Lawsuit for failure to comply with POLST

Thaddeus Pope provides the story of a family that has sued a health care system for failing to honor a “do not intubate” order stated in a POLST (Physician Orders for Life Sustaining Treatment) form. I posted last week on language problems with POLST. The story:

Emily DeArmond lived with brain cancer for most of her young life. As she approached her final months, her parents met with her oncologist, her neurosurgeon and a medical ethicist to discuss Emily’s care in light of her rapid decline.  Together they completed a POLST.

Several weeks after completion of the POLST, Emily’s parents found her unconscious in bed.  They rushed her to a nearby emergency room affiliated with Kaiser, Emily’s provider.  They told the staff about her POLST, which included the order: Do Not Intubate.  They did not want Emily to endure any painful, invasive procedures in her final days.  But the emergency physician failed to honor the order and forced a breathing tube down Emily’s throat.  She endured the presence of the tube until she was transferred to another Kaiser facility, where doctors withdrew it and allowed Emily to die.

Pope believes this is the first lawsuit filed for failure to comply with a POLST form. The comments section of the post is interesting with discussion of why take a child to the ED if they had “do not intubate” noted in s POLST form and others wanting more details from the case, and exactly what the POLST form said. Pope notes that likely the family panicked when their child was in distress (understandable) and went to seek help and support, they just did not get the type they wanted or expected.

I hate to be a broken record, but this is just another example of how our culture and therefore the health care system we have produced cannot deal directly or well with the issue of limits in what medicine can do, and attempts to begin doing so will bring about conflicts. This has got to be worked out, regardless of what mix of reform policies we adopt moving ahead. It is first and foremost a cultural issue. There is no technical answer to these sorts of conflicts.

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