life.  There are conditions where I would prefer death to life as well.  But I want it to be my choice, not based on company policy.

      Truth is generally the best vindication against slander - Abraham Lincoln; 1864

      by Debis Diatribes on Mon Mar 04, 2013 at 10:20:39 AM PST

      [ Parent ]

      •  my mom entered the independent living (12+ / 0-)

        facility when she was fully mobile, capable of doing her daily chores though forgetful.  Rather than move her when her conditioned worsened, we were able to fund 24/7 nursing assitants by selling her home, eventually that will be exhausted.   But everyone said she would probably do much worse if we moved her away from familiar surroundings and her main problem at the time, forgetting she would fall down if she walked, meant no level of care, really answered the need to keep her from breaking bones.   Eventually she will probably need skilled nursing care.

        As for the discussion with my mom being difficult, it actually wasn't.   We have had many close relatives with cancer, Alzheimer's, etc.   After a seeing so much lingering death with greatly diminished capacity, it is easy to accept that if you incur a debilitating disease with no cure that death at some point is a release.  

        Whether the corporate policy is appropriate at independent living facilities, or any other kind, I would agree is very suspect.   But try to save a life no matter what as the highest priority when dealing with advanced age,  I would question just as much.  I see too many of mom's cohort who complain that they have lived too long, they aren't suicidal, but they wouldn't lift a finger to save themselves, and are vocal about not wanting to be saved.  Again, I still think this is becoming a cause celebre that many elderly would rather remain a personal choice and that they don't really disagree with.

        •  End of Life (6+ / 0-)

          jfromga
          I absolutely agree with you that there is a time to let our elderly go.  I also agree that it should be their decision, not ours.

          Again, I know how lucky I am that my mom has both her long and short term memory, and is still very mobile, even though she uses a cane and her speed is more deliberate that speedy.

          We both agree that when her time comes, we hope it is quick and painless.

          I've added an update to my diary.  I found a copy of the 911 call as well as a copy of action report by the Bakersfield Fire Department (links in update).  

          Thanks for your comments

          Truth is generally the best vindication against slander - Abraham Lincoln; 1864

          by Debis Diatribes on Mon Mar 04, 2013 at 12:15:34 PM PST

          [ Parent ]

        •  cause celebre is right - plays right into the (8+ / 0-)

          forced birth movement. "see the slippery slope when you allow the fetuses to be killed? Next it's your Granny!"
          I for one, in these difficult financial times, would not rob my children of the legacy that I worked my whole life to build for them so I can go out slow and hard.

          "You can die for Freedom, you just can't exercise it"

          by shmuelman on Mon Mar 04, 2013 at 04:26:03 PM PST

          [ Parent ]

  •  Very disturbing. (13+ / 0-)

    This was covered on GMA this morning.  Since it is an apartment complex for the elderly as opposed to a nursing home, the are perfectly within their rights, according to Dan Abrams, not to provide life saving procedures like CPR.  Of course that doesn't mean he wasn't shocked.  What is shocking is that the family thinks this nurse's behavior was ok with them.  Makes me wonder if this 87 year old woman had a fatal medical condition, which has not come out, which would be the only thing that could at least make sense in my mind.  At any rate, the nurse's chilling attitude made my flesh creep.  And to top it off her boss was there and backed her up.  If I lived there, or had an elderly family member there, I'd be putting up a "for sale" sign immediately.  Just chilling.

    "They love the founding fathers so much they will destroy everything they created and remake it in Rush Limbaughs image." MinistryofTruth, 9/29/11

    by AnnieR on Mon Mar 04, 2013 at 10:02:02 AM PST

  •  I think the issue that needs to be considered (14+ / 0-)

    is the extent to which emergency services are being relied on by other medical and health care providers to fill in the gaps.
    In our town, where EMS and the Fire Department are coordinated, it's not usual for fire personnel to be called to help very obese people get off the pot. While it certainly keeps personnel on their toes and makes them familiar with the community's assets and weak spots, trained EMS personnel are being used to provide services for which practical nurses would be sufficient.
    But, we've got a nursing shortage!
    Or rather, budgetary constraints makes it more convenient to rely on EMS than to employe constant care providers.

