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Rod Brouhard, EMT  P

Nurse Refuses to Do CPR on Dying Bakersfield Woman. Tragedy or Not?

By March 5, 2013

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A 911 recording from a senior facility in Bakersfield, CA is making national news. In the recording, a woman identifying herself as "Colleen" and saying "I'm a nurse" refuses to perform CPR on a patient who sounds like she's having agonal respirations, a sign of cardiac arrest. The 911 dispatcher gets very frustrated with the nurse's refusal to help. I'd even say the dispatcher was disgusted.

There's a feeding frenzy in the media waters right now and I suspect the facility is going to be consumed. There's even talk that California's lawmakers are considering some knee-jerk legislation to make sure a tragedy like this never happens again.

But, is this a tragedy?

Here's the deal: this is an "assisted living" facility, which is also sometimes referred to as "independent living." It means the residents get very little medical care, if any. Some facilities have staff members dedicated to doling out medications, but it is not a certified position and these folks - "medication technicians" as they're often called - do nothing more than hand out patients' medications according to a schedule. It's up to each resident to administer their own medications and other healthcare.

In a nursing home or "skilled nursing" facility, there are licensed nurses who can perform medical care including CPR if necessary. That's different than an assisted living facility. It's not uncommon for assisted living facilities to have policies against doing CPR. In the recording, the dispatcher doesn't seem surprised by the staff's refusal to help at first. She even says, "I understand if your facility is not willing, but give the phone to the stranger" to do CPR.

Technically, the patients and their families are well aware of the policies of facilities like this when they move in. Indeed, it should be noted that the patient's daughter in this incident has reportedly said she's satisfied with how the facility handled her mother's emergency.

In reality, I think many families don't quite know to what extent the staff at these places will go to remain hands off. It's not something most families want to think about. Patients and families figure this is the last stop on the line and don't consider how it will play out. The idea of living a good, productive life and allowing the end to come naturally conjures images of peacefully slipping away in your own bed.

Unfortunately, going quietly and painlessly in the middle of the night a la The Notebook is not for everybody. Death is often much more messy and confusing.

I think my problem with this story is the juxtaposition of the staff calling 911 for EMS to respond with lights and sirens - endangering the lives of responders presumably to help a dying woman - while not willing to provide the most basic medical care she needs until responders can arrive. The caller even asks how long until the fire department gets there.

Really? How much longer for the fire department? If you're worried about the woman's chances, start pumping on her chest.

There's another way to handle this situation. If a condition of residency is to have a do not resuscitate (DNR) order, then the "nurse" could have skipped the 911 call altogether and simply called the mortuary when this woman passed away.

Reportedly, this woman did not have a DNR order. If that's the case, then staff should be performing CPR. Even if the family in this case is okay with the outcome, that doesn't mean it was handled correctly.

The thing about CPR is that it can only help a person in cardiac arrest. Doing nothing is guaranteed to result in death. Doing CPR provides a chance of survival. It's not a great chance, but it's all the patient has.

Calling this a tragedy is just the feeding frenzy in action. This is the death of an 87 year old woman living in a senior facility. CPR might have helped and might not have. If doing CPR wasn't an option for the folks who've been entrusted with this woman's life, then maybe EMS should not be responding with lights and sirens to 911 calls from this facility.

If either the ambulance or fire engine was involved in a fatal crash rushing to the aid of a woman surrounded by caregivers unable or unwilling to provide care, that would be a tragedy.

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Comments
March 7, 2013 at 8:58 am
(1) gabi says:

I agree with your assessment.

March 8, 2013 at 12:41 am
(2) Ross says:

Seems to me you are a hard-hearted person who thinks just because a person is old it isn’t a tragedy. It is always a tragedy if a person might have been saved and lived another few years. You don’t know if she wanted to or not. The real tragedy is that a nurse was more afraid of rules than she was interested in possibly saving a life. Morally, it is important for any of us to play “good samaritan”, if possible, and this was possible.

Admittedly, California is not the place to try to be a “Good Samaritan”. We have whackout leftists in the 9th Court of Appeals that anything can happen—mostly bad. This nurse was between a rock and a hard place. She would have come out of it real fine if she had tried CPR, even if it failed. She’s lucky, it doesn’t sound like the family will sue her, but I would have if it had been my mother.

March 10, 2013 at 8:04 pm
(3) Rod says:

Ross, I’m not hard-hearted at all. My point is that this elderly patient and/or her family had to sign an agreement to live in this facility. That agreement likely says the only ‘care’ she’ll receive is food, a place to sleep and some activity time. I’m saying if this is what we’re going to allow for our elderly, then it’s not a tragedy; it’s an education problem. Folks should know this is a possibility.

On the other hand, I have to say I think it’s ridiculous for a senior facility not to do CPR. It’s even more ridiculous for them to skip the CPR but still call 911. Every minute they aren’t doing CPR reduces the patient’s chances by another 10%.

March 8, 2013 at 1:10 pm
(4) Katy Butler says:

On the surface, this is shocking. But look deeper. While researching a book, I discovered that less than 8% of people given CPR outside a hospital survive for more than 6 months, and fewer still survive with their mental facilities intact. For an 87-year-old woman already in assisted living, the odds of being restored to a meaningful life are far lower. Many elderly people, including both of my late parents, express their preference for a relatively speedy and natural death when the alternative is being resuscitated with brain damage, a death in an ICU hooked up to machines, or yet another final illness a few weeks or months later.
Katy Butler, author, “Knocking on Heaven’s Door,” Scribner fall 2013

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