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(LA Times)   911 dispatcher "Is there anybody that's willing to help this lady and not let her die?" Nurse at senior living center "Um, not at this time"   (latimesblogs.latimes.com) divider line 438
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23477 clicks; posted to Main » on 03 Mar 2013 at 9:13 PM (1 year ago)   |  Favorite    |   share:  Share on Twitter share via Email Share on Facebook   more»



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2013-03-04 01:50:58 PM

Relatively Obscure: The more you eat the more you fart: Diaf.

My experience has literally saved hundreds of lives, farkwad.

Dont talk about things you have no.actual knowledge about.

The more you eat the more you fart: but you CAN bring a braindead person back with it.

Take your own advice.


I can forgive him/her for not knowing about the Emergency and Imminent Harm rules that HIPAA has regarding the release of PHI to care team members, depending on what area of healthcare he/she works in. The Healthcare Industry has created a multitude of Jailhouse Lawyers thanks to the HIPAA and HITEC acts, and a poor job of educating providers.

And, to be fair, you CAN get a veggie back by doing CPR (or an organ donor), but that is NOT your call to make - you don't get to play the prediction game of who's gonna walk out with a CPC score of 1 a few days later. You act on the assumption that, unless stated in a DNR or Advance Directive, the patient would want you to do everything you could for them.

What I cannot forgive is this fear-mongering rumor spreading about someone being successfully sued for providing CPR to a patient who indicated it, without having any knowledge of a DNR. I find it odd that, doing a Google search, there is NO mention of this case. I also searched several trade and professional publications, such as Nursing World, Journal Of EMS, Journal of Prehospital Care, and the AHA's own Circulation publication, and there is no mention of a case of a nurse or group of nurses being sued for what he/she stated.

If he has more information on the case, I would actually welcome it since I teach BLS and Heartsaver, and would be very interested to know the details of the case.

The fact of the matter is thus: No DNR, Questionable DNR authenticity, or incomplete DNR = You get CPR. I'd rather defend to a jury that I did everything I could on the patient's behalf - and to the court of public opinion - more so than "Well, I just let him die because it seemed better." Regardless of my personal opinions on the matter.
 
2013-03-04 01:51:33 PM
Also, thanks  finnished for the month of TF!
 
2013-03-04 01:55:35 PM

The more you eat the more you fart: So...shenanigans for YOU as well, for making assumptions about a situation that you know nothing about. Very apparent that you are completely unfamiliar with what it is like working in a hospital or LTC facility.


Yeah, I don't always get along with hardinparamedic, aka BronyMedic.  Mostly about the role of my union in the EMS field.  But he's pretty damned knowledgeable about the healthcare industry as a whole and EMS specifically.  He's demonstrated this more than once.  I wouldn't go around accusing him of ignorance when it comes to stuff like this.

I think you're missing the word "successfully" in his declaration about no one being successfully sued for performing CPR when indicated.  I'm not prepared to call you a liar about your friend getting sued, but did he lose?  If he won the lawsuit, then he was not successfully sued.  I've been unsuccessfully sued because someone hit the parked ladder truck I was driving, it was a big waste of my time but didn't cost me anything else.
 
2013-03-04 02:00:38 PM

lizyrd: Yeah, I don't always get along with hardinparamedic, aka BronyMedic.  Mostly about the role of my union in the EMS field.  But he's pretty damned knowledgeable about the healthcare industry as a whole and EMS specifically.  He's demonstrated this more than once.  I wouldn't go around accusing him of ignorance when it comes to stuff like this.

I think you're missing the word "successfully" in his declaration about no one being successfully sued for performing CPR when indicated.  I'm not prepared to call you a liar about your friend getting sued, but did he lose?  If he won the lawsuit, then he was not successfully sued.  I've been unsuccessfully sued because someone hit the parked ladder truck I was driving, it was a big waste of my time but didn't cost me anything else.


Check your email. :)

I'm not trying to call him a liar. I just think that he has the facts of what he's saying incomplete, or there is something going on that he was not aware of.

It'd be pretty ground-breaking to see someone in healthcare successfully sued for providing the standard of care without malpractice or negligence for something like CPR. I don't think it would be something that would have been kept local either - it would have made national news, if not in trade publications, then in the mass media.
 
2013-03-04 02:02:17 PM
(Can't use any formatting here are work for some reason so I can't quote anything without doing it all manually...so...)

Good to know all the differences around the region.  Three years ago, the CPR classes taught here in Poway were just teaching and certifying with no breaths.
 
2013-03-04 02:04:11 PM

The One True TheDavid: nmemkha:

 [Y]our(sic) not a 87 year old having a heart attack, nor are you standing there watching your mother die.

Saying you would now is easy.

If letting my mother go was called for I'd have no problem with it. Why cave in her fragile ribs and maybe leave her brain damaged from lack of oxygen? She's miserable enough already.

That remind me, I've got to update my Final Directive to make it VERY clear they should "Just let me die damn you!"

How many languages should I have "Do Not Resuscitate" tattooed on my chest in? English, Spanish and Chinese sound obvious, but there should be no doubt.


