DSHS: Independent living nurses not required to give CPR
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SEATTLE -- An elderly woman died last Tuesday after a nurse at her California retirement home refused to give her CPR, and experts say the same thing could happen here.
According to the recorded 911 call, a staff nurse called to report that an 87-year-old woman living at the Bakersfield independent living home had collapsed in the dining room with breathing problems.
The nurse told the 911 dispatch operator, Tracey Halvorson, that the elderly woman, Lorraine Bayless, was only taking about one breath every 15 seconds.
During the call, the nurse refused Halvorson's clear directions to perform CPR, saying that the retirement home doesn't allow such procedures on its residents.
"Can anyone there do CPR? Give them the phone please … I understand if your facility is not willing," Halvorson said during the recorded call. "But give the phone to the stranger. This woman is not breathing enough. She is going to die if we don't get this started."
"I understand," the nurse replied. "I am a nurse, but I can not have our other senior citizens who don't know CPR (interrupted)."
Almost 10 minutes after the call was placed, an ambulance arrived at Glenwood Gardens. Paramedics took Bayless to a hospital, where she was later pronounced dead.
The facility is owned by a company called Brookdale Senior Living, which has facilities in 36 states, including 12 in Washington. Many of those facilities -- including one in Lynnwood -- are under the Clare Bridge brand.
Nurses at the Lynnwood facility refused to answer if they are ordered not to give CPR. They referred all questions to corporate headquarters. A statement from headquarters said the Bakersfield nurse properly followed policy.
Good Samaritan laws protect average citizens who help out in an emergency situation, and large hospitals have lots of insurance and training. Caught in the middle are assisted living facilities.
Roger Leslie is a top expert on elderly care law and said it boils down to profits before patients.
"That seems ridiculous to me. And what I'd say about this is that if it seems ridiculous to me and to you, then it's going to seem ridiculous to a jury," he said.
Much depends on whether the facility is a nursing home or an independent living facility, which are not regulated by the state. The Department of Social and Health Services confirms that staffers are not obligated to give CPR, only to call 911.
The Bakersfield nurse may be in additional trouble. While she was following company policy, she may have violated her nursing license by refusing to give life-saving care.
Leslie urges all families shopping for elderly care to set aside difficult emotions and read everything twice before signing a contract.
According to the recorded 911 call, a staff nurse called to report that an 87-year-old woman living at the Bakersfield independent living home had collapsed in the dining room with breathing problems.
The nurse told the 911 dispatch operator, Tracey Halvorson, that the elderly woman, Lorraine Bayless, was only taking about one breath every 15 seconds.
During the call, the nurse refused Halvorson's clear directions to perform CPR, saying that the retirement home doesn't allow such procedures on its residents.
"Can anyone there do CPR? Give them the phone please … I understand if your facility is not willing," Halvorson said during the recorded call. "But give the phone to the stranger. This woman is not breathing enough. She is going to die if we don't get this started."
"I understand," the nurse replied. "I am a nurse, but I can not have our other senior citizens who don't know CPR (interrupted)."
Almost 10 minutes after the call was placed, an ambulance arrived at Glenwood Gardens. Paramedics took Bayless to a hospital, where she was later pronounced dead.
The facility is owned by a company called Brookdale Senior Living, which has facilities in 36 states, including 12 in Washington. Many of those facilities -- including one in Lynnwood -- are under the Clare Bridge brand.
Nurses at the Lynnwood facility refused to answer if they are ordered not to give CPR. They referred all questions to corporate headquarters. A statement from headquarters said the Bakersfield nurse properly followed policy.
Good Samaritan laws protect average citizens who help out in an emergency situation, and large hospitals have lots of insurance and training. Caught in the middle are assisted living facilities.
Roger Leslie is a top expert on elderly care law and said it boils down to profits before patients.
"That seems ridiculous to me. And what I'd say about this is that if it seems ridiculous to me and to you, then it's going to seem ridiculous to a jury," he said.
