The Houston Chronicle clears up one question about the cancelled transfer of Andrea Clark: the doctors in Illinois discovered that they could not meet the needs of Andrea. More than likely, this was as they viewed the records released to them by the hospital, after the family signed the release.
Wesley Smith’s “Secondhand Smoke” has a letter from Andrea Clark’s lawyer to St. Luke’s Episcopal Hospital. There are a few things I think I can explain.
Under # 2, the discussion about the “interim summary” and the doctor’s “making himself unavailable to the family”
The best interim summary – a synopsis of the medical record and treatment during this hospitalization - is going to be in that ethics consult. If you need more information, it will only be from the time that the report was written until now. More than likely, the ethics committee has reviewed the chart, summarized and discussed the events described by the nurses notes, physicians notes (including progress notes, consults and surgical and procedural notes), and labs and tests. Or, you could just look at the “Assessment” of the last consult on the chart and work your way forward from there.
I wrote before that it is not reasonable – much less “unconscionable” – that the doctor took his vacation, if he arranged coverage. This is a hard lesson that we have to learn in med school or residency. We can’t be at work, on call 24/7/365. We can do it for days or even weeks at a time, but we have to get some rest without phone calls and trips to the hospital at night, sometime. If we have families – and want to keep them – we had better learn this lesson well.
#3, the discussion about HIPPA is mistaken in assuming that the medical record can be changed. Lawyers have taught us better than that! The procedure is to have the patient (or surrogates) write their assessment and it is added to the record. Nothing would be removed from a medical record, especially not the ethics committee consult.
#5, the request that Dr. (3) be removed from the case, with the objection that he is an “ob-gyn.” The specialties of members of the ethics committee are irrelevant to their function on the committee. In fact, many committees, like this one, have lay members including clergy, who have specialized training to offer. Not all of them will have formal clinical ethics training. There are books and papers about the practice of clinical ethics, and many certification and degree courses available. None of the members needs to be able to actually treat the patient. They should have a general understanding of medical care and disease. The actual care and report on a patient’s status and treatments come from the attending doctors, nurses, the chart, and sometimes consultants (such as neurologists).
If the committee did not believe what the attending told them about the medical care and status of a patient, I imagine that they would report him to the hospital medical administration. They certainly wouldn’t agree to confirm his treatment.
I’m sure that Dr 3 will be more than happy to withdraw from the case.
#7, the assertion that anyone would attempt “to unduly or unreasonably persuade, intimidate or bully any potential treating physician into accepting Dr. 3's opinion that life-sustaining treatments should be withdrawn” is not realistic. The best description of trying to get doctors to cooperate is that it’s “like herding cats.” We’re a pretty independent, prideful bunch, who depend on and live by our skills and reputations. We are self-driven to be the best.
(I’ll tell you a secret that’s gotten me through the day without many – well, with fewer than there could be – cat fights: remember that most if not all of the docs were the kids who always made A’s and thought themselves smart and competent. If you challenge this self-view, you will end up with someone motivated to prove you wrong and to be smarter and more competent than ever.)
I don’t know how #8 can be satisfied. Any pressure from the insurer will be in the form of denial of payment, requests for documentation, preauthorization and daily status reports. I doubt that anyone would keep any notes on any of this.
As to the last 2 paragraphs, I would suggest that the lawyer should file her papers with the court for a delay as laid out in TADA, but I doubt that the doctors will stop the intensive life-sustaining care before the meeting that is scheduled. I don’t understand why the doctor just doesn’t take over the case. Perhaps their doctor can get emergency privileges. There’s no validity to the claim that the law requires transfer to another facility, except where no doctor in that facility will accept transfer of care.
Finally, the care has been deemed futile and not in the best interests of the patient. That is not to pass judgment on quality of life or whether life is worth living. It simply means that the treatment and the side effects that build up from it hurt the patient more than it helps.
Monday, May 01, 2006
Prolife medical comment on Andrea Clark
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3 comments:
Thank you for another excellent rebuttal of what has become an echo chamber of misinformed fury at physicians and health care facilities.
Even the lawyer seems to have her knickers in a knot to the point of being insensible. HIPAA, for example, permits the clinicians to share information among themselves without the patient's/family's permission if it is for the purposes of patient care (as must be done for consults). The ethics consult falls into this category and the family really has no control over it.
Thank you both, Maureen and Catholic Mom, for your comments.
I just wish I could help out by interpreting some of the medical jargon and soften the harsh rhetoric.
And it bugs the dickens out of me to see misrepresentations of the actual law.
I wonder whether the hospital records department was cautious and refrained from sending records to the Illinois doctors before they had written consent and/or whether this caution about HIPPA was one of the reasons for the demand that the family make a decision ASAP, rather than delay to Saturday or Sunday.
As it stands, I don't know how to define "natural death" while a patient is on dialysis, a ventilator and pressors. I'm afraid that she will only be allowed release after failed CPR when she has a massive heart attack, sepsis (gangrene)in one of her extremities due to low blood flow caused by the pressors, bleeding due to the liver congestion and sepsis, or when the liver congestion leads to overwhelming liver failure.
I have not been privy to the counseling and confersations between Andrea Clark's family and the physicians at St. Luke's hospital. However, I have seen the sort of impasse being displayed publicly in this case when patients and their families feel there has been no sensitivity or respect for their perspectives. During a traumatic time of illness, patients and their families need to have information repeated over and over in order to fully process it. If the doctor is too busy to do this, someone else needs to be designated to compassionately listen and respond to concerns. Anger results when family members do not feel they have been adequately heard.
Many in the medical community do not hold all human life as sacred or dignified. They are quite willing to dispose of any life deemed imperfect. Note the case of Haleigh Pourtre. I do know that my own grandmother was in her late 80's when she suffered a stroke and developed aspiration pneumonia. She was on a ventilator. A social worker boldly asserted to my mother that the best thing she could do was to pull the plug, put my grandmother in a dark room and get death over with. My mother called me, quite distraught, because the social worker had offered her recommendation without getting to know my mother or my grandmother. I could tell my mother wasn't ready to let go and was really hurt by the callous manner of the social worker. I told my mother it was perfectly acceptable to try a course of antibiotics to treat the pneumonia and see how my grandmother responded. My grandmother did respond, was extubated, and was discharged to a nursing home. She lived another eight months. During that time she reconciled with family members and everyone felt that valuable time had been gained.
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