I vote for cuniform and pictograms
 
2013-03-04 02:09:07 PM

WhoGAS: Good to know all the differences around the region.  Three years ago, the CPR classes taught here in Poway were just teaching and certifying with no breaths.


You have to understand too that it depends on what you take and what level. ACLS/PALS/NRP is going to teach a different way than BLS-HCP, which is going to teach it different than HeartSaver/First Aid, which is going to teach it different than American Red Cross or NSC CPR.

Hands-only CPR is good for Adult victims of Primary Cardiac-causes of arrest only, such as Sudden Cardiac Arrest and arrest related to arrhythmia. The reason is that it buys time for the heart to be defibrillated and  resume an organized rhythm by forcing perfusion of the myocardium (muscle) of the heart through coronary artery flow. In adults, that blood is already heavily saturated with oxygen in these patients, and the decreased metabolic demands will keep it that way for some time.

Since the above is the most common reason that adults arrest, it's why it's pushed so hard to lay people, who were not doing CPR because they had to do the kiss of life to a stranger.

It's absolutely useless for children/infants, and adults who have a cardiac arrest due to a respiratory or metabolic cause. In pediatrics, the primary causes of arrest are related to hypoxia, since they USUALLY have healthy hearts. Hands-only CPR is a death sentence for people who are hypoxic before the arrest, as they need ventilation and oxygenation during cardiac arrest. Professional CPR providers will recognize this, and it's why it's discouraged from being done at the Healthcare Provider level.
 
2013-03-04 02:10:10 PM

BafflerMeal: RandomRandom: JMacPA: That's great and all, but is CPR going to make her any deader? What exactly are the negative aspects of an attempt?

It's torture, it breaks ribs, it doesn't work.

The vast majority of retired physicians in nursing home end-of-life situations do not sign releases for CPR.  They know it doesn't work and have no desire to be tortured by the practice in their last moments of life.

It's not evil or cold to deny CPR to the nursing home population.  Given that it doesn't work on them, absence of CPR is just more compassionate.


I have broken so many ribs in my time with CPR.  From infants to elderly I have never seen CPR work.  Cracked chest or not.  Anecdotal to be sure, but people outside of health care still seem to think it's magic.


But you still do the CPR because it has a chance to work.

/or are you worried you might get fired if you don't?
 
2013-03-04 02:28:21 PM

hardinparamedic: Dictatorial_Flair: A lot of people in this thread have not seen the aftermath of being "saved" by CPR. I hope you never have to.

I've had a person walk up to me, shake my hand, and tell me thank you for doing CPR on them two years after I did it.

I've seen a 17 year old athlete survive after two hours of CPR while being crashed to ECMO for myocarditis, neurologically intact.

I've also seen people live long enough to have their family say goodbye to them, and die in the surrounding of their loved ones rather than alone in the middle of the grocery store.

And I've seen people end up in the nursing home from it.

That's not going to stop me from doing my job, and doing it for people who need it. Because I don't get the choice to play God, and decide who's going to have a CPC outcome of 1 when they walk out of the hospital. I do what I do because I know it's the best chance that patient has to survive, and I act on the assumption that they would want to live until proven otherwise, or it's proven to be futile to resuscitate them.

No healthcare provider gets to make that choice, and even Doctors have to justify why. The thought that people wouldn't help another human being because it "might not work" is sickening, and contrary to the oath every healthcare provider - nurse, RT, MD, DO, Paramedic - takes when they enter their profession.

CPR doesn't work every time, for a myriad of reasons. Some reversible in the field, some not. It's not a magic bullet like TV portrays it, but it is the best, and only chance for survival in a patient who is in a non-perfusing rhythm.


VERY well said and spoke from obvious experience!  I appreciate the work that you do and I'm sure the countless patients who have survived under your care against all odds when it "might not work" appreciate it as well!  Keep up the good work and sleep well knowing that you have done everything you could save lives...whether or not they survive is arbitrary....you're doing your job legally, ethically and morally.
 
2013-03-04 02:38:57 PM

hardinparamedic: Also, thanks  finnished for the month of TF!


You're doing a good job.
 
2013-03-04 02:40:22 PM

hardinparamedic: lizyrd: Yeah, I don't always get along with hardinparamedic, aka BronyMedic.  Mostly about the role of my union in the EMS field.  But he's pretty damned knowledgeable about the healthcare industry as a whole and EMS specifically.  He's demonstrated this more than once.  I wouldn't go around accusing him of ignorance when it comes to stuff like this.

I think you're missing the word "successfully" in his declaration about no one being successfully sued for performing CPR when indicated.  I'm not prepared to call you a liar about your friend getting sued, but did he lose?  If he won the lawsuit, then he was not successfully sued.  I've been unsuccessfully sued because someone hit the parked ladder truck I was driving, it was a big waste of my time but didn't cost me anything else.

Check your email. :)

I'm not trying to call him a liar. I just think that he has the facts of what he's saying incomplete, or there is something going on that he was not aware of.

It'd be pretty ground-breaking to see someone in healthcare successfully sued for providing the standard of care without malpractice or negligence for something like CPR. I don't think it would be something that would have been kept local either - it would have made national news, if not in trade publications, then in the mass media.