Much depends on whether the facility is a nursing home or an independent living facility, which are not regulated by the state. The Department of Social and Health Services confirms that staffers are not obligated to give CPR, only to call 911.
The Bakersfield nurse may be in additional trouble. While she was following company policy, she may have violated her nursing license by refusing to give life-saving care.
Leslie urges all families shopping for elderly care to set aside difficult emotions and read everything twice before signing a contract.
It is the company policy to not get involved if they have an emergency.. she called 911 as their process calls for... honestly people are so hell bent that this lady should be losing her license but honestly the corporate policy is to do what she did / didn't do which in this case was perform CPR... the hatred should be directed at corporate for this place and no where else... but also I want to know WHAT THE FAMILY has to say about what happened... to me it would stop most of this business if the family says 'I knew when we signed this that this was in there...' honestly if they allow peoples in ability to read what they sign clearly to be a universal out this is floodgates of lawsuits for everything.. just like the stupid mortgage crisis where people who 'didn't read the fine print' get to say 'oh boo hoo I didn't know this meant that... what a load of BS if signed contracts are not able to be held to the LETTER that which they were written what the hell good are they!
TV shows would have us believe that CPR always saves people and afterward they happily go back to their normal way of life. This might be true for young people in good health, but age, disease, and infirmity have a big effect on CPR outcomes. CPR not only breaks ribs and sternums, it can cause internal hemorrhaging, aspiration pneumonia, permanent cognitive deficits, or even irreversible coma. The "nurse" who called 911 was probably warned about these outcomes in older people.Â
The issue at hand IS NOT whether this woman would have lived (like on TV) or barely lived (like in real life) or died.
The issue IS absolutely that the Nurse not only refused to do CPR herself, but she also refused to allow for anyone else to have a chance to perform this potentially life saving act.
This nurse needs to lose her license over this. She is duty bound AND most likely required by law to perform emergency aid unless there is a signed do not rescusitate order.
@FormerMarineSgt not an issue if the corporate policy is to not perform it.. AND ... the resident signed that agreement acknowledging that fact!
Unless there is a signed DNR Order, every nurse is bound by, "Duty to Act".
I really hope that this nurse loses her license for life. Her actions are totally unacceptable for a medical professional.
@Deathcheater Just the nature of a society that runs on wealth. She didn't want to lose her job so she does her slave holders bidding.
This is a tough call but if a person has a DNR order in place that has to be considered by any person working as a caregiver as his or hers final choice...
@Windowseat there has been no evidence offered that a DNR order existed in this situation.Â
No one is required to give CPR but people have a duty to if they have some sort of compassion. Still no proof that this woman had DNR. I'm sure if she had the nurse would have mentioned it to the 911 operator. In the end its up to you and your family to make sure you get the medical help you require. I'm guessing she had no family to help make sure she staid safe. The nurse shouldn't lose her license unless she violated a law and it appears she hasn't. But at the same time I would put pressure on her from the public to show her what the cost is of taking profit over compassion.
Way to go media for reporting something you don't understand.
First off, NO ONE is required to perform CPR. A patient has the right to determine their own level of care including opting out of CPR if they so desire. Doctors, nurses and even us EMT's and Medics need to abide by the patients wishes. They can communicate their wishes to us in the form of a POLST form.Â
Second, an assisted living facility is NOT a health care provider. There is a difference between an Assisted Living Facility and a Skilled Nursing Facility. It has nothing to do with profits and everything to do with their licensing. The terms are NOT interchangable and different laws apply.Â
Third, most patients in these facilities have an advanced directive on file in the form of a DNR, POLST, or Living Will. Advanced Directives are legally binding documents and MUST be obeyed by healthcare professionals including us responders. They can be over ruled or cancelled by the patient, family, or Durable Power of Attorney though.Â
Lastly, how many of you people condeming this facility would have performed CPR if you were there? It is easy to say you would but in reality a surprising number of people freeze in times of crisis. I would bet at least 2/3 of the people who say they would have done CPR would have frozen had they been in this situation. I see it every day. Â
@seattleemt First, no where in the article was there any mention of a DNR, POA, Family members, or a PTs refusal. Two, Duty to Act! Three, most nursing home I pick up from dont have a DNR for the pt on file. If there is one it is usually not signed. In either case CPR is given. Â
Half you people can not read? lets try again shall we? --- >Â Much depends on whether the facility is a nursing home or an independent living facility, which are not regulated by the state. The Department of Social and Health Services confirms that staffers are not obligated to give CPR, only to call 911.
