Skip to comments.Austin doctors want to withdraw care from vegetative patient (Terri Schiavo type situation)
Posted on 04/28/2006 6:36:10 AM PDT by Cat loving Texan
Family objects and says woman is still aware; seeking transfer to another facility in Texas By Mary Ann Roser
Friday, April 28, 2006
Against her family's wishes, doctors at North Austin Medical Center have decided to stop treating an Austin woman after determining that she is in a persistent vegetative state, a case that echoes some of the wrenching issues raised in the Terri Schiavo case.
However, hospital officials agreed Thursday to give the distraught family, which disputes that the 63-year-old woman is in a vegetative state, more time to find another facility to take her. The hospital supported the decision to either transfer the patient or stop life-sustaining care by Saturday. The new deadline is June 5.
Officials said they were acting under the authority of a 1999 Texas law that allows doctors to stop ongoing care in medically futile cases after giving families 10 days' notice. But officials said that the extension offered more options.
The hospital told the family and its attorney, Jerri Ward of Austin, that it had found a nursing home in Illinois willing to take Lang Yen Thi Vo. But Vo's daughter, Dr. LoAnn Trinh, said that she feared her mother was too weak for such a long trip and that having her so far from home would be difficult.
"That would be a last resort," Trinh, 33, said.
Trinh also said her mother had expressed a desire to have life-sustaining measures taken. In the Schiavo case, which drew worldwide attention last year, the husband of the Florida woman who had been in a vegetative state for 15 years said she would not have wanted to be kept alive, but her parents disagreed. The case resulted in a protracted legal battle. The courts ordered her feeding tube removed, and she died more than a week later.
In Vo's case, Ward filed a petition in Travis County Probate Court on Thursday morning asking for more time to find a facility closer to Austin. A hearing was set for the afternoon, but after hospital officials agreed to continue treating Vo until June 5, the hearing was canceled.
The extra time is "very good news," said Ward, who is representing Vo and her family pro bono, or without a fee. But the law "gives such pitiful protections to families in this situation" that a lawsuit challenging it may be needed, Ward said.
She also represents a family in Houston in a similar situation. The hospital there, St. Luke's Episcopal, found a placement, also in Illinois, for the patient, Andrea Clark. But that hospital has not agreed to a similar extension, Ward said.
Ward said she isn't sure how successful Vo's family will be in finding a Texas placement. Once a facility brands a patient's ongoing care as futile, it is hard to find others willing to take the patient, she said.
Trinh, a general practice and emergency medicine physician who practices in Austin and Corpus Christi, said she, her two siblings and her father all dispute that Vo is in a persistent vegetative state.
Her mother has had two strokes and has lost the ability to talk and move. She speaks Vietnamese, not English, which could account for the blank stares nurses and doctors say they get, Trinh said.
She was able to scribble her name until the swelling in her arm several months ago worsened because of a kidney dialysis shunt, she said.
Vo was hospitalized at North Austin after a dialysis treatment in December and developed a bad infection as well as other complications, including high blood pressure and fluid in the lungs, which required a respirator to help her breathe, Trinh said.
Vo still has the blood infection, which Trinh said makes it impossible to evaluate the extent to which she is impaired.
The doctors taking care of Vo said they see a patient in a terminal, irreversible condition.
Dialysis and other care is "only prolonging her dying," said Sheri Wallace, ethics committee chairwoman, in a letter to Vo's husband, Binh Trinh, after reviewing the case.
Wallace also wrote that a neurologist reviewed Vo's brain functioning and noted that she had no higher cognitive functions.
Further, "she only opened her eyes to mild pain and had blinking reflex for visual threat . . . , did not respond to visual stimuli, and . . . is in a vegetative state."
The ethics committee recommended to stop treatment.
The hospital does not withdraw care but merely supports the doctors, Wallace said.
The decision was a wrenching one for the doctors and staff, said Wallace and Dr. Steve Berkowitz, chief medical officer for St. David's HealthCare, which operates North Austin.
"One of the most difficult parts of the art of medicine is to realize it can be in the patient's best interest not to intervene," Berkowitz said.
Neither could recall a similar case in which doctors agreed to withdraw care and a family in Austin objected.
LoAnn Trinh said she sees a financial reason behind the decision.
Her mother soon will exhaust her Medicare and Medicaid benefits. Wallace and Berkowitz said that they had no idea of Vo's financial status and that it was not a factor.
To overrule a family is wrong, said Trinh.