    Congress rationing dollars and industrial magnates hoarding them makes it necessary to base decision on the availability of dollars, rather than rational needs assessments.

    How much is that doggie in the window? How much is that old woman worth?

    The U.S. isn't materialistic because we like to own things; we're materialistic because human beings are being treated like things. Buying and selling are characteristics of the ownership society. George W. Bush had that right.

    We organize governments to deliver services and prevent abuse.

    by hannah on Mon Mar 04, 2013 at 10:02:30 AM PST

  •  There are many reason not to do CPR on a (23+ / 0-)

    very elderly person.

    Fragile bones that could shatter, for one. Bones are often broken during chest compression, even for the young.

    The patient's family, one who is a nurse, was satisfied with the care.

    Sounds like there is more to this story. Very inappropriate to compare not doing CPR on an 87 year old to the Nazis & their murderous campaign, should perhaps even get donuts for that.

    For the record, don't want any one doing chest compression on me or any member of my family at age 87. If they weren't dying already, the vigorous chest compression needed for CPR could finish off the very elderly.

    We could do better at DK then get caught up in MSM non-fact based hysteria.

    WE NEVER FORGET Our Labor Martyrs. For Jan: Right-to-Work/Right-to-Live(?)

    by JayRaye on Mon Mar 04, 2013 at 10:37:08 AM PST

    •  Thank you: (3+ / 0-)
      Recommended by:
      pianogramma, ZenTrainer, JayRaye

      Most people do not understand how incredibly violent heroic measures are. Real life is not a goddamn episode of a hospital drama.

      People are freaking out about this because they're faced with real questions about mortality and end of life care.

      See also:

      http://www.utne.com/...

      You said the air was singing / it's calling you, you don't believe / These things you've never seen / Never heard, never dreamed.

      by CayceP on Tue Mar 05, 2013 at 07:34:23 AM PST

      [ Parent ]

  •  I simply don't understand (7+ / 0-)

    the policy of this facility. Why hire a nurse at all, if you're not going to allow him/her to practice the most basic life support skills?  It seems to me that the liability would be much greater to have trained personal doing NOTHING, than having responsibility for whatever injuries might occur from performing CPR. (see good semaritan act)

    Apparently, this facility housed "independently" living seniors, which to me says they did not have any imminently fatal illnesses. It seems unconscionable to be housing seniors, and not at least have a defibrillator and people trained to use it on the premises. Many times, a sudden collapse such as the one this woman appeared to experience, are due to arrythmias, which if converted quickly can save lives. They are completely automated, give verbal instructions and are totally user-friendly. Airports, schools, grocery stores and most public places have them available. You don't need to be a doctor or nurse or trained EMT to use one.  Training in basic life support takes only a few hours of one's time.

  •  The nurse was right. (27+ / 0-)

    Reading the transcript from the independent living facility, what actually happened was that the dispatcher, who apparently did not know when it is appropriate to start CPR, was demanding that the nurse, or someone else, begin it on a woman who still had a heartbeat and was breathing on her own, simply because she felt the woman wasn't breathing enough.

    The reality is, you never do CPR on anyone with a pulse, regardless of whether or not they're breathing.

    The only 'chilling' thing here was that an emergency dispatcher was demanding actions that would only have caused far greater injury to an 87 year old woman, and perhaps killed her right then and there.

    Despite the fact that she later died, at that point in time, the nurse's actions protected the woman from 'well-meaning' but medically incompetent assistance.

  •  as a nurse i find this disgusting (4+ / 0-)

    the company has written bylaws that under mind the whole point of nursing. if you cannot perform cpr, then you cannot perform the hemilch.
    so if there is a fire, does this mean they do not assist the residence to evacuate? what if one is having a heart attack? do they just allow the attack to happen?
    the nurse seems to have forgotten what her job is and i hope she slept badly that night. if it were me, i'd have done what was necessary to save the patient.

    as far as i am concern, both the facility and the nurse are responsibility for this woman dying.

