WhiteCoat

The Nurse Who Denied CPR

I’m in shock about the case where a nurse refused to give CPR to 87 year old Lorraine Bayless in a California senior living facility – a housing setup akin to an apartment complex.

Ms. Bayless fell unconscious in the dining room of a senior living facility. Facility members called 911. Ms. Bayless wasn’t breathing and the 911 operator recommended that the facility member perform CPR. The person at the facility would not perform CPR.

It took EMTs about 7 minutes to arrive on scene. Ms. Bayless later died from a “massive stroke.”

The 7 minute call can be heard HERE in its entirety.

A couple of other things made known in the case were that the senior living community did not have any trained medical staff. Remember – the facility was similar to an apartment house. In addition, Ms. Bayless had made known her intentions to “die naturally…without any kind of life-prolonging intervention.” According to the family, Ms. Bayless knew that there were no medical staff when she decided to live at the facility.

So why am I in shock?

Look at all the whacked out opinions that are being generated from this case.

Some people demand criminal charges be filed against the people who wouldn’t help.
One person recommends “Depraved Indifference Homicide
Another person notes that if a law says that “you cannot deliberately withhold medical care from a dying person” then ignorance of the law is no excuse for failing to act – applying that hypothetical to this case, of course.
Bakersfield California police are looking into whether there was anything criminal and the county Aging and Adult Services Department is determining whether “elder abuse” may have taken place because of the incident.
The thing is that if criminal charges were appropriate, then everyone in the dining room of the senior living facility who saw Ms. Bayless collapse would have to be thrown in jail. No one helped her. Let’s just charge everybody with a crime.
California can’t pay its bills as it is, so it is unlikely that they will criminally charge a group of elderly patients requiring nursing care and then be required to provide continuing medical care to them. Maybe they’ll all get electronic monitoring bracelets and weekly visits via the wheelchair van to a parole officer, instead.

Then the “experts” across the news stations pile on.
Virginia Commonwealth professor of geriatrics Dr. Peter Boling stated that without advance directives, patients “wind up sometimes in a very painful and trying situation.” This quote seems to acknowledge that patients may receive unwanted CPR if  there is any question about a patient’s wishes.
CBS legal analyst Jack Ford calls the actions “morally reprehensible” but also notes that our society has become much too litigious.
Ah, but what about California’s Good Samaritan statute? It exempts people who provide emergency care from liability for civil damages, but it also contains exceptions. Providers have to act in “good faith”. It doesn’t apply to those who are grossly negligent. And it doesn’t apply if the provider is being compensated. Employees of the senior living facility are, by definition, being compensated. So a plaintiff’s attorney may have the ability to circumvent the protections afforded in the Good Samaritan statute just through the “compensation” angle.
Other people argued that the 911 operator took all liability for the actions of the nurse. How does such a promise, which is essentially a verbal contract, absolve the nurse from liability when the nurse is the one performing the actions? If a lawsuit was filed, the nurse would still be named regardless of the 911 operator’s promises.

Then there’s the question of a DNR order. According to the Bakersfield Fire Department there wasn’t such an order on hand when paramedics arrived. Not that people carry DNR orders around with them in their pockets or anything. After all, this was a dining room in an apartment complex, not an ICU bed. But even if that was the case, does there have to be a readily producible advance directive available to prevent unwanted care?

A sweet old lady entered a senior living facility knowing that there were no trained medical staff and not wanting any life-prolonging treatment.

Now a firestorm has come down on the living facility for abiding by the patient’s wishes and pundits all over the internet are basically demanding that we perform medical procedures on patients who don’t want them. Don’t agree? It’s off to jail with you. You’re a criminal.

Ms. Bayless’ family issued a statement saying in part

We regret that this private and most personal time has been escalated by the media. Caregivers, nurses and other medical professionals have very difficult waters to tread in the legal and medical landscape of our country today.

About the only thing potentially criminal about this case was the unauthorized dissemination of Ms. Bayless’ private health information to the media.

Are state and local authorities investigating that?

