Woman dies as nurse refuses to perform CPR

[davidn3600]

BAKERSFIELD, Calif. (AP) — An elderly woman being cared for at a Bakersfield retirement facility died after a nurse at the facility refused to perform CPR on the woman after she collapsed, authorities said.

When the 87-year-old resident of Glenwood Gardens collapsed at the facility around 11 a.m. Tuesday, a staff member called 911 but refused to give the woman CPR, Bakersfield television station ABC23 reported Friday.

In refusing the 911 dispatcher's insistence that she perform CPR, the nurse can be heard telling the dispatcher that it was against the retirement facility's policy to perform CPR.

http://www.sfgate.com/news/article/Elderly-woman-dies-after-nurse-refuses-to-do-CPR-4323453.php#ixzz2MWUgR5ad

[bluedigger]

1. I saw this report earlier today and couldn't believe it.

The poor 911 operator was desperate to get somebody to perform CPR.

[840high]

7. What if there

was a DNR order?

[bluedigger]

10. That was not the reason they gave in refusing to perform CPR.

The retirement facility released a statement extending its condolences to the family and said its "practice is to immediately call emergency medical personnel for assistance and to wait with the individual needing attention until such personnel arrives."

Read more: http://www.sfgate.com/news/article/Elderly-woman-dies-after-nurse-refuses-to-do-CPR-4323453.php#ixzz2MXrXmT8Z

[sakabatou]

78. What kind of fucked up practice is that?!

[Tempest]

115. If there was a DNR order, emergency wouldn't have been called. n/t

[pipi_k]

120. As of this morning...

I heard on the news that there was no DNR order

[LiberalFighter]

2. They need to lose their license.

[pinboy3niner]

5. The licensure of the nurse, other staff, and the facility are in jeopardy

Local news interviewed a medical ethicist whose reaction was

[Dorian Gray]

104. She's a nurse

and refused to perform CPR on a dying patient? WTF???????

[progressivebydesign]

144. Sorry, but you don't do CPR on a "dying" patient. You do it on a dead patient. n/t

[anneboleyn]

148. No not "dead." CPR is crucial to maintain oxygenated blood flow

in persons who are in imminent danger of death (meaning gasping for breath/inadequate breathing which will result in death; no pulse/heart stops due to heart attack, etc.), not "dead" but dying.

http://www.mayoclinic.com/health/first-aid-cpr/FA00061

http://en.wikipedia.org/wiki/Cardiopulmonary_resuscitation

Good old wikipedia has a good explanation of the proper procedure.

This woman was clearly in need of CPR (I am assuming she needed chest compressions as well as artificial respiration) as she was not breathing adequately on her own per the nurse's own report -- clearly, since the woman died soon after the 911 call -- to sustain her vitals. CPR is precisely performed on dying persons -- persons in acute distress. This woman MIGHT have lived had CPR been performed until the EMTs arrived and could defib her if appropriate. I didn't hear the nurse say if she had a pulse but I am assuming that the nurse realized (as did the 911 operator) that CPR was appropriate. She did not perform the CPR for *legal* reasons, as she stated, not for medical reasons. She clearly states that she was not permitted to perform CPR because of the "rules" of the independent care facility.

[Dorian Gray]

150. Thank you....

I was going to respond, but you gave the perfect answer.

[glinda]

39. They (our local news) said most States have this "order" in Senior Facilities.

[LiberalFighter]

99. And the teabaggers were worried about death panels?

[pipoman]

3. If "retirement facility" means skilled nursing facility,

(as I suspect) A policy against CPR may be quite reasonable.

[HipChick]

4. I wonder if residents had a DNR order..

[pipoman]

21. I work in a skilled nursing facility

I believe there are more residents who would be disappointed if they were resuscitated. My sister died last year at 50 of pancreatic cancer. Several months before her death she embraced the idea of death as do most terminally ill people at some point. People who are receiving "skilled nursing care" in a "skilled nursing facility" (these are very specific classifications with very detailed descriptions in insurance policies and defined by medicare) usually being treated for memory care, parkinson's, and a myriad of other ailments...all of them debilitating to the point of requiring around the clock nursing care. These people for the most part know they are going to die there and are good with the idea of death. They, like everyone else wish when their time comes they close their eyes and just not wake up. There are things worse than death and these people see them every day. A policy for a facility for no CPR may be the most humane policy..further each resident would most likely have to agree with this policy upon entering.

[HiPointDem]

62. A skilled nursing facility is a nursing home certified for Medicare. It includes lots of kinds of

care, including rehabilitative care.

Why would I need skilled nursing or
rehabilitation care?
You get skilled nursing care to
• help improve your condition, or
• maintain your current condition and prevent it from getting
worse.
You get skilled rehabilitation care to
• help improve your condition within a
predetermined time period, or
• set up a maintenance program designed to maintain your
current condition and prevent it from getting worse.
Skilled care helps you get better, function more independently,
and/or learn to take care of your health needs. You and your
family will be able to take part in setting your health goal. See
pages 21– 22.

http://www.medicare.gov/Pubs/pdf/10153.pdf

So no, I don't see any reason that SNF's as a blanket rule should have 'no cpr' rules.

[pipoman]

105. True,

Not "skilled nursing facilities" (as a whole) as much as departments within "skilled nursing care". Skilled nursing care may include people who are recovering from treatments or ailments with high probability of returning to an independent environment. Maybe departments within skilled care could have blanket DNRs (not that I necessarily believe it would be the best scenario, and my employer doesn't have such a policy I am aware of) for anyone receiving care in that department..i.e. memory care, Parkinsons, etc., it may be reasonable. Further to qualify for skilled care medicare billing one must meet medicare guidelines which are very specific. I'm not saying this is the case, only that if a facility has a policy of no resuscitation for certain types of treatment or if they are sure all people in those programs individually have DNRs, the resident would necessarily have to know and agree in advance.

[malaise]

86. That's perfectly reasonable but if that is their policy

why do they call emergency services?

[pnwmom]

93. Good question. I've heard that if you don't want attempts at resuscitation,

you shouldn't call 911. But that's if your relative has a DNR.