Thanks!

Almost as bad as the lawsuit fearmongering is the attitude that "it doesn't work, and she was old, so why bother?" Certainly, I may be DNR at that age and situation, but who am I to tell anyone else what quality of life is worth living compared to death?
 
2013-03-04 02:48:43 PM

lizyrd: Almost as bad as the lawsuit fearmongering is the attitude that "it doesn't work, and she was old, so why bother?" Certainly, I may be DNR at that age and situation, but who am I to tell anyone else what quality of life is worth living compared to death?


What I would really love is for some of the things that have been said in this thread along those lines to be repeated in a Court of Law, or Deposition in a lawsuit. Especially "She was old, what's the point"

I think you would actually see physical dollar signs form in the eyes of the Plaintiff's Attorney. Like, Old Fashioned Loony Toons Style.
 
2013-03-04 02:55:07 PM
hardinparamedic:

Hey. Just wanted to say I appreciate what you do, both here and out in the real world.
 
2013-03-04 03:02:42 PM

1. Put snakes on plane: hardinparamedic:

Hey. Just wanted to say I appreciate what you do, both here and out in the real world.


I really appreciate you saying this, but, there's a lot of people on FARK that deserve that. Not me.  Medic Zero, Lizyrd and many others also do the same job as I do, and they deserve it just as much. As much BS and crap as Lizyrd puts up with being a Fire/EMT, I'd say he deserves a lot more.

I may rib him because he's a damn union hosejock (:P), but he's a good guy.

I just do what I'm good at. I come off as an asshole at times to people, but eh. Everyone does.
 
2013-03-04 03:09:47 PM

hardinparamedic: And, to be fair, you CAN get a veggie back by doing CPR


Not if they've suffered legitimate brain death.
 
2013-03-04 03:13:31 PM

FarkinSneakyBastage: Can I please have the freedom to choose how and when I die and not rot to death in one of these depressing shiatholes they call a retirement community? That'd be great, thanks


So you would rather be alone in a house,  with no one to talk to, no one to help you, no one for company,  With overgrown garden and a house in ill repair.    I  would rather go to a retirement village and have people around,  people to care, people to help.   What I would not like is to be in a hospice or a single bed nursing home with piss filled sheets and staff completely fed up with wiping the shiat of old people's arses.  Those nursing homes are simply the waiting rooms of the dead,   I wish to make sure that I have departed before reaching that point.  But a retirement village that is fine by me.


Of course if you are still at the stage of life with good health and a wife (husband) then stay in your own house but to insist when it is obviously a burden seems rather stupid and most people start looking at retirement villages when taking care of a house is a burden or they are on their own.
 
2013-03-04 03:14:37 PM

Relatively Obscure: hardinparamedic: And, to be fair, you CAN get a veggie back by doing CPR

Not if they've suffered legitimate brain death.


Yeah, but the body has a way of shutting it down when that happens.

static.ddmcdn.com
static.ddmcdn.com
www.uninet.edu

/Damn you Akin, you have given the world a funny joke in that comment.
//Disclaimer: The Last Picture is from a University in Spain. It is public domain, found on a GIS, and not taken by myself, or with any patient that my system has been involved with.
 
2013-03-04 03:23:04 PM
Ugh, a cold caloric. Why not do an apnea test and be done with it?
 
2013-03-04 04:21:48 PM

nmemkha: BarkingUnicorn: nmemkha: BarkingUnicorn: nmemkha: Don't Troll Me Bro!:  It's hard for me to blame someone for deciding not to throw away their job (possibly career) to keep an 87y/o "alive" for a couple more years at most.

What if it was your mother? Or you? Would you feel the same?

Yes, I would.  An 87 year-old who survives such an incident is very unlikely to enjoy her remaining days.

Much of the dying's suffering is caused by their survivors.

You say that now, but your not a 87 year old having a heart attack, nor are you standing there watching your mother die.

Saying you would now is easy.

Yes, it is easy now.  My mother died in 1995, as I watched.  It was the best thing that could have happened to her, and I'd have been a poor son had I clung to her.

Did she die alone and sacred on the floor of some two-bit care facility as people just stood and gawked at her?

Would you have been pissed if she had?


How my mother died is nobody's business.

No, I wouldn't.  Everyone dies alone and most die scared.  Rarely is death dignified, contrary to what you've learned from movies.
 
2013-03-04 04:23:20 PM

catzilla: Comedy gold right here....


Yeah it was hilarious singlehandedly reviving a guy and saving his life.

Dictatorial_Flair: A lot of people in this thread have not seen the aftermath of being "saved" by CPR. I hope you never have to.

 Guy was up and around later that night.
 
2013-03-04 04:38:24 PM

hardinparamedic: starsrift: Ahhh. Didn't see that one, both TFA and and the local story didn't mention she was DOA as that sentence suggests, only that she "later died".

I'm not trying to be an asshole to you, either. Sorry if it comes off as such. I'm getting off a 24 hour shift, so mondays and all.

