Independent Living Facility Refused to Perform CPR

[redheadbaker]

BAKERSFIELD, Calif. (KABC) -- An elderly woman being cared for at a Bakersfield retirement facility died after a nurse there refused to perform CPR on her when she collapsed.

When Lorraine Bayless collapsed Tuesday morning, a staff member at Glenwood Gardens called 911 but refused to give the 87-year-old CPR.

In refusing the 911 dispatcher's insistence that she perform CPR, the nurse can be heard telling the dispatcher that it was against the retirement facility's policy to perform CPR.

During the exchange between the nurse and the dispatcher, the dispatcher can be heard saying, "I don't understand why you're not willing to help this patient."

"Okay, then hand the phone to a passerby. If you can't do it, hand it to the passerby and I'll have her do it. Or if you've got any sitting citizens there, I'll have them do it," says the dispatcher.

A little more than five minutes into the call, Bayless remained untouched, barely breathing on the dining room floor.

About seven minutes after the facility dialed 911, Bayless was taken in an ambulance to the hospital, where she died.

The executive director of the nursing home says it is their policy that staff does not attempt CPR in these types of situations.

"Our practice is to immediately call emergency medical personnel for assistance and to wait with the individual needing attention until such personnel arrives. That is the protocol we followed," the statement read, adding that the facility would conduct a "thorough internal review of the matter."

Bayless was a resident of the home's independent facility, which is separate from the skilled and assisted nursing facility.

abclocal.go.com/kabc/story?section=news%2Fstate&id=9013895

[ttt]

WTF???

[SusanBAnthony]

I don't know why they have that policy, or why anyone would want to live there, and why they have nurses at all if that is their policy.

But, assuming it was well communicated and residents are aware of it, I don't have a problem with it.

[pamela]

I hope the family of every resident sees this and moves them out. How can they have NURSES refuse basic care. How are they even a nurse then, not just a glorified sitter? Actually, I can't even say sitter because I expect my sitter to perform CPR as needed. Especially as directed by 911 dispatchers.

[StrawberryBlondie]

Wait... is it their policy to never help and always call emergency services in every situation, or is this just related to CPR?

[ringstrue]

WTF is the point is having a nurse work there (and being paid nurse-level hourly wages) if they aren't going to do CPR?

[caden]

WTF. and no one felt the need to explain the rationale behind that protocol? Seriously, journalists?

[starlily]

Mar 3, 2013 13:23:55 GMT -5 caden said:

WTF. and no one felt the need to explain the rationale behind that protocol? Seriously, journalists?

Yeah, I need to know more about the actual policy, why it's in place, and if the residents/their families know about it and still agreed to live there.

[Deleted]

Is it possible the patient had a DNR?

[redheadbaker]

Mar 3, 2013 13:36:30 GMT -5 @septimus said:

Is it possible the patient had a DNR?

Why would they have called 9-1-1 for help, though? 

[sushi]

So many questions. Such as did this woman have a pulse? It said she was breathing at least.

Cpr on a person that old is a nasty thing with broken ribs if you do it right. I don't know if the policy is due to treat of law suits, but I wouldn't be surprised.

[sushi]

Mar 3, 2013 13:40:35 GMT -5 redheadbaker said:

Mar 3, 2013 13:36:30 GMT -5 @septimus said:

Is it possible the patient had a DNR?

Why would they have called 9-1-1 for help, though? 

Because you want transport to a hospital for non resucitative care. It happens often, including with hospice patients.

[IIOY]

Mar 3, 2013 13:35:10 GMT -5 starlily said:

Mar 3, 2013 13:23:55 GMT -5 caden said:

WTF. and no one felt the need to explain the rationale behind that protocol? Seriously, journalists?

Yeah, I need to know more about the actual policy, why it's in place, and if the residents/their families know about it and still agreed to live there.

My gut reaction is that it might be a liability issue, because I'm struggling to imagine why else this would be the policy.

[Deleted]

Mar 3, 2013 14:11:47 GMT -5 sushi said:

So many questions. Such as did this woman have a pulse? It said she was breathing at least.

Cpr on a person that old is a nasty thing with broken ribs if you do it right. I don't know if the policy is due to treat of law suits, but I wouldn't be surprised.

Broken ribs can result from correctly-done CPR on anyone, not just the elderly. That's why many states have Good Samaritan laws to protect lay rescuers from lawsuits over complications of CPR.