  •  Reminds me of a case in town with security guards (5+ / 0-)

    who didn't respond when a teenage girl was getting the crap beat out of her by a bunch of other kids.  Their reality was they'd lose their jobs if they did intervene.

    I'm a nurse, and I can't imagine sitting there watching someone die.  I also don't understand a policy for a facility that doesn't let the staff perform CPR.  

    Glad I wasn't in that position.  Not sure what I think about the whole thing.

    For every vengeance there is an equal but opposite revengeance

    by mothnflame on Mon Mar 04, 2013 at 12:55:21 PM PST

  •  another case of news not knowing (10+ / 0-)

    so often these stories turn out to have many more layers. I was disgusted with the news reporter I heard making a huge deal about this with no thought of implications.

    I am more sympathetic with the family having their private moment stolen without their permission.

    It is far different when a family shares an issue. I'm all on board with helping shine light on an issue when those involved ask.

    But when outsiders think they know it all - I step away until we know more.

    "Eating your seed corn is not a good business model." - FishOutofWater

    by saluda on Mon Mar 04, 2013 at 03:02:29 PM PST

    •  Agree (2+ / 0-)

      Remember that movie, "Absence of Malice"?

    •  That's a good point. (4+ / 0-)

      My own comments were based upon a transcript of the 911 call provided by a writer who wrote about it for one of the local papers out there (unfortunately, the link I followed to read it was in the earlier, deleted diary), and it's entirely possible even that transcript was edited.  I think the fact that the daughter (who was also apparently a nurse) was satisfied probably means that when she reviewed what had been done and at what point in time, she probably would have done the same for her own mother.  With the added boxquotes at the bottom of this diary, we now have information that by the time EMT's arrived, the patient had transitioned to non-breathing and pulseless, and the question becomes 'When'?  That was the point at which CPR should have been initiated, if it was going to be.  Given the press coverage, I'm fairly sure there will be an investigation that will determine if there was negligence, whether on the part of the dispatcher, the nurse, or both.

  •  The most the nurse would do is call 911. (0+ / 0-)

    I believe that is the point.

  •  The movie of The Reader seems to track the (0+ / 0-)

    book closely based on your brief description. Have not read the book...

  •  When a next of kin puts a relative into a health (10+ / 0-)

    care facility, they are asked (they being the patient if competent and or the next of kin) to make decisions about when and how much medical treatment is to be given.

    People do have a right to refuse treatment.  That is what right to die or living wills do.

    Does the author know for a fact that the patient had not already made such a decision?

    It sounds like the relatives were Ok with what happened, and that the women was admitted with the understanding that resuscitation was not to be given.

    This also is the procedure of Hospice.  People go there to die because their bodies are dying.

    I watched my dad die, and I have watched patients die, gradually and very quietly with out a sound or flicker.  Their body just stops working.
    They were already years beyond ever getting "well."

    Sometimes it just makes no sense to have somebody electrocuting them and pounding on their chests and breaking their ribs to prolong their suffering.

    The nurse may not be a monster, she likely was doing exactly the patient has asked.  And she has likely seen more deaths in any given year than most us see in a life time.
    Dying is a natural part of life.

    There is a time to let the dying die.

  •  Yesterday (1+ / 0-)
    Recommended by:
    solliges

    they said another resident called 911, IIRC.

    "The light which puts out our sight is darkness to us." Thoreau

    by NancyWH on Mon Mar 04, 2013 at 05:43:55 PM PST

  •  I'll tell you what's shocking (8+ / 0-)

    What's shocking to me is that the author would compare this nurse to a Nazi war criminal without knowing the relevant facts of what happened.  "Well, if it was this, then it was that." "If it had been this, she would have said that."  I'm an ER nurse.  I've been in this nurse's shoes.  Its not easy, even if there is a DNR, to watch someone go when you have the skills and tools to fight on.  Even when you know it is the patient's wish, even if you know it is for the best, you still ache to jump in and fight.  If you want to speculate as to what this nurse thought about on her drive home, I can tell you.  This was a horrible night.  

  •  This is not the diarist's fault but this story (1+ / 0-)
    Recommended by:
    mrkvica

    shows that by trying to get the headlines the media completely distorted the story. As you can see from the comments here, what actually happened was very different from the sensational description in the media.