The problem is, and it's been pointed out over the course of the thread, that the nurse didn't just tell the dispatcher that she disagreed with him, and that she felt he was breathing adequately, if not in distress, but rather that she absolutely refused, and she's on tape as saying her facility policies will not let them perform CPR.

The facility is going to stand behind her now because they have to circle the wagons with that statement being public knowledge. By now, I'm willing to bet the State Nursing Board, as well as the Long-Term Care facility licensing board have begun an investigation into the matter.


Under California law, unlike at a nursing home, staff members at independent living facilities are not legally required to provide medical aid, according to Mary Winners, an expert on senior care.
"It's really more like a hotel where they will offer you concierge services, you'll get meals, they'll have housekeeping, they'll change your bed, but you can't even get care," she told TODAY.

As for the nurse, she has no legal obligation to put herself at risk of losing her job.  We might admire her for doing so or scorn her for not doing so, but that has nothing to do with her license.
 
2013-03-04 04:52:11 PM
hardinparamedic:
I think what's infuriating to me more given the situation and tape is that there is a "facility policy against doing CPR".

Don't forget that the source is a news story. "Facility policy" is a bit of a stretch. More likely that is part of the directives for staff, residents and family that they (resident/family) agree to when admitted.
Also, I'm glad you said that you actually worked in a care facility as a CNA. So many paramedics have no idea what working in a health facility is like, and therefore have no business giving judgements on the abilities or skill levels of the staff. We are all in the same business of caring for sick people.

Ps. I always enjoyed the old macho Fireman/Paramedic rivalry. What a hoot. I hope you know where my support lies. ;)
 
2013-03-04 05:15:22 PM

BarkingUnicorn: Under California law, unlike at a nursing home, staff members at independent living facilities are not legally required to provide medical aid, according to Mary Winners, an expert on senior care.
"It's really more like a hotel where they will offer you concierge services, you'll get meals, they'll have housekeeping, they'll change your bed, but you can't even get care," she told TODAY.

As for the nurse, she has no legal obligation to put herself at risk of losing her job.  We might admire her for doing so or scorn her for not doing so, but that has nothing to do with her license.


Really?

I pulled up the California State Board of Nursing website. They seem to disagree.

As used in Section 2761 of the code, "gross negligence" includes an extreme departure from the standard of care which, under similar circumstances, would have ordinarily been exercised by a competent registered nurse. Such an extreme departure means the repeated failure to provide nursing care as required or failure to provide care or to exercise ordinary precaution in a single situation which the nurse knew, or should have known, could have jeopardized the client's health or life.

As used in Section 2761 of the code, "incompetence" means the lack of possession of or the failure to exercise that degree of learning, skill, care and experience ordinarily possessed and exercised by a competent registered nurse as described in Section 1443.5.

In addition

2761. Grounds for action
The board may take disciplinary action against a certified or licensed nurse or deny an application for a certificate or license for any of the following:

(a) Unprofessional conduct, which includes, but is not limited to, the following:

(1) Incompetence, or gross negligence in carrying out usual certified or licensed nursing functions.

(2) A conviction of practicing medicine without a license in violation of Chapter 5 (commencing with Section 2000), in which event the record of conviction shall be conclusive evidence thereof.

(3) The use of advertising relating to nursing which violates Section 17500.

(4) Denial of licensure, revocation, suspension, restriction, or any other disciplinary action against a health care professional license or certificate by another state or territory of the United States, by any other government agency, or by another California health care professional licensing board. A certified copy of the decision or judgment shall be conclusive evidence of that action.

(b) Procuring his or her certificate or license by fraud, misrepresentation, or mistake.

(c) Procuring, or aiding, or abetting, or attempting, or agreeing, or offering to procure or assist at a criminal abortion.

(d) Violating or attempting to violate, directly or indirectly, or assisting in or abetting the violating of, or conspiring to violate any provision or term of this chapter or regulations adopted pursuant to it.

(e) Making or giving any false statement or information in connection with the application for issuance of a certificate or license.

(f) Conviction of a felony or of any offense substantially related to the qualifications, functions, and duties of a registered nurse, in which event the record of the conviction shall be conclusive evidence thereof.

(g) Impersonating any applicant or acting as proxy for an applicant in any examination required under this chapter for the issuance of a certificate or license.

(h) Impersonating another certified or licensed practitioner, or permitting or allowing another person to use his or her certificate or license for the purpose of nursing the sick or afflicted.

(i) Aiding or assisting, or agreeing to aid or assist any person or persons, whether a licensed physician or not, in the performance of, or arranging for, a violation of any of the provisions of Article 12 (commencing with Section 2220) of Chapter 5.

(j) Holding oneself out to the public or to any practitioner of the healing arts as a "nurse practitioner" or as meeting the standards established by the board for a nurse practitioner unless meeting the standards established by the board pursuant to Article 8 (commencing with Section 2834) or holding oneself out to the public as being certified by the board as a nurse anesthetist, nurse midwife, clinical nurse specialist, or public health nurse unless the person is at the time so certified by the board.