[pipoman]

101. Apparently in this case

the person wasn't in the health care part of the facility, rather independent living. People in independent living (except for those with DNRs because of some health issue) shouldn't be under a blanket DNR so should receive emergency care if needed. This sounds like a mistake or bad policy of not allowing facility employees to assist in emergency treatments. At the facility I work at, I, not working in healthcare but in dining, have never been told I shouldn't assist. On the contrary, I have been trained on the use of a portable defibrillator near my office and have been kept up on changes in recommended CPR procedures. I have performed the Heimlich maneuver on a resident of independent living and that person to this day introduces me to her guests as 'her savior'.

[pinboy3niner]

102. Good for you!

If someone in this life counts you as his or her savior, you can go to your rest content.

[malaise]

106. Then there should be CPR

nurses in that section for those without DNRs

[pinboy3niner]

109. Absolutely

The presumption always shoud be in favor of life, no matter what your employer prescribes as its "policy."

[pipoman]

110. I don't disagree

I was just stating I could imagine a policy in some facilities of not resuscitating people receiving skilled care, not that I believe such a policy is necessarily the best option..

There also enters the possibility of regulatory issues or issues of liability imposed by states or facility insurance companies...this is all speculation..no idea what facility policy is being imposed in this case..

[anneboleyn]

149. The nurse did not say so. Only that she was not permitted to perform cpr

because of their "rules."

[pinboy3niner]

12. From the linked story, she was in the "independent" part of the facility

An ambulance arrived several minutes after the call and took the woman to a hospital, where she was later pronounced dead. She has been identified as Lorraine Bayless, a resident of the home's independent facility, which is separate from the skilled and assisted nursing facility.

Apparently, in the independent section only non-skilled nurses will respond, for the purpose of not assisting.

[pipoman]

25. Sounds odd for sure

I can envision a call coming into the facility and a nurse from a department within "skilled nursing" which has a DNR policy not realizing that the no DNR policy only applies to skilled nursing. A mistake...a tragic mistake if so..

[HiPointDem]

13. because...?

[pipoman]

26. see post 21

[HiPointDem]

65. see post 62. SNF is a facility certified for medicare and does not necessarily = end of life care.

[pipoman]

108. True to a point..the distinction between

a "skilled nursing facility" and "skilled nursing care" is that the facility may have areas which are not skilled care. Or may have areas within skilled care which are more recuperative with a purpose of returning residents to a more independent arrangement. OTOH, aside from recovery, few people who enter skilled care in a skilled facility ever come out of skilled care and do ultimately pass while in skilled care...and most are receiving care for potentially (or surely) fatal ailments.

[Hassin Bin Sober]

16. The article says she was part of the "independent facility"

Separate from the skilled and assisted facility.

Not sure what the difference is and why call requesting rescue help?

[pipoman]

33. Part of the function of a "CCRC"

(continuing care retirement facility) is assisting all residents on campus. Some CCRCs have their own "I've fallen and I can't get up" buttons independent living residents can get which when pushed sends a signal to a monitored nurses station in the nursing facility and facility nurses are first responders. From there I suspect a misunderstanding about the boundaries of a blanket DNR portion of the facility and other areas of the campus with no such policy.

[Hassin Bin Sober]

41. Did you (anyone) listen to the tape? I didn't see a link in this article.

I saw the transcript as I worked out yesterday. The nurse was clearly requesting help. She just wouldn't (couldn't) give it.

I think there may have been a misunderstanding as you say.

[davidpdx]

95. My grandfather and his wife (not my grandmother because it's his second marriage)

lived in a retirement center in a condo duplex. The idea is they have different levels of care, that one being the lowest level. If something happens, then they move into the main building where they are watched closely but still have some independence. When we visited we had to go into the front building to sign in and then drive around to the back where there was a gate for the area they lived in. Granted his wife had money so obviously they lived well (he didn't unfortunately). Personally I thought she was a snob. He passed away three years ago and I've exchanged a few letters with her and that's about it.

[glinda]

43. I thought it was just Senior Housing which is different from

Assisted or Skilled Care.???????

[pipoman]

49. Yeah,

it does look that way unfortunately..

[da bear]

80. insurance

I work in an assisted min skilled facility. We have no full time nurse and qmaps (me) give them their meds while caregivers help.with dressing and clean the rooms. our sop is to call 911 but do no CPR or anything other than layman assistance. Cuz the insurance will not cover anything we do above that. We actually had a lady get fired for doing CPR. She was an insurance liability.

[ismnotwasm]

48. No

It's an individual choice by law. I've worked in LTC. It's not always the best decision, the survival rate is low in any circumstances, and coding the elderly is tough, ( you're more likely to feel ribs crack, for instance) but it is their choice. Even an 'undecided' code status is treated as a full code.

Unless the law differs in different states, it looks like this nurse was incredibly negligent and will probably lose her license. You don't make these choices for people, unless they are incapacitated and you have legal medical power of attorney.

[TwilightGardener]

6. Did this elderly woman have a DNR order? Was this a licensed nurse,

or an aide of some kind (everyone is a "nurse" until proven otherwise anymore). WAS this actually facility policy, and why? And it's wrong to assume that CPR would have saved this woman--did the staff even establish that the woman had no pulse and wasn't breathing? Was she actually in cardiac arrest? So many details unknown, makes it hard to judge.

[H. Cromwell]

8. Had A DNR in place

The 87yr old DID have a DNR order in place. perfectly legal and right Not to do CPR.

[Hassin Bin Sober]

11. Then why was the nurse calling for rescue?

Did you listen to the tape?

The nurse was clearly requesting rescue help.

[840high]

17. That was standard

procedure in the home Dad lived in. He did have a DNR order but paramedics were called anyway.

[Hassin Bin Sober]

20. Don't you think they should clue in the rescue squad racing to get there?

Or the dispatcher for that matter?

[joeybee12]

135. I think the dispatcher wasn't trained well...

I would think that'd be a question they are told to ask...

[Warpy]

19. That's standard procedure

for any resident who suddenly becomes very ill.

[niyad]

36. the linked article does not indicate that she had a dnr. have you seen another report? if so,

the link would be helpful.

as others have indicated downthread, we know that performing cpr on a person of that age is not the wisest choice. but having all the facts would be helpful, because something sounds a little off here.

[roxy1234]

98. Link below

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.

http://www.dailymail.co.uk/news/article-2287442/Glenwood-Gardens-Dispatchers-desperate-plea-nurse-save-woman-87-stopped-breathing-refused.html#ixzz2MW76IAN3

So yea, everything was in the up and up and the family would have sued the hell out of the nursing home and the nurse if they had gone ahead and performed CPR on her.