This was NOT a nursing home and the woman herself had a DNR- Good Lord I hope I can trust my caretaker at that age to DO WHAT I SAID NOT TO DO and let me go when I am called..Â
@Kelly Babbit Is there a story that says she did have a DNR?.... so far that fact in point has been absent.. I'd like to know... but I for one am willing to bet there was something along that very line... which folks are refusing to put to paper... and instead are chewing out this poor nurse for doing what she was told to do!
@Freespeech @Kelly Babbit When you stand in front of a jury the line, "but they told me to do this" will not hold much weight. You are responsible for you actions and your actions alone! I for one would want to act with a clean conscience and do my job by rendering care, at least comfort care (i.e. O2) at the bare minimum! But then again I don't shoot for minimums.
  Â
I'll be joining the pickets today protesting the company and their killer elder abuse...
 Clare Bridge of Lynnwoodwww.brookdaleliving.com
18706 36th Ave W
Lynnwood
@BuddyHolly You are clearly ignorant and don't have a clue to the real facts. Do you believe everything the media tells you?
@seattleemt @BuddyHolly They just like to hear themselves rant irregardless of the facts. They obviously have never dealt with an elder passing, nor do they have any real care for the dignity of an individual. I feel for this family, it is never easy to loose your loved ones, even when you know it is close, they certainly dont need this media circus nor the outcry from those that just like to hear themselves cry foul, doesnt seem to matter that it appears to be unwarranted in this case. "I am ignorant, hear me roar!" sad...
She was potentially capable of saving a person's life and didn't even try. Shame on the company that invented that policy and shame on the nurse. Both should have their licenses revoked.
This is the purpose of this facility. To ALLOW you to die when your time comes. The woman moved into this facility, knowing this, and wishing this as she also signed a DNR. If the nurse had jumped in, this would have been against the 87 year old woman's wishes to die and not have someone break her ribs to keep her alive.
@sometimesright If it was time for the lady to go......why call 911?
@MidnightRambler @sometimesright I guess I forgot that you seem to know when It is best to let people go. When you have a heart attack at 55, maybe I'll with hold care saying "it was time for you to go". Why even transport the 6 yr old mva pt going into shock? I guess it was his time to go. Why recessatate an 87 year old woman? Adding an extra 2 to 8 years onto her life isn't really worth it. I mean how precious is life anyway?Â
@sometimesright Perhaps I am missing something in the article, but where does it say this patient had signed a DNR form? If the implication is that anyone in an adult care or independent living facility has to sign a DNR form to move in, that's absolutely incorrect
@justinsane There's far more to this then meets the eye. Why don't you educate yourself on end of life care, CPR on elderly adults, Legal issues (DNR, liability, etc), and such forth before making such condemning pronouncements. You'd be surprised what's behind all of this.
Another example of the media (for whatever reason) manipulating the news and people's emotions.Â
@sometimesright Yes, because if they did an article about what it looks like to do CPR, which is very brutal, on an extremely frail, ill, elderly person, who has a slim to no chance of recovering fully, the pendulum would swing the other way - people would cry harsh. I watched paramedics pull a lady off of her bed, onto the floor for a firm surface, then proceed to do CPR. It was very brutal on such a frail little thing. They brought her "back" only for her to die hours later at the hospital (thankfully).
I have also seen any number of people with anoxic or hypoxic brain damage from CPR. Sure, they're "alive".... but I know that most would not wish to live that way if they knew.
@Thunder @sometimesright If you don't want CPR sign a DNR-arrest and keep it on you at all times. It is not for us to decided.