What I'm wondering is why the nursing home doesn't have such protection. IDK if Good Samaritan laws (assuming they exist in whichever state the home is in) would apply since they are intended to protect the lay rescuer, but there should be something covering them. Hospitals have their patients sign a consent to treat document upon admission which I'm fairly certain covers acute arrest management.

[meshaliuknits]

Mar 3, 2013 14:11:47 GMT -5 sushi said:

Cpr on a person that old is a nasty thing with broken ribs if you do it right. I don't know if the policy is due to treat of law suits, but I wouldn't be surprised.

That's where my mind went. Broken ribs are common with young folks being treated with CPR. I imagine its at least twice as bad when its old folks.

Sent from my EVO

[UMaineTeach]

what are the laws regarding CPR for licensed medical professionals acting the the capacity of a licensed medical professional?

like I know, as a teacher, I have to report if a kid is getting beaten if they are in my class/school, but if I see a kid getting beaten at the neighbor's house it's my choice.

I would think that if you are a nurse who is being a nurse right then, in the absence of a DNR or similar document, you would have to provide any life saving intervention you are trained or licensed to do.

[MrsAxilla]

Mar 3, 2013 14:41:09 GMT -5 UMaineTeach said:

what are the laws regarding CPR for licensed medical professionals acting the the capacity of a licensed medical professional?

like I know, as a teacher, I have to report if a kid is getting beaten if they are in my class/school, but if I see a kid getting beaten at the neighbor's house it's my choice.

I would think that if you are a nurse who is being a nurse right then, in the absence of a DNR or similar document, you would have to provide any life saving intervention you are trained or licensed to do.

This is exactly what I was thinking, too.  

[Deleted]

Mar 3, 2013 13:11:48 GMT -5 SusanBAnthony said:

I don't know why they have that policy, or why anyone would want to live there, and why they have nurses at all if that is their policy.

But assuming it was well communicated and residents are aware of it, I don't have a problem with it.

IME, that's unlikely. Typically in healthcare facilities, such policies are "communicated" by handing someone a list or a guidebook and asking the patient/family to sign a document stating that they received the written policy - neither of which patients typically read.

Hell, facility staff hand documents all. the. time. to patients and say "Here, sign this". Patients, particularly those of the older generation, almost always sign without even a glance. I see this almost every day at work (hospital procedural department) and as a patient/patient's parent myself I have found I am expected to sign without reading. But with long-term care facilities in particular, the amount of legal documents is staggering IME.

My mother spent six weeks in one after breaking her ankle. I walked into her room one day to find someone from administration holding a pile of documents half an inch thick and handing document after document to my mother "You need to sign this" "Sign this one" "Now this one" as my mother signs without even asking WTH she's signing. I saw the admin try not to grimace as I casually said "Mom, you do know you're allowed to read that before you sign, right?"

*IF* this no-CPR policy exists (and that's a huge IF) it's probably buried in some signed consent document somewhere, to which the admins will point as evidence that the patient/family knew of and agreed to the policy.

[Deleted]

This article raises more questions for me than it answers.

Was the nurse really a nurse or a "staff member" as she was referred to elsewhere?

I can kind of understand their policy, a little bit.  The woman was not in the assisted living or nursing home part of complex.  She was living independently in a retirement home.  I guess they figure those people aren't paying for medical care.  On the other hand, if you're a nurse and you come across someone who's retired on the grounds, how can you refuse to do cpr if you know it?  Let's say the woman had a visiting child or grandchild collapse, or maybe a landscaper collapses - would the nurse still refuse to help?  Seems pretty screwy if you would do more for someone with no affiliation to the home than you would to a paying customer.

I really can't take seriously the idea that liability due to possible broken ribs is the reason.  The liability for death has to be much more serious.

[shouldbworkin]

I agree, I'm not really sold that the "staff member" was a nurse. It's independent living, not a nursing home. They are very different. And, I can see why they wouldn't allow it for liability purposes. Not saying it's a great policy, but imagine the lawsuits they could open themselves up to by doing CPR improperly in that population! Even doing it properly, if the outcome isn't what the family wants they could be sued anyway and that is expensive, as well.

[caden]

Mar 3, 2013 15:20:47 GMT -5 sandsonik said:

This article raises more questions for me than it answers.

Was the nurse really a nurse or a "staff member" as she was referred to elsewhere?