[SunSeeker]

129. The LA Times and a local station said there was no DNR.

Even if there had been a DNR, the nurse did not know about it. She was not refusing help because there was a DNR in place. She was refusing help because of the home's policy to ONLY call 911, for ANYONE--whether or not they have a DNR. If this nurse knew this woman had a DNR, she would have told the dispatcher.

http://www.latimes.com/news/local/la-me-0304-senior-dispatcher-20130304,0,43655.story

[roxy1234]

133. You made a good point

But imagine this scenario, the nurse tries a successfully performs a CPR, the woman survives but with complication. What is to prevent this lady from suing the ass off the hospital cos as far as she is concerned the agreement with the facility says that the 911 dispatch perform CPR not the nurses.

People have to be careful what agreements they are signing in the sue happy nation.

[progressivebydesign]

145. thank you. People LOVE to get outraged about everything. nt

[SoCalDem]

89. Since she had a DNR, they should have moved her to her room

and let her go in peace.. That's what DNRs are all about, but it still has to be hard for the people who want to help..even when the help asked for by the person, is to do nothing

[RobinA]

103. Not Only is It Legal

but the facility could get into trouble for resusitating her with a DNR in place. This DOES happen. Even if the person saved is relatively OK after the event. The red tape and rules about who can do what when in the medical field are byzantine and the consequences of not doing the right thing, even it the outcome is OK, are significant. Common sense does not apply.

[nobodyspecial]

9. If I was 87 and in a nursing home

I would have a DNR on file.

[DURHAM D]

14. This is a stupid story.

Occupants in these facilities fill out their own orders. They are reviewed with the occupants (and family if appropriate) on a regular basis. Generally they are kept very handy, most often on the back of the door of each occupant's room or apartment. My parents lived in a retirement community for the last 14 (mother) and 15 (father) years of their life and they had do not resuscitate orders from day one.

[Warpy]

15. I would have tripped the code team

if my 89 year old dad hadn't made himself DNR close to the end. It would have been like jumping on a strawberry box, 89 year old ribs being that fragile. And he'd been self care, living at home until his final illness, not frail enough to be in a nursing home.

I hope this nurse has written policies and procedures to back her up at that particular nursing home. In frail elderly people CPR is not going to work well and can leave them with serious injuries, the least of which are a shattered ribcage and lacerated lungs and liver. It's good that she called paramedics instead of jumping in.

My sympathies are with the patient's family. It's not easy to lose someone no matter how old they are. However, immediate CPR is not always indicated.

[Hassin Bin Sober]

23. That makes the most sense.

Defibrillate versus CPR (absent a DNR)

To this day I still get pissed thinking about my mom being revived twice before she passed. She had a DNR in the hospital (terminal lung cancer). I can only imagine what she went through.

[Warpy]

31. I've seen things like that

and it's why I'd have tripped a code team if he'd gone into cardiac arrest. I wanted my dad to live forever but not like that.

It just doesn't work well in frail elderly people, no matter how much families want it to. I used to get furious when ER was on, nobody ever got broken ribs, the code always worked, and they all lived and got well and went home. I wish verisimilitude had entered into it somewhere.

[X_Digger]

52. There's nothing like that wet pop of ribs breaking on an elderly patient. *sigh* n/t

[Warpy]

55. Yeah, and you can feel it all the way up your arm.

I wish more people were educated on what "do everything" means for a 90 year old.

[Major Nikon]

73. That is sad

When my dad was terminally ill the hospice nurse told us not to call 9-11 when he passed because the paramedics would try to revive him. I'm glad we didn't have to go through that. It must have been horrible.

[aquart]

158. My Dad was also revived with a DNR in place.

[TwilightGardener]

32. Absent a DNR, and assuming the caller was an RN or LPN/LVN, then

I think licensure and state board of nursing practice laws would override facility policy. Bottom line, the nurse has a duty to act according to the regulations and requirements of her state license, despite anyone else telling her any differently. Which means that if a suit is filed, the nurse will be hung out to dry by her facility, and the facility's lawyers will point the finger at HER to protect themselves.

[Warpy]

34. Not necessarily

Nursing homes are different. The one where I worked would call the paramedics rather than have any of us perform chest compressions.

If the policy is a written one, she won't be hung out to dry. I think the family is probably looking to hit the legal lottery and will be happy with an out of court settlement, a make-it-go-away payday.

[TwilightGardener]

47. I'm surprised that it would be legal to not allow staff to respond as they've

been trained and licensed to do--they have a duty to the patient just by working in that facility and being licensed. Not all nurses have ACLS, but all do have BLS, as do certified aides. Simply being elderly and living in an assisted-living facility shouldn't mean you are at the mercy of however long it takes for EMS to arrive, when you have licensed or certified personnel present who are trained in basic resuscitative efforts. If the family really wanted to press, I think a case could be made against either the nurse, the facility, or both. Of course, this is assuming there was no DNR that applied to this patient.

[Warpy]

50. Nurses and other BLS certified people have never had an absolute

obligation to perform chest compressions in all circumstances. There are exemptions.

In this case, in the presence of a DNR order, had the nurse started compressions, she would have been open to an assault charge.

The responsibility to the patient was discharged when paramedics were called.

[TwilightGardener]

56. I'm not saying she wasn't in a tough spot. I don't necessarily think

she did the wrong thing. But there needs to be closer examination of whether facility policy contradicts the state board practice act. I find it strange that the nurse was not allowed to begin resuscitative efforts (provided the patient truly was pulseless or was in respiratory arrest), since even non-medical facilities have AED's now--they are in common use. Besides, what if this woman had simply had a foreign object airway obstruction?

[R B Garr]

140. That was exactly my question regarding whether a nurse has a professional duty

above and beyond an employer's policy as part of a licensing procedure and/or medical profession oath of some kind that I'm not aware of.

Even the explanation of a possible DNR for this person (are they even called patients in a nursing care facility?), there needs to be a more standardized method of explaining the emergency to 911. That nurse really came across as almost a little nutty with her stammering and lack of focus. For a nurse, I would assume she would have had to be in control of the scene until other medical professionals arrive. It seems there needs to be better procedural communication as an industry standard in retirement homes. That was pretty shocking to listen to the lack of urgency and disorientation of that nurse.

