Skip to comments.Hospitals can end life support; Decision hinges on patient's ability to pay, prognosis
Posted on 03/19/2005 7:19:45 PM PST by ambrose
March 8, 2005, 12:33AM
Hospitals can end life support Decision hinges on patient's ability to pay, prognosis
By LEIGH HOPPER
Copyright 2005 Houston Chronicle
A patient's inability to pay for medical care combined with a prognosis that renders further care futile are two reasons a hospital might suggest cutting off life support, the chief medical officer at St. Luke's Episcopal Hospital said Monday.
Dr. David Pate's comments came as the family of Spiro Nikolouzos fights to keep St. Luke's from turning off the ventilator and artificial feedings keeping the 68-year-old grandfather alive.
St. Luke's notified Jannette Nikolouzos in a March 1 letter that it would withdraw life-sustaining care of her husband of 34 years in 10 days, which would be Friday. Mario Caba-llero, the attorney representing the family, said he is seeking a two-week extension, at minimum, to give the man more time to improve and to give his family more time to find an alternative facility.
Caballero said he would discuss that issue with hospital attorneys today.
Pate said he could not address Nikolouzos' case specifically because he doesn't have permission from the family but could talk about the situation in general.
"If there is agreement on the part of all the physicians that the patient does have an irreversible, terminal illness," he said, "we're not going to drag this on forever ...
"When the hospital is really correct and the care is futile ... you're not going to find many hospitals or long-term acute care facilities (that) want to take that case," he said. "Any facility that's going to be receiving a patient in that condition ... is going to want to be paid for it, of course."
Patient showed emotion
Caballero said he believes the hospital wants to discontinue care because Nikolouzos' Medicare funding is running out.
Spiro Nikolouzos, a retired electrical engineer for an oil drilling company, has been an invalid since 2001, when he experienced bleeding related to a shunt in his brain. Jannette Nikolouzos, 58, had cared for her husband at their Friendswood home, feeding him via a tube in his stomach. Her husband couldn't speak, she said, but recognized family members and showed emotion.
On Feb. 10, the area around the tube started bleeding, and Nikolouzos rushed her husband to St. Luke's for emergency care. Early the next morning, she said, the hospital called and said he had "coded" and stopped breathing and had to be placed on a ventilator.
A neurologist told her, she said, that he is not brain-dead and the part of the brain that controls breathing is still functioning. Although his eyes were open and fixed when he first was placed on the ventilator, he has started blinking, she said.
A missed opportunity
Dr. Marcia Levetown, director of palliative care at The Methodist Hospital, said moving Nikolouzos to a nursing home or other type of facility may not be an option if his body is dependent on several types of technology, such as mechanical ventilation and kidney dialysis.
Levetown said when families and hospitals take their disagreements to court, it often means the hospital has missed an important opportunity in the family's emotional healing.
Often missing from aggressive medical care is empathy for family members and acknowledgment of grief, she said.
"The acknowledgment of 'You clearly love your husband very much. You've done the good fight' " makes a difference, she said. Levetown also tells families, "Whatever might be beneficial, you've made sure he's gotten that. We all wish he could get better ... How can we best honor this man ... as we accompany him in his next journey?"
Law allows removal
State law allows doctors to remove patients from life support if the hospital's ethics committee agrees, but it requires that the hospital give families 10 days to find another facility.
A similar case is still in the courts. Texas Children's Hospital wants to discontinue life support on 5-month-old Sun Hudson, who was diagnosed shortly after birth with a fatal form of dwarfism. His mother, Wanda Hudson, wants her son's care to continue at the hospital.
On Wednesday, a judge will consider whether Harris County Probate Court judge William McCulloch may remain on the Hudson case. Caballero, who represents Wanda Hudson, filed a motion that McCulloch remove himself from the case after making what Caballero said were biased statements.
I have my flame-proof suit on, so I'll start. How many resources should be spent on palliative therapy? And at what age? Children who have yet to live their lives but have no chance to? Oldsters who are ready to check out at 80+?
Who could be saved in the meantime using those resources?
The Gubment should pay, and if the patient doesn't want the treatment? Too bad.
Except Terri is not on "life support", she is merely getting food and water, AND her parents WANT to take her home and care for her themselves.
I think whether or not she is in PVS shouldn't even be the issue, it should be whether her husband, who has been living with another woman and has two children by her, and clearly has a conflict of interest with Terri's being kept alive, should be allowed to make life and death decisions for Terri.
I went through the whole heroic procedures with my grandma about 12 years ago. I am on the pull the plug on this side of the arguement.
Health insurance should be like car insurance. Everyone SHOULD HAVE TO HAVE IT. If you don't have it, then the government should bill you for it.
Brain death means you are not coming back. I don't care how many millions of prayers are offered.
Like my foolish Christer aunt offering up prayers for her autistic grandson. It isn't going to change anything. !7 years ought to learn her.
Autism isn't brain dead. And Autistic children with a VERY EXPENISVE therapy can go on to live normal lives. I think the govt should cut spending for Aids and help these families with autistic children.
Then I think the government SHOULD bill it for YOU.
She is NOT brain dead.
People who are brain dead are totally on life support, Terri isn't.
People who are brain dead don't look up and follow balloons with their eyes, like Terri.
And as I said several times already, I think whether or not she is in PVS shouldn't even be the issue, it should be whether her husband, who has been living with another woman and has two children by her, and clearly has a conflict of interest with Terri's being kept alive, should be allowed to make life and death decisions for Terri. Especially, when Terri's parents are willing to assume all responsibility for her and care for her, whatever her condition is.
"Like my foolish Christer aunt offering up prayers for her autistic grandson. It isn't going to change anything. !7 years ought to learn her."
I answer with a phrase often seen in the Bible. "Is anything too hard for God?" Who is the bigger fool, your aunt or you? It is not wise to mock those that pray.
In fact, if this poor family wanted to pay privately for this expensive care, the hospital would be constrained from taking their money.
This is the bastardized 'insurance' we are all entitled to, and this is the kind of 'care' we are thus sentenced to.
I actually think this family has a fair shot at compelling this hospital to continue to provide care for this poor fellow. If they do, and if only a small number of families and patients took a similar tack, under current Medicare payment rules, the hospital industry could be bankrupted in a very short time.
I'm not for Universal healthcare.
That's the problem, does anyone have a solution? Where is all this money going?
Mechanical ventilation and dialysis? What kind of a life is that?
"Like my foolish Christer aunt offering up prayers for her autistic grandson"
So do many others, who are not Christian.
If you don't think prayer is powerfull, you are ignorant on the entire subject of spirituallity. And of the very nature of humankind.
BTW-your Aunt might very well actually be a fool, I don't have any possible way to judge the truth of your statement.
But you OTOH, are publically proving your crass stupidity, which goes well beyond simple crudeness, by calling her a "foolish Christer" for praying for her family.
She would probably just try to forgive you, and pray for your soul if she happened on your post.Now you might not like that, or approve, but you might want to hope she says a few prayers on your behalf.
Because I just sent up a quick "prayer" that you be taught a lesson on the power of prayer.
She shoots. She Scores!
(Will she rip off her shirt???)
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