(k) Except for good cause, the knowing failure to protect patients by failing to follow infection control guidelines of the board, thereby risking transmission of blood-borne infectious diseases from licensed or certified nurse to patient, from patient to patient, and from patient to licensed or certified nurse. In administering this subdivision, the board shall consider referencing the standards, regulations, and guidelines of the State Department of Health Services developed pursuant to Section 1250.11 of the Health and Safety Code and the standards, guidelines, and regulations pursuant to the California Occupational Safety and Health Act of 1973 (Part 1 (commencing with Section 6300), Division 5, Labor Code) for preventing the transmission of HIV, hepatitis B, and other blood-borne pathogens in health care settings. As necessary, the board shall consult with the Medical Board of California, the Board of Podiatric Medicine, the Dental Board of California, and the Board of Vocational Nursing and Psychiatric Technicians, to encourage appropriate consistency in the implementation of this subdivision.

The board shall seek to ensure that licentiates and others regulated by the board are informed of the responsibility of licentiates to minimize the risk of transmission of blood-borne infectious diseases from health care provider to patient, from patient to patient, and from patient to health care provider, and of the most recent scientifically recognized safeguards for minimizing the risks of transmission.

(Added Stats 1939 ch 807 § 2. Amended Stats 1953 ch 1053 § 1; Stats 1977 ch 439 § 1; Stats 1978 ch 212 § 2, effective June 6, 1978; Stats 1979 ch 933 § 2; Stats 1983 ch 696 § 2; Stats 1984 ch 144 § 11; Stats 1987 ch 850 § 15; Stats 1991 ch 1180 § 4 (SB 1070); Stats 1992 ch 1350 § 4 (SB 1813); Stats 1994 ch 26 § 61 (AB 1807), effective March 30, 1994, ch 1275 § 16 (SB 2101); Stats 1997 ch 759 § 17 (SB 827). Amended Stats 2000 ch 568 § 8 (AB 2888).)

Considering the failure to provide CPR when indicated constitutes gross negligence or incompetence, depending on the situation, if what is being portrayed here is true then this woman has a good chance of losing her license if her actions were put to the reasonable nurse standard.

At any rate, this woman has no future in nursing. No place will hire her after a foul-up this big.
 
2013-03-04 05:15:49 PM

hardinparamedic: 1. Put snakes on plane: hardinparamedic:

Hey. Just wanted to say I appreciate what you do, both here and out in the real world.

I really appreciate you saying this, but, there's a lot of people on FARK that deserve that. Not me.  Medic Zero, Lizyrd and many others also do the same job as I do, and they deserve it just as much. As much BS and crap as Lizyrd puts up with being a Fire/EMT, I'd say he deserves a lot more.

I may rib him because he's a damn union hosejock (:P), but he's a good guy.

I just do what I'm good at. I come off as an asshole at times to people, but eh. Everyone does.


This will be my last circle-jerk comment, but what you do is great. I'm scared to death when I'm working the ambulance and a serious pedi call comes in. I'd rather go to 200 drunk, belligerent skells than one seriously hurt or sick kid. My hat's off to anyone that chooses to specialize in that area.
 
2013-03-04 05:28:31 PM

Dumski: Ps. I always enjoyed the old macho Fireman/Paramedic rivalry. What a hoot. I hope you know where my support lies. ;)


Since you worked in the ER, I'm going to assume with whatever one you were sleeping with at the time. :P

/srsly. it's like a soap opera in thar.

Dumski: Don't forget that the source is a news story. "Facility policy" is a bit of a stretch. More likely that is part of the directives for staff, residents and family that they (resident/family) agree to when admitted.
Also, I'm glad you said that you actually worked in a care facility as a CNA. So many paramedics have no idea what working in a health facility is like, and therefore have no business giving judgements on the abilities or skill levels of the staff. We are all in the same business of caring for sick people.


You're absolutely right. Nursing homes and assisted living facilities ARE limited in what they can do in an emergency, and shockingly restricted to the point they have to call for orders to put someone in active respiratory distress on oxygen before EMS arrival. But what I saw as a CNA made me realize I'd never put my family in a nursing home, especially one that was a medicare-only facility. Two LPNs in a facility at night with 60 patients, and 15 total care patients to one CNA meant that you could only do the best you could. Every two hour round ended in time to do the next one, usually.

The first one I worked at I was fired after I reported a CNA for striking an elderly patient and stealing his food. Turns out the ADON was relatives with the CNA I reported, and the next morning I was told I should quit, otherwise they were reporting me to the state for leaving a "total care patient unchecked all night", despite the fact I had documentation the patient was clean and dry 15 minutes prior to going off shift. Strangely enough, there was not an incident report or photograph taken, which was their corporate policy for accusations of abuse.

As a Paramedic, I've worked multiple patients in nursing homes that were in unrecognized cardiac arrest. I know of a nurse who was fired and reported to the state for diverting drugs who went to work in one while under active investigation. I've seen a sepsis patient that was left to lie in their own filth for a day, and when the diaper was taken off her labia came with it.. I've seen DKA and hypoglycemia all go unnoticed.