[SunSeeker]

76. There was no DNR, and the nurse would have good samaritan immunity from assault charges.

The law varies from state-to-state with regard to the specific scope of immunity protection granted for administrators of CPR. Federally, under the Cardiac Arrest Survival Act (11/2000), Congress granted immunity from civil damages for administering CPR and using an AED with some restrictions (i.e. immunity does not apply in cases of gross negligence and/or willful misconduct).

In California, for example, Good Samaritan immunity is granted to those trained in CPR and "who in good faith, renders emergency CPR at the scene of an emergency," those who provide such training ("local agencies and other organizations&quot , and those who provide instruction.

Nationally, bystanders do not have a duty to respond, however, common carriers and businesses have a duty to call 911 and to provide medical aid until professional services arrive.

http://wiki.answers.com/Q/What_does_the_law_say_about_administrating_CPR

The responsibility to the patient was not discharged when paramedics were called.

[SunSeeker]

18. The nurse was only authorized to help those who pay extra $$$$ to be in the assisted living section.

"[the deceased woman was] a resident of the home's independent facility, which is separate from the skilled and assisted nursing facility.

The retirement facility released a statement extending its condolences to the family and said its 'practice is to immediately call emergency medical personnel for assistance and to wait with the individual needing attention until such personnel arrives.'"


They better settle the inevitable lawsuit quickly.

[DURHAM D]

22. Not going to happen if a DNR is in place.

[Hassin Bin Sober]

29. Maybe the next lawsuit will be the person killed in the resulting car accident...

... from what is basically a false alarm.

I don't understand the logic of calling for rescue of someone with a DNR.

I just sat bedside for five days with my father in law dying of cancer. When he arrested we didn't call an ambulance. We called the hospice nurse to pronounce him.

Seems to me there should be a better process in place for gathering 87 year olds with DNRs than risking life and limb to speed through traffic. Can fire rescue even deal with DNRs?

[pipoman]

42. Independent living people are frequent fliers

and often are resuscitated to go on with their lives for more years.

[Hassin Bin Sober]

46. Yes. I've know plenty of healthy high eighties folks who wanted to keep on living.

[SunSeeker]

40. The home admitted its policy is to not touch ANYONE in the independent living part of the home.

You can bet if there was a DNR, the home would have mentioned it, instead of all the mea culpa lines about condolences to the family and that a "thorough internal review of the matter" would be conducted. As the article--and the home--pointed out, the deceased women lived in the independent living part of the home, not the assisted living/nursing section.

This sounds like it was just a case of you didn't pay the money for assisted living/nursing, you don't get the CPR.

Here's the home's statement:

First and foremost, we extend our deepest sympathies and condolences to this individual’s family on the passing of their loved one. We also appreciate the assistance of emergency personnel who arrived immediately to assist in rendering first aid. 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. That is the protocol we followed. As with any incident involving a resident, we will conduct a thorough internal review of this matter, but we have no further comments at this time.


http://www.turnto23.com/news/local-news/glenwood-gardens-in-bakersfield-refuses-cpr-releases-statement-on-policy-and-residents-death

[pnwmom]

91. They can have a policy like that legally as long as they are up front about it.

People living in a retirement community -- which she was -- are living with hotel-like services, not health care or other special assistance.

[SunSeeker]

121. Doubtful. That nurse had ethical obligations as well.

Any human being with CPR training would be ethically obligated. And you can bet they didn't tell any senior or their families they were marketing their $2,000/month "hotel" to that should their "hotel guest" collapse while eating in the lunch room, they will ONLY call 911 and then just watch the "hotel guest" die--not even check if the "hotel guest" is choking or just do simple chest compressions. That is less help than she could have gotten from passersby had she collapsed in front of a supermarket or an actual hotel. Did you hear the 911 tape? The dispatcher begged the nurse to find just that --a passerby--who that dispatcher could then instruct to do chest compressions. The nurse said no. Unbelievable that you and others are defending this home in this thread.

[pnwmom]

141. I'm not defending the home, but the daughter did say that she thinks

her mother would have died even if she had had CPR.

Maybe she knows something about her mother's condition that made her say that.

(And it's probable, I think, that she and her mother knew about the facility's written policy and consented to it.)

[pnwmom]

90. Why do you say that? My MIL lived in assisted living and had a DNR in place.

They're not incompatible.

[DURHAM D]

111. My comment was in response to the last sentence.

[nadinbrzezinski]

44. If there is a DNR in place

there won't be a lawsuit. if there was no DNR in place...

And yes, I have performed CPR in elderly patients. and your chances of having a successful code are low and the broken ribs are impressive. This is what might have led to that internal policy, which countermines standard medical protocols unless there is a DNR in place.

For the record, the article mentions DNR at no point, so this is speculation on all our parts.

[SunSeeker]

54. CPR success is usually low, but not a reason to not even try.

An elderly person can survive cracked ribs. A stopped heart, not so much. Considering this women lived in the independent living part of the facility as opposed to the assisted living/nursing part of the facility, I think there is a good chance she did not have a DNR in place.

But the real issue here is why this facility had an admitted policy not to do CPR or ANYTHING other than call 911 when it comes to any medical emergencies suffered by ANY residents of the independent living facility (as opposed to the assisted living/nursing facility). The home's full statement is here: http://www.turnto23.com/news/local-news/glenwood-gardens-in-bakersfield-refuses-cpr-releases-statement-on-policy-and-residents-death

The specter of this NURSE just sitting there waiting for the paramedics, staring at this dying women, is mind boggling.

Again, I think it just comes down to money. The facility did not want to provide nursing help to residents who were paying cheaper rent at the independent living part of the facility...and the nurse did not want to lose her job.

[nadinbrzezinski]

57. As I said, the difference is truly a DNR or not

[SunSeeker]

66. There was no DNR, but the real issue is the home's inhuman policy.

"On the tape, a different Glenwood Gardens employee said that an elderly woman had passed out in the facility's dining room while eating. She was barely breathing and, according to KGET-TV, did not have a do-not-resuscitate order."

http://www.latimes.com/news/local/la-me-0304-senior-dispatcher-20130304,0,43655.story

But regardless, whether or not she had a DNR, the reason this story is picking up steam is that the home has a POLICY of ONLY calling 911 in case of medical emergencies. Do you agree with the home's policy?! The LA Times article provides a lot more details. The nurse's conduct is chilling. She insisted on following the home's inhuman policy. She just sat there and watched this women. What if this women had stopped breathing because she was choking on food (she collapsed in the dining facility)? To not even touch her to see if she was choking or refusing to do just simple chest compression for a few minutes. Unbelievable.