34 Responses to “The Nurse Who Denied CPR”

  1. Thomas Bliss says:

    My main concern is that the resident did not have a DNR on file, No DNR.. then attempt to administer care, period. Especially if you are a Nurse or other health care provider.

    I for one will remain independently shocked at the inaction of the “healthcare staff”, aside from what the media is doing to “pile-on” the hype.

    Thanks for the post.

    • Libby says:

      I am a hospice nurse. This situation had a good outcome. The woman had a massive stroke. This means days, weeks, months in medical ICU, tube feedings, and no good recovery of function. I work with people dying for weeks, months, occasionally a year or two. I want to go like this 87 year old woman, no prolongation, little to no suffering.

      • Derrick says:

        This situation had a good outcome, but that is not the point. The point is, at the time that the 911 call was made, it was not known why this woman collapsed, and it may or may not have been known what her code status was. What was known was that a staff member of the facility called 911 seeking EMERGENCY assistance. When the dispatcher attempted to engage the staff member in starting that assistance via CPR, the staff member declined for fear of violating policy. That is horrible, and should be the focus of the discussion.

    • Libby says:

      Everyone is missing the point….the facility had a policy of not performing CPR, the woman and her family were aware of his. There is no alternative but to call 911, whether one hopes for resuscitation or not. I don’t find it odd to call 911 when someone collapses, whether or not a qualified person is available to perform CPR.

  2. Dumbus Gumbus says:

    “A sweet old lady entered a senior living facility knowing that there were no trained medical staff and not wanting any life-prolonging treatment.

    Now a firestorm has come down on the living facility for abiding by the patient’s wishes and pundits all over the internet are basically demanding that we perform medical procedures on patients who don’t want them.”

    Great, except for two things.

    1. The nurse called 911, and urged the ambulance to hurry. Clearly her intention was not to let the patient die peacefully per her wishes. She likely had no clue what the patient’s wishes were, and instead was too afraid of violating policy to perform the most basic of (possibly lifesaving) interventions.

    2. We only learned in hindsight that this particular patient wanted no treatment whatsoever. What happens when the grandmother next to her (who is otherwise healthy and hoping to live to see her granddaughter married next month) chokes on her steak? Just let her drop too? After all, clearly no old person in a non-nursing home could possibly want any attempts made.

    In an acute situation with no family and no advance directives available, assuming a possibly viable patient, what reasonable choice is there, other than assume that the patient wants treatment?

    The “liability talk” sounds like nonsense. Who has actually lost a lawsuit for performing CPR? How many times every year do untrained bystanders perform CPR? What damages would even be claimed?

    • Libby says:

      I am a hospice nurse. The legality is, if one is not on hospice there is no way to die quietly. There is no legal alternative to 911. Who would you call, if not 911? It’s not like someone dies and you just call a funeral home. It would be way too convenient for murderers that way.

      • PJ says:

        Actually, one solution is to not call 911 for some time. When my grandfather was dying at home, that’s exactly what I told my grandmother to do…when he died, wait at least two hours before calling the police non-emergency number to report a natural, expected death at home.

    • WhiteCoat says:

      They did assume that the patient wanted treatment – that’s apparently why they called 911.
      The issue is whether people should be mandated to perform CPR and whether there should be criminal or civil charges taken against those who do not perform CPR.
      The general public learned afterwards that the patient wanted no treatment. We don’t know the policies of the retirement community, but at least some evidence points to the fact that no immediate medical care was well known to the residents when they moved there.
      As for liability – look up the term “wrongful living” on Google. The fact that you can be sued for performing some actions and then have to hire an attorney to defend you (whether or not the suits are ultimately successful) often serves a deterrent to performing such actions.

  3. Christine says:

    Why was there a nurse there if there was no trained medical staff? I hate how the media keeps saying that she died as a result of CPR not being preformed. If she needed CPR, she was already dead and it’s unlikely even an hour of high quality CPR and a boat load of ACLS drugs would have changed that.

    • WhiteCoat says:

      If the caller had an RN, that doesn’t mean that she clinically practiced. Look at all of the RNs that retire and go into administration.
      Try going to one of the RN administrators in a hospital and asking him or her to describe how to perform CPR to you. Bet that most can’t.