  •  This is not quite accurate: (3+ / 0-)
    Nursing is not known as a highly-paid or easy profession
    The median income for a Registered Nurse in the US is about 55K/year. That's not exactly highly paid, but it's not too shabby. Nurses with advanced training can make much, much more. Nurses in administration can make even more. The median income for an LVN/LPN is about 40K/year. CNAs make much less, with a median income of about 25K. That is certainly not highly paid.

    I'd be interested to know what kind of "nurse" this person was. I highly doubt it was an RN or even an LVN. I suspect this was a CNA (Certified Nursing Assistant).

    What is truth? -- Pontius Pilate

    by commonmass on Tue Mar 05, 2013 at 02:55:33 AM PST

  •  One of the issues that was addressed was (2+ / 0-)
    Recommended by:
    mrkvica, mamamedusa

    that the patient or family of the patient is aware of the policy of DNR at their nursing home, they sign documents that acknowledge their awareness.


    The religious fanatics didn't buy the republican party because it was virtuous, they bought it because it was for sale

    by nupstateny on Tue Mar 05, 2013 at 04:06:45 AM PST

  •  There may be some mis-communication here. (2+ / 0-)
    Recommended by:
    mrkvica, chimene

    Company policy? Is their policy to call 911 for any major medical event? Because the type of facility is not a medical setting and doesn't have medical staff, the "nurse" being a stepped up housekeeper (no offense intended)? Is the DNR order wrapped up in that phrase "company policy" and no one unwrapped it?
    I must admit that hearing that company policy prevented life saving action was very provoking, but when the details come out, it sounds to me like the nurse did what she and the patient's family thought was best. And she was backed up by the company policy and the DNR.
    The 911 dispatcher also did what she thought was right, but not having all the information (and possibly adequate training) and not being on the scene, was a little off base (not much and not reprehensibly).
    I have several friends that work in nursing homes as CNAs. They seem to periodically have to leave the job and go do other things for a few months or years, because of the horror of watching these patients dissolve. They basically tell of working a long drawn out hospice job with the false hope of "living", that many of their patients, in their moments of lucidity, beg to be eased out and that's against company policy (and the law) for these young women to comply.
    I can only imagine that when she went home that night, it wasn't with any kind of smug or selfrighteous or happy mood. Even when you do right in this kind of a situation, it's rough, and then to have the media and the rest of the world witness your worst day at work, pick it apart without having been there, vilify you, even compare you to a Nazi prison guard, that would define having a bad day.

    If I ran this circus, things would be DIFFERENT!

    by CwV on Tue Mar 05, 2013 at 04:43:02 AM PST

  •  This is a case of bad reporting... (4+ / 0-)
    Recommended by:
    chicagobleu, mrkvica, mamamedusa, chimene

    Also known in the biz as "rip and read", meaning you rip the story off the teletype machine and read it on the air, not checking it to ensure its accuracy.
    We don't have teletype machines anymore, but the practice continues - don't look into the story, don't ensure all the facts are in, just DO IT to garner ratings.

    Fact is, many folks have DNR's in place. One gets to an age where the realization is that you don't want to be kept alive on a machine, or as a vegetable. Death itself is not as feared as being incapacitated.

    Now the nurse in this situation did not state the woman had a DNR, but by the diarist's explanation, that it was company policy leads me to think that you have a DNR in place when you live there as there are no medical personnel, as there would be at assisted living or a nursing home.

    We are trained to believe, in this country, that you take all measures to keep a body alive, even when life after an event may not be of quality. We find it hard to let go.

    In this case, the nurse didn't explain herself, and the news outlets did nothing to confirm facts before reporting it. In our 24/7 news era, you gotta get the story out at all costs. Facts don't always matter.

    Sad.