I am not a nurse, but I was trained to do CPR and First Aid by my office where I work, as were many of my co-workers (and they refresh our training every few years). We are ready to step into action should anyone collapse. And we are just a regular office with a healthy workforce, not a seniors home. EVERYONE working at that seniors home, from the receptionist to the janitor, should know how to do First Aid/CPR and be encouraged to do it.

[nadinbrzezinski]

68. Absent a DNR the policy violates

A few bioethics rules for starters.

Why I said, the issue hangs on a DNR or lack of it.

[pinboy3niner]

74. That's why the nurse's callousness is so shocking

I've known a lot of R.N.s, but I don't think any of them would withhold potentially live-saving assistance in an emergency, no matter what their facility's "policy" dictated. R.N.s go through a lot of very rigorous training in both nursing theory and practice which they are unlikely to discard so easily.

It's not clear in this case what kind of nurse was involved, but it would be very surprising if it turned out to be an R.N.

[nadinbrzezinski]

127. I don't think it is that shocking

It's the kind of society we are evolving into...me, I, how will this affect moi?

If she does CPR...she will lose her job.

In reality we should not know this happened, because this happens more often, not just in retirement places, than we'd like to think.

Yup, bioethics rules are violated, but bioethics, like philosophy, is not required.

Now, here is what I would like to see happen...and don't expect it by the way...state policy mandating CPR in non-DNR patients living in a facility like this, who are living independently and happen to fall down, like this case.

If there is a DNR, carry on.

[SunSeeker]

79. The issue of the propriety of this policy does not hang on whether there is a DNR.

The fact that many of the home's residents may have DNRs that may get the home off the hook in their particular instances does not save this policy. A policy that the home will not render ANY aid to ANY resident in the independent living section of the home, whether or not there is a DNR, is inhuman, unethical and would appear to be illegal on its face for such a facility.

[nadinbrzezinski]

124. What part of we agree is missed here?

[HiPointDem]

82. while eating? and they couldn't even touch her to check for obstruction? now *that* would be

lawsuit material.

[vankuria]

112. My Dad had CPR at 92

and survived with no cracked ribs. He was a healthy 92 and was in the hosp. with pneumonia and went into cardiac arrest. He came back very quickly but was in a weakened state. He survived for only another few weeks because he never got his strength back. We were thankful for the extra time.

When my mom was in her 90's and in a nursing home at 94, the first year she did pretty well and had no DNR. The 2nd year she went through quite a bit and decided a DNR was good to have.

My understanding is this lady was in Indep. Living at this facility and the policy was no medical procedures were done on those living independently. I would think that if an emergency situation came up and there is medical personnel right there, they would perform whatever was necessary. The fact that this woman was living independently must've meant she was in reasonably good health for her age. When I listened to the nurse who called 911, she said nothing about a DNR, I would think when the 911 dispatcher was instructing her to do CPR, she would've explained a DNR was inplace.

[sweetapogee]

136. there is a difference

between CPR in a hospital setting and say in a nursing home. Every time that I have been involved in CPR compressions in the field, even with patients that I was sure had passed, the patient required aspiration. A patient requiring CPR also needs an advanced airway and IV drug pushes. An AED is only going to deliver shock for certain rhythms (V-TACH or V-Fib). This may buy time but 4 minutes is the general rule without high quality compressions and I think 10 minutes with. Even EMT-Ps in my state will not shock a patient in asystole but will do compressions and place an airway in and vent but it depends on the length of time the paient was pulseless. Key word pulseless.

What is not being mentioned in this this rather large thread is once a first responder starts CPR, it takes a EMT-P or higher with asystole showing on a 12 lead, airways in place and all the IV drugs administered and then maybe 20 minutes of compressions before a command doc will allow termination of the effort. In other words, once you start CPR you have to go through hoops and more to terminate even when there are signs inconsistant with life.

Another thing that puzzles me is that the 911 operator was told by the nurse that the patient presenting with shallow breathing. Not defending the Nurse since I wasn't there and HIPPA laws are keeping the nursing home quiet but generally a person who is breathing has a pulse. CPR is generally given when the patient is not breathing. If this was the case the correct first response would be to protect the airway which is not easy, actually impossible to do if a single person is performing compressions.

I believe that the sucess rate for CPR in a non-trauma code is about 3%. Glad your Dad was one of the 3%. A couple of years ago I worked a patient who coded on a beach, responded from my home with full BLS gear and a knowledgeable partner and we managed to get a rhythm with several hundred people watching. The best feeling ever!

[anneboleyn]

151. THIS is the evil truth. The elderly without $$$

are the ones who get the worst treatment. We had several relatives who had to pay out huge sums of money to ensure that they were not treated like other poor souls in a nearby "lower class/cheap" facility for the elderly. The treatment (or rather lack thereof) was absolutely shocking. Frankly it was nineteenth century. The poor persons who ended up in this facility were placed in corners and/or other in random spots in wheelchairs and left for hours at a time, soiled diapers and all.

[H. Cromwell]

24. As I Read

the article there was DNR in place. Anything done to the patient after that is in place is considered assult. To me it was a misleading titled article.

[KittyWampus]

28. And the title of it starts with the word "elderly". Which changes one's initial impression

[pinboy3niner]

30. There is no mention of a DNR order in the report

Not in the video report or in the written story posted with it. Where are you seeing that?

[bluedigger]

37. You must be reading a different article than I.

Nowhere in the linked article does "DNR" appear.

[nadinbrzezinski]

38. There is no mention of the DNR anywhere in the article

also, if there was a DNR there would have been no transport by paramedics.

Yup, have heard enough of these over the radio. Hell, the Coroner is not called either.

[kestrel91316]

61. My mom was in assisted living and we had a DNR on her for years.

When she finally went the facility placed two phone calls: one to my sister, and one to the funeral parlor. Oh, and perhaps one to a physician or the county.

[nadinbrzezinski]

64. Yup, I know that in San Diego at times they still call paramedics

Why? Err on the safe side I guess...but those 1144 (doa's) are followed by DNR and cancel of coroner call out.