  4. ndenunz says:

    I’m with Christine. Was the person who called 911 a nurse or not?

  5. Marilyn says:

    Assisted living facilities, nursing homes and such, all require a “POLST” (Physician Orders for Life-Sustaining Treatment) sheet on file. They don’t want you moving in without that. I knwo that’s the case in Oregon and California at least, because I’ve had my mom in these facilities.

    Even if Ms. Bayless didn’t have an advanced directive, she most likely did have the bright pink POLST.

    Glenwood Gardens bills itself as “independent and assisted living, memory care and skilled nursing”. I’ve not found any articles that address which level of living Ms. Bayless was in.

    No one should be judging the situation without knowing of the existence of this sheet, and what level of care she had signed on for. If her daughter (also a nurse) is at peace with the situation, this shouldn’t even have been made news.

  6. JustOneKalpa says:

    CPR and ALS are medical treatments. Patients who would not benefit from them (think end stage CA) have no more “right” to them than do patients with colds have a right to antibiotics. Providers do not have a “right” to perform them either. If they have good reason to believe that the patient would refuse then administering these treatments constitutes a battery. The idea that you need to present some legal document goes against all ethical principles. The good news is that CPR and ACLS don’t really work very well and Mrs. Bayless would not have “survived” to notice her crushed ribs.

    • WhiteCoat says:

      I’m not sure that the pendulum should swing that far in the opposite direction – that in the absence of information to the contrary we should presume patients don’t want CPR.
      The point with this case is that this was an apartment complex for senior citizens where it was known that medical care would not be immediately available, that the staff called 911 appropriately, and that the staff is being investigated for criminal charges for failing to do something that the patient didn’t want.

  7. Bloodshot says:

    What Christine said. Also: Hopefully this will lead to protocols being reexamined so the next time an old person dies (they do that a lot you know) the staff will be better equipped to deal with the situation.

    As far as I’m concerned, the old lady got what she wanted and her family agrees. This should not have made the news.

  8. ThorMD says:

    Based on what I know if the case, I don’t have a problem with CPR not being performed. And I’m disgusted by everything in the media about it.

    Based on what I know about working as an ER doc for 15+ years, people at Assisted Livings call 911 all the time for people who have DNR’s. They call 911 for people on hospice. They call 911 for people on “Comfort Care Only”. They call 911 ALL THE TIME. We get “dead” hospice and DNR patients all the time from these facilities. Of course, they are not technically dead until I pronounce them dead. But they are still dead. My theory is they don’t want to have to deal with the dead body, or the paperwork, or the grieving family, or the other residents who may freak out. So they call 911 and get the person out of there.

    Also, many people panic when people are dying in front of them. So families of end-stage cancer patients who have “gone home to die” freak out and call 911 at the end, because they are so overwhelmed with the situation.

    It happens ALL THE TIME that people are DNR or CMO and the form is not presented to the medics, and the medics do CPR/ACLS. Then the patient arrives at the ER and the family is PISSED about the CPR etc that was done.

    • Dan says:

      That’s just outrageous. How much does Medicare pay for the ambulance ride and treatment, plus your “care”? Such a massive, massive waste of time, effort, and money, just because people are lazy. Please tell me that you don’t have to rush to the resuscitation room with a crash cart just to pronounce these people. I can’t imagine how much that must piss you off.

      Does anyone know if a tattoo “I Am F(#king DNR” on my chest would be effective if I were to go down?

    • Libby says:

      You are so correct.

  9. BossNurse says:

    Let’s correct one major fact–it was NOT a nurse who refused to do CPR on this resident, it was a “resident services director”, an unlicensed non-medical person.

    “Glenwood Gardens is an independent living facility, and company officials say no medical staff is employed there. The woman who identified herself as a nurse to the dispatcher was employed at the facility as a resident services director, the company said.”

    Just wanted to clear up that fact. Why the hell she told the 911 dispatcher she was a nurse is beyond me.

    • Christine says:

      It was an RN who was working in that capacity, though from what I’m reading it doesn’t look like she had to be an RN, but was.

