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'Code' called contrary to Pt.'s advance directives.

82 YEAR-OLD MARGARET FURLONG WAS A RESIDENT OF GLEN CARE CENTER (GLENWOOD), A SKILLED NURSING FACILITY. She suffered from atherosclerotic cardiovascular disease, hypertension, severe rheumatoid arthritis, chronic leukopenia with anemia, and osteoporosis. Despite her condition, she was capable of making her own health care decisions. In February of 2001, she expressed her health care wishes to her primary care physician, Dr. Falcon. Dr. Falcon completed and signed a document entitled, "Physician Documentation of Preferred Intensity of Treatment," stating that the patient had the capacity to make decisions regarding her health care and did not want CPR, intubation, or mechanical ventilation or other advanced cardiac life support. A few months later, in July 2001, Ms. Furlong signed a document entitled "Consent-Withhold CPR," stating that she understood that a "no CPR order" meant that she consented to an order not to use CPR. She also completed an "Emergency Medical Services-Prehospital Do Not Resuscitate (DNR) Form, an Advance Request to Limit the Scope of Emergency Medical Care." The latter form indicated that she agreed to the DNR directive and gave permission to hospital emergency care personnel to implement it. Finally, commencing July 24, 2001, the Glenwood physician order sheets also contained an order for "No CPR." This order was renewed monthly, effective through March 30, 2002, and was signed by one of the Ms. Furlong's physicians. While at Glenwood, Ms. Furlong developed a severe stage 4 decubitus ulcer over her left shoulder, exposing her glenohumeral bone, and a left shin decubitus ulcer, exposing her anterior tibial bone. These conditions caused chronic and debilitating pain requiring, inter alia, the following pain medications: Vicodin, one tablet every four hours for moderate pain; Vicodin, two tablets every four hours for severe pain; and Vioxx, 12.5 mg. daily for arthritis. The patient routinely complained of pain and routinely requested pain medication to ease her suffering. On March 2, 2002, the patient was taken from Glenwood to Catholic Healthcare West Hospital by her daughter-in-law, Linda Furlong, for treatment for vomiting and abdominal pain. Linda was given transfer papers to take to the hospital with her mother-in-law. Linda provided all of the documents regarding DNR orders to the hospital's emergency room. The patient was assessed at approximately 4 pm by hospital emergency room personnel, the emergency department physician, Dr. Richard Handin, and later by admitting physician, Dr. Bennet Lipper. Despite the fact that it was obvious that since the patient was frail and elderly, lifesaving measures might be immediately necessary no one inquired about the patient's end-of-life wishes. The patient was admitted to the hospital at approximately 10:15 pm. The patient's admission paperwork erroneously indicated that she did not have an advance directive. On March 3, 2002, at 1:15 am, the patient suffered respiratory and cardiac arrest. Dr. Arturo Sidransky provided emergency medical services during a "code blue." He failed to inquire of the hospital staff about the patient's health care wishes when he arrived at her bedside. Consequently, the patient was intubated and given advanced cardiac life support medication. She survived the cardiac arrest and regained consciousness. The patient endured intense pain from March 3, 2002, until her death on March 12, 2002, after life support was withdrawn. The patient's son Patrick Furlong individually, and as his mother's successor in interest, brought suit against the hospital and treating physicians. He sought injunctive relief, damages, and attorney's fees based on alleged violations of the Elder Abuse Act, the Federal Patient Self-Determination Act (PSDA), the Health Care Decisions Law, and Business and Professions Code. The trial court granted the defendants' motion to dismiss. The plaintiff appealed.

THE COURT OF APPEALS OF CALIFORNIA AFFIRMED THE JUDGMENT OF THE TRIAL COURT DISMISSING THE SUIT. The court held, inter alia, that the plaintiff's allegations did not rise to the level necessary to prove that the defendants were liable to the plaintiff for the hospital's nursing staff's management of the patient's pain. The court acknowledged that when the patient obtained pain medication based on a nurse noticing she was grimacing in pain, the patient was required to remain in pain until the medication took effect. However, the court held that taken as a whole, the allegations against the hospital's staff in failing to complete the Critical Care Flow Sheets and manage the patient's pain described negligence (or perhaps gross negligence) in the level of care provided. However, it failed to describe the requisite culpable or reckless conduct required to prevail. Furlong v. Catholic Healthcare West, 2004 WL 2958274--CA
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Title Annotation:patient's
Author:Tammelleo, A. David
Publication:Nursing Law's Regan Report
Geographic Code:1U9CA
Date:Jan 1, 2005
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