While I agree that there are good nurses and aides that go into Elder Care for the purpose of helping people, they're few and far between, and usually found in facilities which are not medicare dependent, or hospice care. Most nursing home nurses, and aides are there because they have to be.

They are underpaid for what they do, abused - by both the administration, patients and their families - and often understaffed to the point they either burn out and take it out on the patients, or injure themselves.
 
2013-03-04 05:54:38 PM
Hippocrates weeps from his grave.
 
2013-03-04 05:55:53 PM

hardinparamedic: Dumski: Ps. I always enjoyed the old macho Fireman/Paramedic rivalry. What a hoot. I hope you know where my support lies. ;)

Since you worked in the ER, I'm going to assume with whatever one you were sleeping with at the time. :P


Unless they were a woman. I'm a guy. Not so much of a soap opera in the ER where I worked. Just a bunch of burned out RN's and Dr.s doing more with less. Thats why I went to a cozier job like ICU!

Your descriptions of what you encountered are not good. I guess I am talking about the hospital employed Nurses rather than LTC ones. I live in Canada, and everyone is working with bigger patient loads and sicker patients. As we Baby Boomers start the downward slide, the system will get even more bogged down. I'm glad I'm out.
Oh, and I have no intention of ending up in a bed in a care facility with someone wiping my ass. I have a plan!
 
2013-03-04 06:14:44 PM

Dumski: Your descriptions of what you encountered are not good. I guess I am talking about the hospital employed Nurses rather than LTC ones. I live in Canada, and everyone is working with bigger patient loads and sicker patients. As we Baby Boomers start the downward slide, the system will get even more bogged down. I'm glad I'm out.


Oh. You mean floor nurses! Floor nurses are pretty cool. They have a thankless job, and they dont get the props that the ICU and ER nurses get.

Yeah. The State of Long Term Care systems in the US is scary. You have good nursing homes that take great care of people, but these are often private pay only facilities, or they provide some niche specialty care, like ventilators, eventual discharge-to-home ortho rehab, or long-term pediatrics.

Most survive on Medicare Part A funding, and Medicaid from the state if you meet their criteria (typically co-morbid conditions, like end stage dementia and renal failure requiring dialysis). They're underfunded, understaffed, and dependent on keeping costs as low as possible.

There's a reason that litigation stemming from LTC facilities are a boom industry in the United States.
 
2013-03-04 07:33:49 PM

hardinparamedic: Considering the failure to provide CPR when indicated constitutes gross negligence or incompetence, depending on the situation, if what is being portrayed here is true then this woman has a good chance of losing her license if her actions were put to the reasonable nurse standard.

At any rate, this woman has no future in nursing. No place will hire her after a foul-up this big.


Oh, I think any employer that wants employees to follow orders regardless of their personal feelings would have a look at her.

The nurse might lose her license if she was performing the job of nursing at the time, or representing herself as a nurse to residents who reasonably relied upon her representation to  their detriment.  A nurse is under no obligation to render aid while she's moonlighting as a stripper.  It appears that the old lady's contract specified that no medical care would be provided.  The old lady's daughter, who is also a nurse, seems to understand this.

Do you understand that a doctor has no obligation to give you CPR if you collapse on the street while he's walking by, or even if you stagger into his office without an appointment? You are strangers; no relationship exists which creates an obligation to you.  Now, a doctor in an ER is holding himself forth as someone prepared to treat strangers at any time; but in a private practice, a walk-in is a trespasser to whom no duty of care is owed automatically.
 
2013-03-04 10:17:57 PM

BarkingUnicorn: Oh, I think any employer that wants employees to follow orders regardless of their personal feelings would have a look at her.


...The Nuremberg Defense?

BarkingUnicorn: The nurse might lose her license if she was performing the job of nursing at the time, or representing herself as a nurse to residents who reasonably relied upon her representation to  their detriment.  A nurse is under no obligation to render aid while she's moonlighting as a stripper.  It appears that the old lady's contract specified that no medical care would be provided.  The old lady's daughter, who is also a nurse, seems to understand this.


That's a nice, non sequitorial thought there, but she wasn't moonlighting as a stripper, was she? No. She was employed by the facility, and identified herself as a nurse. You don't get to pick and choose which standards of care you go by there. Even if you can only provide basic care, you have to provide it to the level of competency and ability that a reasonable person would have acted in.

Withholding lifesaving care is not a reasonable act. By any means. If the woman had a DNR, they could have told the dispatcher that and it'd been the end of it.

BarkingUnicorn: Do you understand that a doctor has no obligation to give you CPR if you collapse on the street while he's walking by


Of course not, legally. Ethically, yes he does. Morally, yes he does.

BarkingUnicorn: or even if you stagger into his office without an appointment?

BarkingUnicorn: Now, a doctor in an ER is holding himself forth as someone prepared to treat strangers at any time; but in a private practice, a walk-in is a trespasser to whom no duty of care is owed automatically.

BZZZT. WRONG. Big Whammy, no money on that stop. He has a legal obligation to provide basic-level care and stabilization to the extent of his abilities, while awaiting the arrival of an ambulance to transport the patient to a hospital. If you stagger into a doctor's office and he refuses to even just call 911, he's failed to fulfill his duty to act - created when you said you needed help in an office which advertises a physician service.