  10. Dan says:

    I’m beginning to think that after a certain age our default assumption should be DNR, and people should need DR — do resuscitate — orders. Who wants to have their ribcage smashed and their body subjected to additional tortures in the 1% chance of them living on a vent for another 6 months?

    • Libby says:

      You are so right! Many people are brought back from a sudden catastrophic event only to die by inches afterwards. I do not want that! I am a hospice nurse and see it all the time. I would actually be ok with no heroic measures after age 75, 80 at most. If one is reasonably healthy, this should not be a problem.

  11. The power of the media…
    The most amazing thing I noted from this article was the amazing grace the family exhibited in their released note to the media.
    Jim

  12. Emily says:

    What bothers me the most is that this “nurse” wasn’t refusing CPR on the basis of a DNR order, she was refusing it based on a policy. If she had told the 911 operator “I am refusing to perform CPR because this woman is a DNR,” I think I would feel very different about the situation. During the call she was basically saying that she wanted to help and didn’t want the woman to die, however was refusing due to policy rather than ethical principles.

    Also, like others, I am curious why a nurse was on the scene when this facility supposedly does not employ medical staff. She was obviously part of the staff since she was familiar with the policy to not perform CPR, so what gives?

    • WhiteCoat says:

      Valid point. Same thing ran across my mind.
      Then I try to imagine being in an extremely stressful event, not knowing what to do, having people running all around me at the scene, and having someone yelling at me on the phone to do something I’m not comfortable doing. Would I be entirely engaged in the conversation and be able to express my thoughts in perfect prose? Probably not.
      This is one of the things that bothers malpractice litigants sometimes – you have a few minutes to decide what to do and plaintiff attorneys who weren’t there have a few years to prove why what you did was wrong.

  13. Xsurgerdoc says:

    Today we have more MDs in Congress than ever before. This is an example of the blame being their’s. ie. > 80% of all NH care is ultimately borne by the federal or state government. Therefore a simple act of Congress which could be done today requiring all who enter such a facility have a big red DNR , or big blue DR bracelet placed on their wrist. “POLST” is just too politically correct and hard for all to remember.This would save $billions of dollars in personnel, drug, EMT, and aftercare costs , as well as countless days and months of utter misery for those few who survived the rib-crushing.
    Dumbus talks about the minuscule chance of loosing a “good Samaritan ” lawsuit, but I’m sure Whitecoat agrees that the time and money we must spend in our defense is the real reason for our CYA maneuvers , thus the huge added cost to USA healthcare.
    The real culprit here is the media, digging for a scoop on who to blame for this “travesty ” which occurs hundreds of times daily kept quiet by well meaning and humane caregivers interested in a quiet , peaceful, frequently pain free passing, particularly in patients who have made their wishes known AHEAD OF TIME.
    This is an opportunity for a national forum on this very wasteful and absolutely unnecessary subject.

  14. Ally says:

    Two things really annoy me about this case:

    1. The staff member in question was NOT a nurse! Stop calling her one! Independent living facilities don’t employ RNs. It just sounds sexier to report that a nurse refused to perform CPR, I guess. “Untrained Aide Refuses to Perform CPR” isn’t quite as sensational.

    2. Everyone is ignoring the statement put out by the family, which states that their loved one was fully aware that there were no trained medical professionals at the facility and that she wanted to die naturally with no heroic interventions, and that they’re happy with the care their loved one got and have no plans to sue. If the family feels that way, that settles it! Why does the rest of the world have to be so pissed off about this when the family isn’t?

    It’s so weird how terrified we are of death in this country.

    • Well, because maybe the family didn’t care about her enough either. Who knows? It still seems weird that the “attendant” wouldn’t help at all even though she called 911 for help. It’s been extremely interesting to hear these other points of view, though: maybe I just got sucked up into the media “scandal” and can’t face the end of life. Does CPR really break everyone’s ribcage? And how does Libby know that she suffered a “massive stroke”? I guess if it’s someone’s time, it’s someone’s time, but just because someone is old doesn’t mean they want to die..