That story does not say if a DNR was in place, but a DNR means no CPR. Why I wonder.

[sibelian]

81. Yes, EXTREMELY misleading, if there's a DNR, the nurse is not EMPOWERED to resus.

Total codswallop!

[HiPointDem]

83. it didn't say anything of the sort.

[KittyWampus]

27. The Actual Title Is ELDERLY Woman Dies As Nurse Refuses to Perfom CPR. Why Was "Elderly" Left Out?

[morningfog]

35. What difference does it make?

[Journeyman]

51. The article was also "updated" at some unspecified time. . .

perhaps that clarification was added after the OP posted the article.

[SmileyRose]

45. more crappy journalism

story written to cause outrage toward the nurse. Conveniently leaves out she had DNR orders AND smashing on 87 yr old ribs is stupid. Shattered ribs and punctured lungs?

[SunSeeker]

60. Where do you read that she had DNR orders?

It's nowhere in the article or video. Nor in the other article linked in that article. http://www.turnto23.com/news/local-news/glenwood-gardens-in-bakersfield-refuses-cpr-releases-statement-on-policy-and-residents-death

And cracked ribs are a risk with any CPR effort. A nurse should be able to do CPR without cracking ribs, let alone puncturing a lung. Regardless, cracked ribs are not fatal. A stopped heart is.

My outrage is more at the facility, which has an admitted policy not to touch residents of their independent living home (opposed to their pricier assisted living facility). They put that nurse in that position, and unfortunately, she was able to suppress her humanity enough to follow their policy.

[Samurai_Writer]

138. Cracked ribs, CPR and the Elderly

You said:

"And cracked ribs are a risk with any CPR effort. A nurse should be able to do CPR without cracking ribs, let alone puncturing a lung. Regardless, cracked ribs are not fatal. A stopped heart is. "

Actually, if you are doing CPR RIGHT... you WILL crack ribs, almost always, in the elderly. The amount of force you need to do chest compressions is high... have you been in a real CPR situation, giving compressions for 3-5-10 minutes or more? I have. It is extremely hard to do, and extremely tiring. Nurses and other trained personnel do crack ribs, frequently. And CPR CAN kill an elderly patient, from cracked ribs and just the trauma of the CPR.

CPR only works in 1 out of 10 cases. And that is all cases. In the elderly, CPR rarely helps. As a nurse, I am obligated to perform CPR on any patient that does not have a DNR in place. And I do. But we try to get our patients and their families to realize the risks of CPR, and to have a DNR in most cases.

As for this article, IF the patient did not have a DNR, then the nurse should lose her license for refusing CPR. However, if there WAS a DNR in place, she legally CANNOT give CPR to that patient.

I'm a geriatric nurse, and love my patients, and provide them with the best care available. But, that doesn't mean that I want to be the one ending up killing them by performing CPR on someone who is frail and already medically compromised. I believe quality of life should be considered over quantity of life.

[bubbayugga]

53. I'm thinking some people need to go to jail over this. There was a duty to this patient

which was not met and she died because of it.

[TwilightGardener]

58. There is no way to know if CPR would have saved this patient.

CPR is just a way of buying a little bit more time before your brain cells are totally gone. It doesn't defibrillate or fix a funky but convertible rhythm, just pushes some blood and oxygen around a little bit longer.

[bubbayugga]

63. We do know that nothing improves your chances of surviving

a cardiac event more than high quality chest compressions adminsitered immediately after the cardiac event-the sooner the better. High quality chest compressions give you a chance. The sooner you get them after the event, the better your chances are. Not receiving them pretty much guanatees that you're going to die. We don't know why the lady collapsed; however, if it was cardiac or respiratory, people need to go to jail and not just the nurse obviously.

[TwilightGardener]

67. I don't think it rises to the criminal--no INTENTIONAL harm was done

to this woman, and if any neglect of duty can be proven (they did call EMS, after all) it will be a civil matter.

[bubbayugga]

69. I think it does and I think the policy was pretty intentional.

[KurtNYC]

100. You are saying that CPR is 100% successful

The success rate for CPR for elderly victims is less than 5%. (And CPR is brutal, as described up thread)

http://www.intelihealth.com/IH/ihtIH/WSIHW000/35320/35323/372221.html?d=dmtHMSContent

[anneboleyn]

153. No help is likely 100% fatal. A person should be given a chance, even if very slim.

Many medical procedures have a small rate of success. The whole point is that persons undergoing the procedure hope to be in the small percent of success, and persons should be given a chance to survive even if the chances of survival are small.

[bubbayugga]

159. I didn't say that and broken ribs are better than death.

CPR is the only thing that does save lives and broken ribs are not guaranteed. It is well established that immediate high quality chest compressions improve post cardiac arrest survival rates more than any other intervention. I have administered CPR in the hospital setting to young and old alike more times than I can remember and I have never lost a patient btw. CPR works especially when it is administered by health care professionals in a healthcare setting immediately after observing the event. On the other hand, standing on the phone refusing to perform CPR guarantees death.

[dkf]

59. According to a local station there was no DNR

On the tape, a different Glenwood Gardens employee said that an elderly woman had passed out in the facility's dining room while eating. She was barely breathing and, according to KGET-TV, did not have a do-not-resuscitate order.



Bayless' daughter told KGET that she was a nurse and was satisfied with her mother's care at Glenwood Gardens, the station reported.


http://www.latimes.com/news/local/la-me-0304-senior-dispatcher-20130304,0,43655.story

[Tempest]

117. Someone posted a link to a story where she did have one. n/t

[pinboy3niner]

122. LINK?

[snooper2]

130. It's up above in the thread

[pinboy3niner]

131. Where? You might at least give a Post number.

[snooper2]

132. well I did half the work for you LOL, post 98

[dkf]

134. Both are quoting the same local station so one has it wrong.

So you get to choose whose reporting you trust, the LA Tines or the UK Daily Mail.