That MD does not have to see you and treat you in his office, but he does have to ensure you are sent to equal or higher level of care if you collapse in his office.

At any rate, these are completely unrelated situations.

BarkingUnicorn: You are strangers; no relationship exists which creates an obligation to you.


Which is not the same thing as happened in this article. At all. You're going off on a completely unrelated tangent here and trying to present the two situations as similar. The fact of the matter is that the woman was a client of the facility which had hired the nurse/nurse aid to act in the capacity of one.

The fact that this woman claims that she was not allowed to do CPR by her employer does not triumph her requirement as a nurse to act, since she was employed by one, to a reasonable standard of care.
 
2013-03-05 12:02:53 AM

erewhon: Abacus9:
Hmmm... I take your word for it. I've heard though that once the heart stops, they're already dead, so you can't really harm them any further. Although I guess that depends on the case and their wishes. Sounds like a rough thing for the patient, but also for the paramedic to have to do.

I guess you get used to it, I really never expected to have to use the training. But so far, three arrests and a Heimlich under my belt. The Heimlich was the most gratifying in that I popped that chunk of food about 4 feet when I hit the right spot, and the guy was immediately better. The CPR episodes were more like and 15 and 16 and (crack) oh my god and 18 and 19 (crack) jesus palomino and 21 and...

Of course, when the guys got there and relieved me it was "well, he was dead anyway" but still, it's sort of stressful to do to someone you aren't mad at.

The really odd thing was the bystanders, you get the wildest suggestions. "Here, stick this candy in his mouth!" Well, no, I'm pretty sure this isn't hypoglycemia...


Remind me to never piss you off (I keed...)

Seriously, sounds pretty grueling. Still, you did what you had to so don't let it get to you.
 
2013-03-05 12:05:26 AM

digitalrain: Abacus9: Lady Indica: To my knowledge (and I could easily easily be wrong here) there's times where breathing alone is called for. I would think this would be one. Drowning is another. Other than that AFAIK, chest compress is most important (to the tune of Stayin' Alive).

Oddly, "Another One Bites The Dust" also works (roughly the same beats per minute)...

But its not nearly as optimistic...


I suppose there's always YMCA or Dancing Queen. Disco's not really known for its versatility.
 
2013-03-05 12:17:02 AM

hardinparamedic: BarkingUnicorn: Oh, I think any employer that wants employees to follow orders regardless of their personal feelings would have a look at her.

...The Nuremberg Defense?


It's not a defense.  It's the way of pharmacies who expect pro-lifers to dispense morning-after pills.

BarkingUnicorn: The nurse might lose her license if she was performing the job of nursing at the time, or representing herself as a nurse to residents who reasonably relied upon her representation to  their detriment.  A nurse is under no obligation to render aid while she's moonlighting as a stripper.  It appears that the old lady's contract specified that no medical care would be provided.  The old lady's daughter, who is also a nurse, seems to understand this.

That's a nice, non sequitorial thought there, but she wasn't moonlighting as a stripper, was she? No. She was employed by the facility, and identified herself as a nurse. You don't get to pick and choose which standards of care you go by there. Even if you can only provide basic care, you have to provide it to the level of competency and ability that a reasonable person would have acted in.

Withholding lifesaving care is not a reasonable act. By any means.


"Colleen" identified herself as a nurse to the dispatcher.  We don't know if she told residents she's a nurse, or if anyone did.  But we do know that the facility informed all customers that no medical care would be provided and the customers agreed.  Therefore, Colleen was not working as a nurse at the time.  She might as well have been stripping for all the duty of care that she had to the old lady.  Standards of nursing care do not apply to people who are not nursing.

Following the terms of your employment and the terms of your employer's contract with a customer is a perfectly reasonable act under the law.  How often do we see clerks fired for trying to stop robberies?  They have no recourse just because we think they're heroes.

No, an ordinary citizen (including a nurse who isn't nursing) does not have to provide any care, even if she can.  In some States, you have a duty to call 911, and that's what these people did.

Colleen was caught in a conflict between her boss, who was right there, and the dispatcher.  She chose her job over the old lady's life.  She had every right to do that.  She did not have a duty to harm herself in order to help that woman.
 
2013-03-05 03:31:20 AM
hardinparamedic:
BarkingUnicorn: or even if you stagger into his office without an appointment?
BarkingUnicorn: Now, a doctor in an ER is holding himself forth as someone prepared to treat strangers at any time; but in a private practice, a walk-in is a trespasser to whom no duty of care is owed automatically.

BZZZT. WRONG. Big Whammy, no money on that stop. He has a legal obligation to provide basic-level care and stabilization to the extent of his abilities, while awaiting the arrival of an ambulance to transport the patient to a hospital. If you stagger into a doctor's office and he refuses to even just ...


Actually a doctor in a private clinic is under no obligation or legal responsibility to act. Morally, yes,  legally, no. EMTALA does not apply to non-emergency facilities. It is his liability, business policy, as well as a possible BSI concern as to whether or not chooses to act. I've been to multiple doctor's offices and some urgent care centers for patients who were not going to be seen by that clinic due to the lack of accepted insurance.