"This is not what mom wants, this is not what father wants and this is not what the family wants," Trinh said. "She is not brain dead. . . . To pull someone off life support would be cruel and unusual."
The family's goal is to get Vo stabilized and take her home, she said. Trinh's father and one of her aunts had been taking care of Vo.
"Ethics" committee recommends stopping treatment. The world is upside down.
Not really like Schiavo since only the doctors want to pull the plug. But it illustrates that once you start down the slippery slope, there is no stopping.
The solution to this problem is to have the legislature do its job, and pass laws that govern this instead of simply leaving it up to the parties and the courts to decide what to do based solely on their own preferences.
But like so many things, the legislators think their job is to collect a big paycheck, make speaches, and be famous. They don't seem to comprehend that they are responsible for making policy, and even if they did, they have no clue how to do so since the qualifications for getting elected have no relationship to whether you understand policy issues.
There is a thread over at DU about this Andrea Clark case, one of her family members is a DU'er. She gives credit to the pro-lifers who helped save her sister. She also thanks DU'er for helping to keep the story in the media.
I will go and try to find the link.
I am glad she was able to save her sister.
Just in case that link does not work, you can find the thread under General Discussion and it is titled, "KILLING MY SISTER - UPDATE - AND THANK YOU.
Unless the legislature is made up entirely of physicians, attempting to cover every contingency of when to end life support would be futile. At some point, the opinions of experts have to be trusted and have to be final. Do you really want a legislature to determine whether one of your relatives lives or dies, or would you rather a physician who knows your relative make that decision with your family.
Note that the vast majority of these cases are resolved between family and physician. It's the exceptions that make the papers.
Note also that in both of the cases in Texas, palliative care is what is needed. Both medical facilities are acute care.
Fine.... Have the legislature pass a law that says the physicians have input. Have the legislature pass a law stating that the judge can play a role. Have the legislature pass a law stating that the family plays a role.
It's not just a question of who plays a role. It's also a question of why they play a role. Currently, the judge simply decides what he thinks is right, even though there is no law that authorizes him to do that. He might think that the physicians have the best input, or he might think that the family does. He might think that the spouse speaks for the family, or he might think that the parents do. They are making it up as they go along, and that is why there is such an uproar over this. If the legislature passed a law telling the courts what to do, then we would not be having this problem, except of course, if the courts simply refused to honor it.
But we aren't there yet, because the legislature won't do its job in the first place.
I don't understand what you're talking about.
The legislature DID its job with the Futile Care Law. Physicians and hospitals are able to decide when a hospital may remove life support, over the objections of a family, with a ten-day notice.
Now, you might think that ought to be 15 days, or 20 days, or more. But this law places the decision in the hands of the doctors and hospitals, and no judges are involved.
Many misconceptions come from medical reports and are on patients charts. My wife used to be a CNA. She had a patient that she fed who would chatter to her and get excited when my wife would enter the room. The woman would turn her head but didn't give others this response.
She was doing charting and saw they had the patient as being deaf. She told her supervisor she's not deaf. So they said prove it then. The nurse hid behind a door and my wife went in the room and called the patients name the woman turned around and started chattering real excited. The nurse was then convinced. What had happened the woman was European Jewish and up till the time her family brought her here she only spoke Russian. The woman understood some English my wife taught her such as cookie etc. She also had numbers tattooed on her. Yea in a nursing home environment and her being from where she was I reckon she figured keeping her mouth shut was the safest thing to do.
Yes, I guess in this case you are right. The legislature passed a law concerning it. In this case, the problem might be that the legislature passed a law that did not allow enough input by others who might want to have a say.
In the Shiavo case, though, the problem was that the law did not really cover the situation, so the judge just imposed his own views. It's kind of hard to get behind that.
This family wants to save their loved one and you just can't stand it!
I about decked a doctor in an emergency room about 4 years ago for refusing needed care for my wife. Had the attending physicians continued their plan of care she would have died. They missed a severe adverse medication reaction that results in acute psychotic behavior. But no mental illness I know of produces a Coma or unconsciousness in a patient.
Families should discuss their wishes with other family members. If doctors and hospitals wish to act against them have an escape plan worked out by trusted family members to seek treatment in a more friendlier state if possible. Be ready to use it if reason does not work.
This family wants to save their loved one and you just can't stand it!
Now that you're done yelling and screaming, do you have anything to contribute to the discussion?
Another woman that Texis is trying to murder.
How is Texas trying to kill her?
Ping for life.
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