[pinboy3niner]

162. The daughter confirms that her mother had no DNR order

Bayless's daughter, a nurse herself, confirmed that her mother did not have a do-not-resuscitate order, but said she was satisfied with the way Glenwood handled the situation.

http://gawker.com/lorraine-bayless/

[jonthebru]

70. I did hospice care for my wife for 12 days a couple of years ago.

She had a DNR arrangement and I was given definite instructions by the Hospice organization not to call 911, for the Police or Ambulance. Their job is to resuscitate and the idea of allowing someone to simply die isn't in their playbook. I was to call the Hospice nurse... at 3 AM, she came, pronounced the death and called the mortuary who came and took my Wife's remains away within the hour.

At that age, 87, or with a terminal disease situation a DNR officially done is the only way to go. Let it go.

[HiPointDem]

72. not the case. i have known several women who were vigorous, as in taking daily walks around the

neighborhood, doing their own shopping, etc well into their 90s.

[HiPointDem]

71. This facility is one of those semi-fancy places that have different levels of care: independent

living, assisted living, skilled nursing and alzheimers/dementia care.

it's owned by Brookdale Living and costs over $2000 a month.

http://www.caring.com/local/independent-living-in-bakersfield-california/glenwood-gardens-ilf

[blkmusclmachine]

75. .

.

[a2liberal]

77. WTF

is with all the different people in this thread claiming there was a DNR or acting as if this story is an attack on their right to have one? I have not been able to find a single article claiming there was a DNR, but several confirming that there was not one. Was there an article at some point that was then updated, is it people misreading "there was not a do-not-resuscitate", or are people really just that eager to defend this "care" facility's policy of not allowing nurses to help people who didn't pay enough money? I really really hope it's a misunderstanding and not that last option...

Edit: it's just 2 people claiming that, I apologize. Going back I see others were just implying it. Sorry.

[SunSeeker]

84. Weird, huh? None of the articles said there was a DNR. Ever.

The scary thing is the callousness of what appear to be health professionals in this thread. And the talk of what a waste CPR is and the legally incorrect suggestion that uninvited CPR is assault (it's not, you have good samaritan immunity if you're trained to do CPR).

It reminds me of the nurses in the hospice where my mom lived the last 6 weeks of her life. She had terminal cancer and had just suffered a paralyzing stroke; she could not talk or even feed herself. For the 6 weeks she lived that way, I visited her every day only to find she had been fed carelessly, with food stuck to her neck and hair. Every day I would wash the food off of her and check her diaper--it was always in need of changing and I always had to ask someone to get to it. On one of those days, one of the nurses walked by as my mother's diaper was soiled and smelling. All the nurse did was pinch her nose and say "stinky." My mom may have been paralyzed, but she could still hear. I could see her eyes dart at that nurse's direction and narrow. She heard her, and she was mad. I was horrified. I should have ripped that nurse's head off but all I said was that she needed to be changed, that is why there is a smell. The thought of my mom, a dignified, educated women who had taken fastidious care of herself all her life to have been dependent on the indifferent, indeed degrading, treatment of these nurses still haunts me to this day.

[Sen. Walter Sobchak]

85. And this is why I am building my parents a private apartment in my own home

I figure I can't possibly do a worse job than the "nursing homes" I have seen other relatives placed in. My parents are very elderly and have mobility challenges but they don't have a death wish. I don't want Nurse Ratched deciding whether their lives aren't worth saving or not.

[pansypoo53219]

87. we HAVE to accept death. sometimes it's your time.

more harm could happen. that woman had a GOOD exit.

[w4rma]

88. You believe that asphyxiation by choking on your food is a "good" exit? (nt)

[pnwmom]

92. Technically, she wasn't being "cared for" at this facility because she was in the independent living

or retirement section -- not the assisted living part.

She was just residing there, in more of a hotel-like environment.

[pnwmom]

94. The daughter's opinion, according to the reporter, is that if her mother had received CPR,

she wouldn't have survived.

I wonder what her state of health was, to make the daughter say that.

[Tempest]

118. Maybe daughter wanted to collect on the inheritance. n/t

[pnwmom]

142. Few people that age are in excellent health.

It's possible this woman was the exception. Or maybe the daughter was being more realistic than some people around here.

We had a friend who was only 57 who died in a hospital of a heart attack after going to the day treatment unit for a "routine" procedure. Even doctors can't save everyone, even under the best of circumstances.

[Tempest]

152. More than you think

87 is the new 67.

My mom's 85 and has the activities of a 45 year old. She clears her 16 acres of brush by herself.

[pnwmom]

161. 87 is the new 67? What a crock.

Congrats on your Mom's continued good health, but she's not representative of most people that age. My mother-in-law was still going strong then, but that's unusual.

[mainer]

97. Why is this news? This happens every day across the country.

Elderly patients die every day when staff doesn't do CPR. The only difference is that 911 -- who doesn't know the patient -- asked the nurse to do CPR and the nurse (who is familiar with the patient and family) used her judgment and said no.

The patient was 87 years old. How many months left did she have regardless of CPR?

The only time I heard about something like this becoming news was when a Christian pro-life nurse's aid got incensed that the hospital refused to perform extraordinary measures on a 90+ year old woman who coded. She called the attorney general's office and made life hell for both the doctors and the family (who wanted her DNR).

[DURHAM D]

107. I am with you.

This happens everyday. My guess is that the dispatcher is a crusader rabbit and she called the media.

[SunSeeker]

123. The nurse did not use her judgment. She was following the home's "no help" policy.

That fact that this home had such a policy and readily admitted it is what is news. The nurse even told the dispatcher she couldn't help the women because of the home's policy, when the dispatcher kept begging her to do compressions. She was not acting out of love and understanding for the women or her family.

[Capt. Obvious]

113. at first glance - where are the George Zimmerman defenders?

They should be in this thread claiming that 911 dispatchers have no authority to give directions to callers.

I had to have read that line of reasoning over 100 times at least back then.

[Tempest]

114. Bakersfield prides itself on its friendly people, but this is how they really are.

I live in Bakersfield.

Most of the people here are self-centered, selfish and don't give a damn about anyone but themselves. It shows in the garbage in the streets, the hatred spread by right wing talk radio (Bakersfield is 65% Republican) and the lack of consideration for pedestrians (one of the highest rates of people hit legally crossing in crosswalks in CA) or other drivers (high rate of traffic accidents in the city).

[Ken Burch]

119. This is the only thing that expresses how I feel about this:

[LisaL]

125. Her own daughter is reportedly satisfied with the care her mother received.

I presume she knows the health state of her mother better than any of us.