    Isn’t it ironic to think that man might determine his own future by something so seemingly trivial as the choice of an insect spray. ~ Rachel Carson, Silent Spring ~

    by MA Liberal on Tue Mar 05, 2013 at 05:16:43 AM PST

  •  As an RN (2+ / 0-)
    Recommended by:
    blue91, BlueDragon

    I am shocked, angry and greatly saddened by the state of care given in facilities like this all over the country.
    I could not and would never walk into a facility that said  that a patient collapsed with no pulse or breathing like this patient was should just be left alone.
    Every day I hear stories like this and many much less dramatic but that still cause patients real harm.

    Unfortunately the fact is that CPR outside a hospital is not overly successful...and in an person in their 80's probably not going to change things.  But is that a reason to do nothing? NOT IN THIS RN's BOOK.

    "..if you keep the hope alive, then change is still possible." Van Jones

    by shanti2 on Tue Mar 05, 2013 at 06:36:52 AM PST

    •  CPR is' something' (4+ / 0-)
      Recommended by:
      mamamedusa, chimene, AdamSelene, J Rae

      It's a horrible thing to do to 87 year old body but it's 'something.'

      As an RN with 24 years of experience doing CPR I can tell you what this woman needed was comfort and human compassion - NOT CPR.

      She needed someone to hold her hand, someone to talk to her gently, someone to be with her on that moment she transitioned into the next realm - NOT CPR.

      Doing CPR would make you feel better but it would be terrible torture for the patient.

      I ask him if he was warm enough? "Warm," he growled, "I haven't been warm since Bastogne."

      by Unrepentant Liberal on Tue Mar 05, 2013 at 07:53:49 AM PST

      [ Parent ]

      •  The guy who taught me CPR called it corpse kissing (0+ / 0-)

        The chief benefit being that the witnesses/survivors believe that "everything that could be done had been done."

        And when the victim is someone you know ... that counts for something.

        Besides ... there ARE rare cases in which manual compression CPR keeps someone's brain oxygenated long enough for real medical resuscitation be possible.  

        And there are specific situations  ... electrocutions and drownings primarily ... in which this kind of heroic first aid DOES "make all the difference."

        But most importantly:  teaching  CPR to random civilians has proved an enormously successful lure for recruiting blood donors and volunteers for more advanced EMT training.

  •  We put mom in a private facility, and (2+ / 0-)
    Recommended by:
    mrkvica, mamamedusa

    insisted that her living will be honored.  We were fortunate that she qualified for Hospice care, meaning some legal weight behind the living will.  If the family is satisfied with the care given, isn't it possible there was a DNR in place?  I'm not sure how these things play out in large facilities, without the weight of Hospice policies to protect them.  Just a thought.  Mom died peacefully, without pain, after we took responsibility to administer her morphine following Hospice guidelines.  

    I'm not looking for a love that will lift me up and carry me away. A love that will stroll alongside and make a few amusing comments will suffice.

    by I love OCD on Tue Mar 05, 2013 at 07:10:57 AM PST

  •  For the thousandth time............... (8+ / 0-)

    You don't do CPR on a breathing person with a pulse.

    The 9-11 dispatcher was attempting to overrule the wishes of the patient and her family - something they had no right to do.

    In real life, doing CPR on a 87 year old is, in my opinion as someone who does this for a living, it's torture and criminal elder abuse.

    If I find a collapsed 87 year old in a situation outside my work I'm not going to start CPR. I'm going to dial 911 and make them as comfortable as I can. I'm going to hold their hand, talk to them gently and comfort them as much as I am able.

    I'm not going to start compressions on their chests which fractures their sternum and ribs 100% of the time and causes intense pain and suffering and accomplishes nothing.

    I'm simply going to be with them and comfort them during their trip into the next realm. That's the COMPASSIONATE thing to do instead of breaking their ribs.

    I've been a RN for 24 years and have had to break ribs via CPR more times than I'd like to remember because the person or the family "wanted everything done" even when the situation was hopeless - that means CPR. That means broken ribs and that in their last moments on earth their bodies will be pounded into a mush of broken bones.

    You can feel and hear them snap, crackle and pop as you push down on their chest doing compressions. That a sound and a feeling that haunts me.

    The nurse in question was simply allowing natural death, which is a blessing in these days of the giant medical-industrial complex, to take place.

    The cry is to 'do something.' Well, CPR is 'something.' It's not a good something but it's something.