Performing CPR on elderly patients is problematic. Â Many have severe osteoporosis and chest compressions could fracture the sternum and attached ribs, causing potentially fatal internal damage and bleeding. Â
That being said, if a resident of a nursing home or independent living facility has a POLST form or other legal documentation stating they are DNR, staff is not supposed to call 9-1-1 or attempt CPR. Â They are only supposed to notify family of the resident's condition and make him or her as comfortable as possible. Â
@Opus8no5Â Hmm... yeah... Where was the DNR? What kind of DNR was it? If its not in front of you guess what! It dose not count. Oh, and if your not cracking a rib your not pushing hard enough.Â
@Opus8no5 That is all spot on, except they are supposed to call 9-1-1 every time and notify the dispatch that the person has a DNR POLST. The paramedics still come, but do not do CPR, they verify that there truly is no pulse or respirations - pronounce. I remember a time when many nurses thought a woman was deceased and paramedics came and found a pulse.Â
Now, if a person is Hospice, then no 9-1-1, only Hospice is called and of course the family in both instances.
Oh well, nuff on this one. Moving on.............
My mother is in a care home, and has a signed DNR (Do Not Resuscitate) order, with orders for staff and Medics NOT Â to take any lifesaving actions , only comfort care. We would be very upset if someone tried CPR against her wishes.
@Gnirk Amen. And had everyone known about the DNR early on, a lot of what's posted here...wouldn't be.
@Joy Johnson @Gnirk How do you know there was a DNR order in place? We don't. If there was, the caller should have stated that to the dispatcher (by law) and then the dispatcher should have forwarded that information on to responders (by law) and that would put a halt to any life-saving efforts. A DNR order and corporate policy are two different things. What the company has said is that it's not their policy, under any circumstances, to perform CPR on a resident that stops breathing - doesn't matter the age - they don't perform CPR under any circumstances.Â
@DawgFan72 @Joy Johnson @Gnirk Exactly.  Thank you.
KOMO wins today's award by not mentioning the DNR...
http://r25.imgfast.net/users/2511/14/12/24/smiles/122449.gif
@TheChosen Well, you certainly got that right. Started quite a whirlwind didn't it?
A dispatcher is not a medical professional. A dispatcher has no authority to order anyone to do CPR. A person breathing has a heartbeat - you don't perform CPR on them. A dispatcher has no authority to override a DNR.
Non-story.
@Papio "A person breathing has a heart beat"??? Anyone breathing has a heart beat but not everyone with a heart beat breaths. And guess what! If they have a heart beat but the heart in not pumping efficiently enough seen a lot in infants and ROSC (return of spontaneous circulation). Then you perform CPR unless a DNR (Original copy, signed by the pt/POA and the doctor, which clearly states the pts medical condition) is present at hand!Â
@Papio Many dispatchers, not sure about California, are trained in 1st aid, CPR, VDR, AEDs and such. I am trained in those things and I am not an EMT or a health care professional. I chose to take those training courses as part of, what I feel personally, my civic duty. That's my choice. Had I been there, I would have administered CPR under the good Samaritan law unless someone showed me this lady's DNR. Which I now believe would have been available. My father had a DNR and had it on him at all times. He had a badge carrier that held his DNR, his med list, emergency contacts, other illnesses, etc....whatever else he felt pertinent when he couldn't speak for himself. Maybe in California, good Samaritans gets sued? But in Washington, that's what I would have done.
@Joy Johnson I'm FA/CR trained and have used several times in the past 10 years. First things looked for is if there is a heartbeat and breathing. If those exist, CPR is NOT done. Today's CR training doesn't even include rescue breaths anymore.
Having sat at the side of both my parents when they passed, I can tell you that when we die (non-violently) our systems will slowly fail and it sounds like this is exactly what happened. No mentioned of obstructed airway, nor any mention (in this article) of other issues like heart attack, or other contributing ailments. Sounds like someone who has reached the clearing at the end of the path and its time to go.
