Life Support: Court Discusses Hospital’s Legal Responsibility.
Legal Eagle Eye Newsletter for the Nursing Profession
June 2015
If there is an actual dispute or even a question about the validity of a document which appears to permit the hospital to withhold life support, or appears to authorize a specific person to give the hospital permission to do so, the hospital must provide life support until the matter is resolved appropriately.
In this case that meant intubating the patient and ventilating her. The patient should have been intubated whether or not the son specifically requested that she be intubated.
A formal meeting should have been called to involve the adult children, the person the patient had years earlier named in her medical power of attorney, the attending physician, representatives from the hospital’s administration, nursing services and ethics committee and a patient advocate.
If that meeting did not result in an acceptable resolution, papers would have to be filed in the local court for a judicial decision.
However correct in defining the standard of care, the family’s expert was too vague how the hospital’s breach of that standard affected the ultimate outcome for this patient. COURT OF APPEALS OF TEXAS April 30, 2015
After the sixty-seven year-old patient passed away her adult children sued.
They claimed the hospital ignored its legal duty to investigate the validity of the documents the patient signed several years earlier which appeared to authorize medical providers to withhold life support.
One son had raised concerns with the patient’s caregivers about his mother’s capacity to sign those documents due to her history of mental illness. He requested an investigation of the circumstances of the signing of those documents before the hospital went ahead.
The Court of Appeals of Texas accepted an opinion as to the legal standard of care for the hospital from the family’s expert, a board certified internist with extensive experience in geriatric medicine.
The physician stated that a hospital is required to ascertain the validity of a document signed by the patient which ostensibly authorizes withholding of life-saving treatment. If there is a dispute or even a question about its validity, a DNR order cannot be placed in the medical chart or life support withheld until the dispute or question is appropriately resolved.
There should have been a formal meeting to bring together the family, the surrogate decision-maker named in the power of attorney, the attending physician, representatives of the hospital’s administration and nursing services, a patient advocate and a representative of the hospital’s ethics committee.
If that meeting did not result in a resolution, papers should have been filed for the matter to be taken up in court.
While all of the above was pending the hospital should have provided life support. In in this case that meant intubation and mechanical ventilation of the patient.
However, in the final analysis the Court was compelled to dismiss the family’s lawsuit. There was no convincing proof that the hospital’s going ahead without an investigation and stopping life support affected the patient’s ultimate outcome. Hospital v. Frausto, 2015 WL 1941515 (Tex. App., April 30, 2015).
More references from nursinglaw.com
http://www.nursinglaw.com/lifesupport1.htm
http://www.nursinglaw.com/lifesupport2.pdf
http://www.nursinglaw.com/persistent-vegetative-state-legal-fundamentals.pdf
http://www.nursinglaw.com/vegetative.pdf