• 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.

    • I’ll be fascinated to see more about this if it progresses to trial. As and ER doc, I can’t say how often I see this. I feel for families who panic or who have been poorly coached on how to progress through the dying process. But I have a sneaking suspicion that they, like so many families in my experience, said something to the ER doc at the time which gave him or her the impression that they wanted the child incubated. Happens EVERY FREAKIN’ DAY in my world (or so it seems).

      Also, I just find it incomprehensible that an ER doc would willfully override both the POLST and the families’ verbally expressed wishes in a terminal cancer patient. That doesn’t pass the sniff test. If that’s what happened, yes, that doc should be held accountable. However, I strongly suspect that when the facts come out, there is more to this story.

      • @ShadowfaxMD
        I will try and get my hands on the complaint; some folks were tweeting about this along similar lines as what you note (meaning two sides to the story). I will link it is I can get it and I will follow the case and update. Also, my wife is a Peds HemeOnc nurse and I have heard her say numerous times that in the instant parents will change their minds and the medical folks are cringing at what they end up doing. Kids are likely a tricky case in any event…

    • Hospice care is vital to families in this situation. If they had a hospice nurse and end of life plan with who to call when they found the child in distress, they might have worked through the panic of the final days in a more healthy way and avoided the hospital entirely. I cannot say enough for timely, compassionate hospice care.
      How much better for all, hospital ER doc, family, and child if the hospital had been avoided. If the family did not want an in-home death, then making arrangements for terminal care made in advance would have been appropriate. I am interested that with the consultations mentioned and the POLST, no plans were made for where the death was to take place.

      • @Susan Rawlins
        I am trying to get more info on the case. I generally agree with all you say about hospice. Key is making such discussions the default and not the exception.