@Joy Johnson "Trained in" does not necessarily equal competency for training others or instructing others. Even a doctor, who is a trained medical professional has no authority to force issue orders, over a phone, to an untrained person without their consent.Â
I might also add, that when my father passed away, with his DNR known by all, the medical personnel still did CPR on him until it was no longer deemed a viable solution (at their discretion). That's when they called it me, when they knew CPR wasn't going to bring him back. I know my dad was ready to go. But, even so, CPR did not seem to get ruled as an extraordinary measure at this hospital? They called when the only choice was to ventilation for survival. My dad made it perfectly clear early on, that if life meant he was on a machine ....forget it!
This is sad but the reality is that CPR on an elderly patient is pretty futile. Even if you do get ROSC, the trauma from the compressions will probay kill them anyway. As anyone who has done CPR can tell you, good chest compressions break ribs. The reality is that you do CPR on dead people, and one of the arguments for it is that it sustains organs for transplants. I hope the news that this woman had a DNR on file is correct.
Good, take her license. She clearly doesn't deserve to be licensed as a nurse.
Maybe as a receptionist....
What people seem to be missing, on top of the liability issues, and the DNR issues, is the simple fact that CPR on someone of this age isn't so simple.
Once you pass 70ish, and especially if you have debilitating health concerns on top of age, the risk of complications increases dramatically. The rate of return drops like a rock. CPR almost always results in at least a cracked rib. At these ages the bones are more likely to be extremely brittle. They have a MUCH higher likelihood of punching through a lung, etc. The complications are likely to kill them even if the CPR saves them. And exactly how much longer are you "saving" an 87 year old for? a week? a month?
To those saying this is ethically wrong, I call you on your B.S. All life ends. At some point we must acknowledge that a person has lived their life, and it's time to move on. Just because there's a chance we MIGHT save them for another week or month doesn't mean we should.
@mhungry Sure, CPR on the old is tricky but then again that's why she went to nursing school. And the nursing home just didn't hire some bum off the street. Whether it is ethical or not to perform CPR on the elderly is not for you to decided! I for one will have a DNR-arrest past 70 and keep it on me at all times. Â
@mhungry If that were my mother, that nurse would be in a hospital for refusing to provide care. Had a rib been broken saving her life everyone would have accepted that as an inevitable risk. But to just write this woman off as debris as you have done is beneath contempt.
@Iconoclast@mhungryWhy is letting an elderly lady go the way she's meant to leave this world "writing them off as debris"? We are way too obsessed with saving "life" at all costs. Death has become ridiculously associated with "evil".  BTW I have news for you: In the end we are all nothing but debris. I want dignity. When it's my time, I want my phosphorus recycled ASAP into new life. Maybe a tree. If I'm lucky, an octopus.
@Iconoclast @mhungry It is a case of walk a mile in their shoes ... You truly would understand if you had to do CPR on a frail elderly woman just once. And I mean that honestly, not vindictively. Same goes for if you've seen the results of CPR: if by slim chance that elderly person regains a pulse and breathing. That usually does NOT mean they are ALIVE as in living a life. It means they are breathing and have a pulse. And when they do die, they will come back to haunt you for keeping them in limbo h3ll, instead of letting them go when their time came.Â
@Iconoclast...if you put your mom in this facility, you would know that they are a DNR facility and would not be expecting them to do CPR, as most likely, you don't want it performed on your mother! That is why they have these facilities!
@Iconoclast @mhungry Better you should sue the facility then hold this nurse accountable. If she was restricted by some asinine policy, it's the facility at fault. Had she gone ahead with the CPR, course now that we know the lady had a DNR that's really not important anymore, but had she gone ahead with it, against the company's policy she might have been held accountable by the facility (for ignoring their directives) or by the family for trying to save this lady when she did not wish it. It was pretty much lose-lose for this nurse. I hold this facility responsible, but it looks like they did the right thing in the end if the DNR is true. Just think they could have used a little more compassion then letting this lady expire in front of an entire dining room full of people. Seems wrong somehow!