Santa Cruz Sentinel has an article about the tragedy that is all too common for many nursing home residents.  Nursing homes fail to train on what DNR status means, and far too often simple care is not provided that would save a resident’s life.  Below are excerpts from the article.

The Tragedy: On Sept. 11, 2007, a 71-year-old woman with cancer was transferred to Pacific Care Manor, a nursing home in Capitola. Just prior to her admission, the woman’s doctor noted that her patient was lucid and responsive and "could have years to live." Most importantly, the patient had also expressed a desire to live.

Shortly after her admission, the woman began refusing food, water and any treatment. Within two days, she was screaming and combative. On day three, the nursing staff suggested that lab work be ordered to determine the cause of the resident’s distress. The facility’s director of nursing overruled the suggestion because "once we know what is going on then we will have to treat her." Instead, the nursing director asked the facility doctor to prescribe pain medication and a "do not resuscitate" order. The doctor complied and, despite the woman’s documented opiate intolerance, he prescribed a Fentanyl patch, Haldol, morphine. He also wrote an order for "no CPR, no hospitalization." His patient cried out "you are all going to kill me" after the forcible administration of the prescribed medications. On Sept. 16, just five days after her admission, the resident died. 

All residents of nursing homes have the right to grant or withhold consent to any proposed treatment.  Residents have the right to refuse or consent to treatment and to receive all information relevant to making their treatment decisions. Providing such information is part of any responsible nursing home’s assessment and care planning process. Federal regulations also reaffirm residents’ rights to informed consent and to refuse treatment.

Regardless of a resident’s mental capacity, no facility may administer treatment unless the resident has agreed or has been specifically adjudicated incompetent by a state court judge. Even after a court has determined that a resident is incompetent, it must make additional findings before terminating a resident’s right to refuse treatment. Without a court order, the provision of any treatment over a resident’s express refusal is a violation of several residents rights and is criminal battery.

Similarly, doctors cannot order "Do Not Resuscitate" orders without the written authorization of their patients. For DNR orders, designated health care agents may sign for the patient. However, doctors may not unilaterally impose DNR orders without a resident or resident representative signature.

Nursing homes throughout California are accustomed to interposing their notions of a resident’s best interests over the expressed wishes of their residents. The Department of Public Health and resident advocates have been generally weak in preventing this illegal conduct. Hopefully, the tragedy in Capitola will serve as a warning to both facilities and advocates about the deadly consequences of disregarding residents’ critical rights to direct their own treatment.

Anthony Chicotel is an attorney for the California Advocates for Nursing Home Reform in San Francisco.

2 Thoughts on “DNR does not mean do not treat!

  1. Gale Bostick on July 13, 2011 at 2:38 pm said:

    Is it permissable in SC for a physician in a Nursing Home to write a DNR order before the consent forms are signed by the patient or their representative based on his undocumented conversation with the patient?
    Thans you in advance for your response.

  2. My mom had a dnr in place for many years that said no cpr or machines. This was only to be used if she happened to be dying from a fatal disease.She took such excellent care of her self that it was just a precautionary measure. The dnr was if she were in this position she would want to pass with comfort measures instead of a painful death.The way she passed was incredibility painful due to the staff. She had a minor surgery to improve her lifestyle which was not necessary. It did help but she went to a facility to recover and was drugged into a coma after her refusal and me explaining to the staff that doctors had said she can not have these strong sedatives.She got home and had an injury due to the drugs when she was trying to recover from the overdose.Then went to the hospital for the drug related injury which was a bruise on her leg. She was then again drugged inro a coma after staff were told about no drugs again. The staff would yell out dnr as they were trying to get my mom to go into cardiac arrest or death.This would be done even if my mom was already in a drug coma. She had got a hospital yeast infection after the surgery that was never treated and went into sepsis shock.There was a doctor who started to treat her for 2 days and her vitals went back to normal and the skin infection was cleared but the treatment was not continued maybe cause they thought it was not necessary since they were trying to kill her.She instead was murdered by the hospital staff because the hospital staff gave her meds that would only be used to make this infection worse. this was her comfort measures no oxygen nothing but deadly meds that did kill her.It was done on purpose since the staff knew what meds she needed but instead gave her a med that was very deadly for her condition. I was wanting to know if it is legal to murder a person who has a dnr such as what my mom had. I know that she would have never ever had a dnr if she knew this was the case, since she loved life so much and was not expecting for the medical staff to take her life from her. If it is legal my next question would be why does the medical staff encourage all people to have dnrs. Is it simply so the staff will not have to work. How can that be legal to murder.Last question why are dnrs not banned instead?????

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