      • Libby says:

        I read the third paragraph of White Coat’s post above…he linked to the report that the woman had had a massive stroke. I don’t just make up stuff if I can help it. I agree that just because someone is old it doesn’t mean they want to die…I see that in my job all the time! Nonetheless, what people in this country don’t know about death and dying is huge. Someone who has a massive stroke at age 87 will likely never get out of bed again, never chew or swallow food again, never even wipe their own heinie again. Everyone’s worst nightmare. I am pro life, but we do need to get over our “life at any cost” attitude. And the daughter is a nurse and likely knows this. And she knew her mother and her mother’s preference. And ribs are almost always (if not always) broken during effective CPR and can lead to punctured organs, such as a lung.

  15. Taelyn says:

    You know what I see. People (Usually) in the Med field, Who think people of a *Certain* age don’t have the right to live or Medical care… We find after the fact she had a Mass Stroke. But at the time of the call her heart was seemingly beating, and she was having trouble “Breathing” Giving her respiratory aid would not be cruel. After such an episode she would not wake up, and after reaching Medical Center and Family She would Not be subjected to cruel means to keep her alive.. Was it more Humane to Have a woman.. Struggling to breathe on the floor, yet nobody would help her? If a person has a DNR and they choke on dinner, should they just be allowed to DIE ?? I think Elderly and Families need to know what they are getting into with DNR’s. And the person who brought up the “”COST”” SHAME ON YOU !! People like you are the problem. My Parents are PRICELESS at ANY age. By Beloved GM never had or wanted a DNR, While she had Dementia, and was legally Blind. She endured by her choosing **2** Hip replacements after the age of 86 and she walked fine with a Walker or a Hand. She was Funny, and enjoyed every moment of life, and even enjoyed her Dementia Dreams.. Once her Doc recommended a Feeding tube cuz she had no teeth, and would get better nutrition.. That didnt work cuz during her “episodes she tugged on it.. so it was removed. After a few weeks she had trouble keeping food down so we took her in, They told us she she was in END STAGE, and convinced us the “KIND” thing to do would be a DNR and Hospice as she prob only had 48-72 hours left.. reluctantly we did.. When she choked on a sip of water they would not help her.. After 24 hrs we removed her and the DNR and went back to ER where after an ABD CT they found an “OBSTRUCTION” from the Tube.. Before the surgery The CNA Left her alone and she was brought food and drink.. She was very clever and managed a bit, but becuz of the blockage she aspirated while choking.. Ended up on a Respirator.. After that she had surgery, NO PROBLEMS!! All In all after a MONTH on a Respiratory first orally then in throat. she was taken off.. She lived 2 years after all that..
    She died in a “”NURSING HOME”” I have no doubt she was either ignored or was allowed to eat and drink without supervision and choked, and they simply called 911..
    I MISS HER !!!! She wanted to live to 100 , instead she died at 93 But those last 2 years are ones I cherish as much as the 91 before them … I can only PRAY she was not in pain, sadly I dont know. Let the FAMILY choose.. They will do right by their loved one.. And You CANT be in pain on a Respirator becuz they induce a Coma.. STOP judging people and their right to life by NUMBERS.. Nowdays we often live into our 100’s .. Who are you all to deprive us of maybe 20-30 years of Life ??? .. My MOTHER and Father are 76.. My Mother is more active and Healthy than I AM !!!!!!
    I would attempt to save ANY LIFE !! even if it were only long enough for Family to say Goodbye…
    Its people Like You all here, That will ensure that I Have in WRITING that if ever needed AL:L life saving measures are in place and will be taken at any Facility..
    You people SCARE ME !!!!!
    Hospice workers .. Hey no surprise they kill by Morphine wanted or not every day and call it Mercy.
    ER DR .. SHAME ON YOU !! who are you so I can be sure TO refuse your services.?. I want Doctors/Nurses who care about Life .. ALL LIFE
    You are NOT GOD.. You don’t get to decide.. God gave you the knowledge and opportunity to help people.. Honor God and DO THAT !!!! If you cant or wont do us ALL a favor and find new career.

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