I can kind of understand their policy, a little bit.  The woman was not in the assisted living or nursing home part of complex.  She was living independently in a retirement home.  I guess they figure those people aren't paying for medical care.  On the other hand, if you're a nurse and you come across someone who's retired on the grounds, how can you refuse to do cpr if you know it?  Let's say the woman had a visiting child or grandchild collapse, or maybe a landscaper collapses - would the nurse still refuse to help?  Seems pretty screwy if you would do more for someone with no affiliation to the home than you would to a paying customer.

I really can't take seriously the idea that liability due to possible broken ribs is the reason.  The liability for death has to be much more serious.

The Independent Living places my relatives have been in charge a la carte for medical care. As in, it's available and provided if you need it, but not included in the price like it would be in a nursing home situation.

[Deleted]

Mar 3, 2013 15:32:01 GMT -5 shouldbworkin said:

I agree, I'm not really sold that the "staff member" was a nurse. It's independent living, not a nursing home. They are very different. And, I can see why they wouldn't allow it for liability purposes. Not saying it's a great policy, but imagine the lawsuits they could open themselves up to by doing CPR improperly in that population! Even doing it properly, if the outcome isn't what the family wants they could be sued anyway and that is expensive, as well.

One doesn't have to be a nurse to have healthcare provider-level (as in not for the lay public) BLS training. This is available to anyone with some kind of clinical background, not necessarily nursing.

And again, I have a hard time believing the facility had no legal protection against lawsuits for doing CPR correctly. 

[ttt]

Can someone explain to me how "independent living" is different from just being on your own in your own apartment?

[AJL]

Mar 3, 2013 16:32:15 GMT -5 ttt said:

Can someone explain to me how "independent living" is different from just being on your own in your own apartment?

It's basically living on your own but with support staff. A lot of facilities provide transportation, meals and dining, activities, as well as medical services available if you request/need them.

Some independent living places are sometimes attached to full nursing care facilities. These types of places it make it easier for married couples where one spouse needs full care for their condition (like Alzheimer's, for example) and allows for the non-ill spouse to live close by.

[UMaineTeach]

Mar 3, 2013 16:32:15 GMT -5 ttt said:

Can someone explain to me how "independent living" is different from just being on your own in your own apartment?

I think it's like college for the olds.
You can cook in your unit or you can go to the cafe, there might be bus rides to the symphony or a museum, all maintenance and outdoor care are provided, you can make friends with people your own age, have a chance to watch TV in the common room or be by yourself in your unit, sometimes there is a nurse in the building or a contract with a local hospital to have someone come by.

[sushi]

Mar 3, 2013 16:32:15 GMT -5 ttt said:

Can someone explain to me how "independent living" is different from just being on your own in your own apartment?

I think it's basically the same, but it's in a community of other old retirees. And they have community centers with activities and stuff. It's probably co located with increased levels of services. So you might be in an apt but your spouse is in assisted living next door.

[IIOY]

Mar 3, 2013 16:35:27 GMT -5 AJL said:

Mar 3, 2013 16:32:15 GMT -5 ttt said:

Can someone explain to me how "independent living" is different from just being on your own in your own apartment?

It's basically living on your own but with support staff. A lot of facilities provide transportation, meals and dining, activities, as well as medical services available if you request/need them.

Some independent living places are sometimes attached to full nursing care facilities. These types of places it make it easier for married couples where one spouse needs full care for their condition (like Alzheimer's, for example) and allows for the non-ill spouse to live close by.

This.  My grandmother lives in a retirement community that has various levels of independence.  There are duplexes (the most independent), apartments, dorm-style housing and finally, a medical facility.  My grandmother is in an apartment, but when she injured herself recently, she was temporarily moved into the medical facility. Once she regained her mobility, she returned to her apartment.  All of these facilities are on the same grounds and residents in each have access to the same intra-community transportation, organized activities, dining, and medical services, as well as home maintenance and groundskeeping.

[ringstrue]

I'm near two independent livIng complexes. The ambulance is there so much they could probably save money building a monorail between them and the hospital.

[emilyj]

Mar 3, 2013 14:41:09 GMT -5 UMaineTeach said:

what are the laws regarding CPR for licensed medical professionals acting the the capacity of a licensed medical professional?

It's been 10+ years at this point, but when I was an EMT in CT and had the EMT sticker on my car, I could have gotten in serious trouble if I passed someone needing help and didn't stop - even if I was off duty. That sticker on my car obligated me to help.

My mom is still a nurse in CT - if she refused in her hospital she'd be fired. She has helped strangers in public, but I don't know that she's legally obligated to in those instances.

[Deleted]

I can't fathom how you sit there for seven minutes knowing how to provide CPR and just deciding not to.