    People die. They just do. We and everyone we know will die. Hopefully it will be after a long full life and hopefully without the bodily insult of useless CPR.

    Because the big secret is CPR DOESN'T WORK UNLESS YOU ARE YOUNG AND HEALTHY - and even then only a tiny fraction of the time.

    If you are a kid or a younger adult I will work your code and do CPR forever - I will give it everything I've got - but in the elderly it's just cruel and something we wouldn't do to our beloved pets.

    Those are some of the reasons I personally think it should be illegal to do CPR on old people.

    I don't like tattoos but in about ten years I'm going to get one across my chest that says "NO CPR"

    I've seen it. I've done it. I don't want it.

    I ask him if he was warm enough? "Warm," he growled, "I haven't been warm since Bastogne."

    by Unrepentant Liberal on Tue Mar 05, 2013 at 07:42:15 AM PST

    •  Yep, I've heard of DNR as a tattoo. On (1+ / 0-)
      Recommended by:
      chimene

      medical professionals. That ALONE should inform readers of how awful it is.

      I'm sorry you've had to do that - but I know you were doing it for a family who wanted "everything" done, when most of the time, if you're honest with yourself, you just want comfort care. You don't want to be in pain. CPR is the opposite of this.

      You said the air was singing / it's calling you, you don't believe / These things you've never seen / Never heard, never dreamed.

      by CayceP on Tue Mar 05, 2013 at 09:53:21 AM PST

      [ Parent ]

      •  I do CPR on the elderly (1+ / 0-)
        Recommended by:
        CayceP

        only if I have to it for the family. But, in the end I think after they see what happens, both the family and myself are scarred by the experience.

        If they knew what it was like ahead of time they wouldn't do it.

        I breath a sigh of relief every time I see a DNR order on the chart of some critically ill older person as they come through the door.

        Comfort measurers and compassion is what they need.

        NOT CPR

        I ask him if he was warm enough? "Warm," he growled, "I haven't been warm since Bastogne."

        by Unrepentant Liberal on Tue Mar 05, 2013 at 10:28:08 AM PST

        [ Parent ]

  •  Last year my 82 year old Mom (4+ / 0-)
    Recommended by:
    BlueDragon, mamamedusa, CayceP, chimene

    almost died of respiratory distress and a whole host of issues due to her 50 years of smoking. When she stabalized and her pulmonary physician talked to her she hadn;t made up her mind about DNR etc. I,as an RN having worked in Cardiac, ICU and Neuro ICU's tried to talk to her about it. Then I broached her MD who ended up telling her all the risks and that she would NOT survive and would end up on a ventilator and then there would be the mess of trying to take her off etc.  At the end she decided that she would be a full code, they should do everything for her and I am not allowed to talk to or see any of her doctors.  It is a touchy subject but unfortunately one that MUST be made before  hand.
    I an only 61 and am a DNR along with no feeding tubes, no IV's nothing but pain management. My VA medical center has this on their records(electronic) and I carry a card with me.  I have no children and have no plans to go but should I do so I had a great life.

    "..if you keep the hope alive, then change is still possible." Van Jones

    by shanti2 on Tue Mar 05, 2013 at 08:06:37 AM PST

    •  COPD'ers are often the ones that want (0+ / 0-)

      everything done and who try to hang on to the bitterest of ends. I think it has something to do with their disease and the fact they can never get their breath.

      I ask him if he was warm enough? "Warm," he growled, "I haven't been warm since Bastogne."

      by Unrepentant Liberal on Tue Mar 05, 2013 at 10:31:22 AM PST

      [ Parent ]

  •  Two reasons for no CPR (0+ / 0-)

    1. From the nurse's point of view: if she disobeyed company policy, she would be fired. Sad but true.

    2. From the care home's point of view: CPR can inflict bruises and broken ribs, leaving the home vulnerable to a lawsuit by greedy survivors alleging mistreatment of the patient. An EMT send with an ambulance does not face that liability.

    Democracy - Not Plutocracy!

    by vulcangrrl on Tue Mar 05, 2013 at 11:33:11 AM PST

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