Games Being Played by St. Luke's?
Andrea Clark's sister was assured (she says) by St. Luke's that Andrea would be maintained through Tuesday. But Jerri Ward, the attorney for the family, just e-mailed me: "I have not been able to get St. Luke's to agree on the record that care will be continued after the weekend. It probably will, but that's not been conveyed to me either in writing or orally."
I will continue to update as more information comes in.
posted by Wesley J. Smith @ 2:52 PM
12 Comments
12 Comments:
It is notable that, throughout this case, the family has continually asserted that grave and mysterious forces are at work that then turn out to be nothing more than the ordinary process of managing these situations under the law as it is written.
The relevant statute explicitly holds that care of the patient can be transferred to any willing physician, and that life support may not be terminated while such a transfer is underway. If the patient is to be transferred to an entirely different facility, the hospital must maintain life support and assist with that transfer. It's not optional; there's no drama about it.
If they really have found a qualified doctor to take over this patient's care, the case is over. It's no longer a question of whether the hospital "agrees" to reverse its decision to terminate treatment - that decision is triggered only by the attending physician's determination that the patient's request for treatment, or advance directive to that effect, is not "medically appropriate". If the (current) attending physician does not feel that way, there is no longer any conflict to resolve.
This is all spelled out quite explicitly in the law (Texas Health & Safety Code Section 166.046, here). All they ever had to do was find a doctor willing to take over the patient's care. They had 10 days to do so, with the guaranteed right to ask for an extension of that deadline, and a guarantee that the patient's care could not be terminated during that process. They found a doctor on the 8th day. What's the big deal?
The futile care protocols state that once the ethics committee says no to wanted life sustaining treatment, it can no longer be provided in that hospital even if another physician is willint to provide the care. That is why the transfer becomes so urgent.
It is quite remarkable that a woman who needs life sustaining treatment to stay alive is not apparently wanted by any hospital in Texas. Scandalous.
There's an elephant in this parlor that no one seems to be talking about: the cost of hospitalization.
Is this a case where the patient and family don't have insurance to cover ongoing life support? And thus where any hospital that takes her on is going to eat the costs of doing so?
The fact that no other institution seems willing to take her suggests that this is the case.
An small addition: the fact that St. Lukes was willing to pay $14,000 to get rid of her strongly suggests that they're trying to cut their losses.
I have a suspicion that's the real issue here, and that the hospital is using "futile care" as a way of getting out from under what could potentially be millions of dollars of unreimbursed expense.
Andrea Clark is fully insured. Futile Care Theory is about money in the general sense, but probably not in this specific case.
If we are going to argue about whether someone in extreme circumstances should have his or her health care covered by the public, it should be in open democratic debate, not decided by bioethicists and committees behind closed doors.
Andrea HAS insurance, including supplemental insurance.
April 28, 2006
Problem with Andrea Clark's Transfer - Updated
Update (9:45pm EST): RightWingNews and MyVastRightWingConspiracy have the latest information - unfortunate news about Andrea Clark and St. Luke's Hospital. Before I go into the details, please contact the hospital (832-355-1000) and express your concern for Andrea's life and their treatment of her. Right now your polite but firm call may be the only chance she has.
Read the rest at: http://www.prolifeblogs.com/
I've covered these questions at my blog.
Specifically, the law does not say that " can no longer be provided in that hospital even if another physician is willint to provide the care."
Mr. Smith, I would really like to know where this idea came from. Is it from 166.046 (g)?
Really, do you think that ICU nurses and doctors caring for patient are like this? Does this scenario - accross an entire city and state - fit with what you know of reality?
I could have told you why other doctors and hospitals will not accept the patient in transfer yesterday, if the radio people hadn't unexpectantly cut me off: because we understand the medical realities and probabilities: the heart failure, the brain damage that led to the ventilator and the ventilator itself, the kidney failure and the side effects of dialysis, and the loss of integrity of blood vessels that require constant readjusting of the pressors (medications to maintain blood pressure), as well as the endocarditis (which also aggravates all of the above) are too many complications to disagree that repeatedly subjecting this woman to dialysis and intensive pressor therapy is cruel to her.
I have been wondering if the doc had first suggested stopping the dialysis and moved to his only apparent recourse -refusal of the ventilator - when the family insisted on continuation of ever increasingly intensive treatments.
Also, as to the reason that the transfer was cancelled: It's not clear at all why any facility that could manage a ventilator and dialysis of a patient could not handle other medications that the patient needs. St. Luke's must have found out that the facility could not actually continue dialysis and or manage the ventilator and the pressors.
Wesley:
Yet another opportunity illustrate the importance of ADVANCE DIRECTIVES.
Had Andrea Clark put her wishes in writing would this battle be raging? At a minimum, we would have had a much clearer understanding of her wishes.
I advocate a DETAILED, precise, illustrative advance directive. I recommend that people include as many hypotethicals and descriptions of potential conditions/levels of disability in which they might find themselves so as to provide guidance.
Every time I speak publicly on this subject, I have medical folks argue with me about the above. They insist that broader language is better and gives the doctors and hospitals more room to assist familie with decision-maker.
I say "baloney." We don't need broad language in such documents. We need as much specificity as possible so as to inform the family and allow them to draw analogies if the precise situation was not contemplated by the patient.
Janie: Yes it would. The Texas statute is about when a hospital does not have to comply with an advance directive. Check out the link at my earlier post and scroll down.
I'm not buying it. I don't think this law could hold up if challenged on the basis of a patient's WRITTEN advance directive.
Has it been attempted?
Be patient, my pretty. I think the law is open to a constitutional assault. We'll see if it comes to that.
Good!
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