[99Forever]

126. This is a problem?

Was this a member of the 1% or just another lazy parasite on the Corporate Bottom Line?

[Zax2me]

160. Wha?

[Recursion]

128. Was the nurse qualified to perform CPR? (nt)

[lynne]

137. I'm rather surprised that 911 was even called -

- most nursing homes have nurses on hand and a Dr. there at least a portion of the day. They deal with death daily. It's not unusual for them to have procedures where they do not do CPR or take other extreme measures in the event of collapse of a patient.

Anyone ever done CPR on an 87 year old person? Do you know what the likely outcome is? I was taught in my CPR class - and it was confirmed by a nursing friend - that CPR on an ill and elderly person is many times not a kindness. You will almost certainly break ribs. Should you bring that person back to consciousness, they will then have to endure the pain from the rib fractures. If a rib punctures a lung, that will more than likely kill them in their older/weakened state. Either way, their quality of life will have turned to misery for whatever little time is saved for them.

The nurse and the institution made the right call in not performing CPR in this case.

[Samurai_Writer]

139. Yes, I have performed CPR on an 87 year old man

And everything you said is correct. Ribs were cracked, lung was punctured, and even after all that, he did revive briefly. We performed CPR, used AED, and administered ACLS (I'm ACLS certified). After we got a heartbeat back, he lasted about 10 minutes, then went into asystole again. More CPR. Came back for about 7 minutes. More CPR. Finally, on the third time, his body just gave out and he could not be revived.

I went home that night and cried more than I ever had.... not because I couldn't save him and that he died, but that I caused his last moments on this earth to be traumatic and painful. He should have been able to go peacefully, but his family would not agree to a DNR.

[anneboleyn]

155. So when should a person not receive CPR? At 80? 70? I am not sure what you are suggesting

be done in practice. Obviously cpr on an elderly person can involve all the difficulties you note, and three times (bringing him "back&quot seems very stressful for all involved, especially, of course, for the man who was dying. But what should be done practically? Should an elderly person not be given cpr at all because of the outcomes you mention -- who would make such a determination? The physicians are deciding to do everything they can to try to revive a dying person and aim for life. I know some are trying to avoid lawsuits and so on. But still at least the patients are being given a chance, and even if they were terribly misguided, it is what the family wanted according to your post.

[Samurai_Writer]

156. It's not a particular age...

When someone has multiple chronic illnesses and multi-systemic issues, is so fragile that CPR would seriously harm or kill them, I believe that they should seriously consider a DNR. I'm not saying that anyone other than the patient or family (if the patient is not competent to make the decision) should have that responsibility. I only hope that the patient and family will take professional advice from their doctors and nurses on the risks vs. benefits of CPR.

As someone who has hospice patients, I do not believe in prolonging a life that is filled with pain and does not have the quality of life that the patient wants. I believe death should be dignified, peaceful and as painfree as possible. Performing CPR on someone who has the issues listed above is the opposite of a dignified death.

[progressivebydesign]

143. MOre to the story, of course, but the "outrage machine" media wants you pissed.

The "Independent Living" places are VERY VERY strict when you move in. I know because I was shopping them for my Mom. The first thing they tell you is that it is NOT assisted living, and there is no health care or oversight involved. A nurse may be on hand to simply hand out meds, or do simple screenings, but it's NOT a medical facility. Assisted living is your basic nursing home, and they say this happened in the Independent part of the place. They make it clear that it's not a medical facility, and you are on your own for medical care. She also may have had a DNR on file.

Here's the other thing. I read the reports on this. The Dispatcher was saying "she's not breathing enough, she's going to die!" Ummm sorry, but you do NOT do CPR on someone who is alive. The report is that she died later on at the hospital. What idiot is trying to force a nurse to give CPR on a live person? The point of CPR is to restart your heart, and keep it pumping. CPR, on an elderly patient, can also break ribs, and do a ton of damage. The woman was not dead at that point, so compressing hard enough (for whatever reason the dispatcher thought she should,) could have ultimately killed her too.) My Mom had CPR last year, and she had broken bones, extreme bruises, and damage that will never be fixed. She actually died, and was brought back. You don't do it until someone has died. So the dispatcher seems to be wrong here.

[1983law]

146. I am trying like hell...

to get my arms around this event. Where have we come as a society? Whoever thought denying life saving care at a health care facility was "outside policy"? At what point did we check simple humanity at the door? Perhaps, is there someone to blame?

I know several in here know I am a lawyer and am married to a health care provider. I have no answer, and I feel terrible for it.

[anneboleyn]

154. I agree -- it is a lack of "simple humanity" as you say. The callous attitude

that some have toward the elderly/and or terminally ill (more often on the right than the left but it seems to be all over the political map these days) frankly shocks me. Why shouldn't a person be given a chance, just a chance, for fucks sake? Moralizing about death in western culture and so on means nothing in a particular case. Maybe this woman would have liked a few days or hell a few hours -- realizing that she was imminently dying -- to say goodbye to her children and so on. As you say just "simple humanity" rather than philosophizing ourselves out of empathy.

[and-justice-for-all]

147. I have never heard of a facility like a nursing home to have a policy

NOT to perform CPR; what a load of shit. I would sue them into oblivion.

[rateyes]

157. Surely to goodness there was a damned AED in a facility like that. Was that even used?

How can people lose their humanity so fucking quickly?

[magical thyme]

163. She was NOT a NURSE

and it was not a nursing home.

More attention-grabbing headlines made of lies.

[Bay Boy]

164. I've been wondering about that

'nurse' is an inaccurate statement. Was she an RN, an LPN, a CNA? To some people any (generally female) person in a medical facility is a 'nurse'.

Where did you see or hear that she wasn't a nurse?

[magical thyme]

165. later articles in MSM corrected some of the misinformation

I saw them at work, so could not log in here and link to them (need to keep the job). But it's another case of the media chasing readers, ignoring facts to get it first instead of right, and deliberately writing provocative headlines.

She was not an RN, LPN or CNA. She was some sort of administrator and so likely not trained in CPR. I don't remember all the details now, but I don't think there was a nurse on duty and that had to do with the level of assistance provided at the facility.

It was an Assisted Living facility, not a nursing home. They provide different levels of care, which are spelled out in their literature and contracts. IIRC, this particular facility specifically did not have medical staff on duty.

And as others have mentioned above, we don't even know if she had a DNR on file.