"Any public, private, or non-profit hospital that offers services for medical, psychiatric or substance abuse emergency conditions is obligated to comply with all of the EMTALA requirements found in 42 CFR 489.20 and 489.24. This would include a freestanding psychiatric hospital that receives persons with emergency psychiatric conditions. All licensed general hospitals are required to comply with section 395.1041, F.S. A hospital that does not offer emergency services is not required to comply with EMTALA. Conversely, a facility that is not licensed as a hospital, such as a CSU, nursing home, assisted living facility, outpatient clinic or doctor's office is not required to comply with EMTALA or section 395.1041, F.S. "
http://www.bakeracttraining.org/files/faq/ba_emergency_medical_condi ti ons.pdf
 
2013-03-05 07:11:13 AM
My, My. This is interesting.

http://www.ems1.com/communications-dispatch/articles/1413956-Police- in vestigating-death-of-woman-denied-CPR/


Firefighters and ambulance personnel arrived at the facility seven minutes after the call came in, Miller said. The county does not know who made the call, he said.

The woman had no pulse and wasn't breathing when fire crews found her lying on the floor, Bakersfield Fire Department spokesman Anthony Galagaza added.

They started CPR and loaded her onto a gurney. The woman was later declared dead at Mercy Southwest Hospital.


So yeah. About that nurse saying the patient didn't need CPR.
 
2013-03-05 07:37:17 AM
I've walked into many arrests that went to hell (arrested) on us as we walked in. If patient was breathing, then odds are they were perfusing the brainstem. Any respiration will negate an BLS response. Those respirations won't last long, and when they stop, BLS/EMR responses will go into play.   Admittedly I've seen high quality CPR w/ advanced airway actually cause spontaneous respirations over 50 minutes after BLS efforts started.

Read my earlier post about CPR and ALS interventions if you need.

People can be sued, dispatchers are medics who can't hack the streets IMO, so quit trying to persecute them.
87 year old people won't meet most ER Doctor's criteria for progressive therapy. you know that.

My service allows us to pronounce if dead when we arrive....

/realmedic.
 
2013-03-05 07:59:51 AM

thehobbes: Actually a doctor in a private clinic is under no obligation or legal responsibility to act. Morally, yes,  legally, no. EMTALA does not apply to non-emergency facilities. It is his liability, business policy, as well as a possible BSI concern as to whether or not chooses to act. I've been to multiple doctor's offices and some urgent care centers for patients who were not going to be seen by that clinic due to the lack of accepted insurance.


I think you missed my point, there. I was not talking about EMTALA. I was talking about what the state considers a civil duty to act. Calling 911 for a patient who collapses fulfills that duty to act. If that doctor so much as touches that patient's shoulder to ask if he's okay, he's created a patient encounter.

thehobbes: I've walked into many arrests that went to hell (arrested) on us as we walked in


So have I. However, based on the information presented and given to the dispatcher, the "nurse" in the story should have recognized a peri-arrest condition, and fulfilled her legal duty to act since she was employed AS a nurse, based on what she was telling others.

I know, for a fact, that had this happened in Tennessee as presented by these articles, the nurse would likely be  facing losing her license and civil penalties, if not criminal charges for negligent homicide for failure to act.

thehobbes: If patient was breathing, then odds are they were perfusing the brainstem. Any respiration will negate an BLS response.


You should know better, hobbbes. What's the first thing they teach you as an EMT-Basic in assessment? Not all respiration is effective.

thehobbes: Those respirations won't last long, and when they stop, BLS/EMR responses will go into play.   Admittedly I've seen high quality CPR w/ advanced airway actually cause spontaneous respirations over 50 minutes after BLS efforts started.


I've seen ROSC after four hours of CPR with a good neurological outcome in myocarditis, too.

thehobbes: Read my earlier post about CPR and ALS interventions if you need.


Yes. I know about the Hs and Ts, and arrest rhythms in adult arrest situations. I also know that effective, high quality CPR in a healthcare setting, performed before the arrival of an EMS agency or code response team is responsible for the high rates of resuscitation we see in facility cardiac arrests since the 2005 and 2010 guidelines.

thehobbes: People can be sued, dispatchers are medics who can't hack the streets IMO, so quit trying to persecute them.


Just because you're mad that you get held over for a BLS interfacility call, don't sell out a part of your profession. And the EMD protocols are evidence based.

thehobbes: 87 year old people won't meet most ER Doctor's criteria for progressive therapy. you know that.


Depends. We don't really know what this woman's morbidity was before she suffered her arrest. If the only reason she was in an assisted living facility was because she had a little hip trouble, yes she would.

At any rate, you don't get to make that call without a DNR in hand, or without very specific criteria being fulfilled.

thehobbes: My service allows us to pronounce if dead when we arrive....


Yeah. So do mine. If they meet very specific criteria. This woman would not have met that criteria since it was a witnessed arrest.
 
2013-03-05 09:19:46 AM
how the f is a nurse not trained in CPR at a nursing home.
 
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