Imagine if you’re the attending on record in the ICU, and find that the federal government is investigating your care in end of life scenarios.
Pallimed discusses an article detailing that exact circumstance at a VA hospital.
Although they found no wrongdoing, they did find “significant variations with the interpretation of appropriate end of life management in the ICU, and recommended the establishment of new guidelines.”
Most doctors write for a morphine drip with the instructions “titrate for comfort.” That leaves significant room for interpretation by the nursing staff.
Can that process be standardized?
I don’t think so. There is significant enough variability in each patient’s end of life circumstance that will make it difficult for formal guidelines to be written.
Related posts:
- Is general surgery the primary care of specialties?
- When your office manager steals, a doctor learns the hard way
- Buddhist beliefs and end-of-life care
- The office visit: It’s all business
- Failure to communicate
- Medical schools are using Second Life to teach future doctors
- Racial differences in end-of-life care
{ 3 comments }
More lawyer oppression of doctors.
Good article, although your write-up is a bit more negative than the original post.
As Kevin points out, “…..Most doctors write for a morphine drip with the instructions 'titrate for comfort'. That leaves significant room for interpretation by the nursing staff…..”
That interpretation got a nurse put on trial for murder in 1982.
Look up Commonwealth v. Capute. The hospital is incorrectly listed as Fall River, it was really Taunton. Metastatic breast cancer, terminal, with severe pain. The physician left sort of a vague instruction like you alluded to. “Titrate to comfort”, or “give as much as she needs”, something along those lines. The nurse followed the order and made the judgment call. The patient died of her disease.
A supervising nurse, small of brain but large of body, in her “wisdom”, chose to drop a dime to the county DA. Typical of politicians, looking for that glamour case to advance a political career. Easier to prosecute a nurse. Mafiosi fight back you know. It turned into a murder trial. The gutless wonder physician helped throw the nurse under the bus. The order was medically defensible, though it’s vague language might have earned the doctor a rebuke from the Board. Far better to let the nurse twist in the wind on a murder charge……
http://www.aslme.org/research/mayday/26.4/26.4a.php
http://query.nytimes.com/gst/fullpage.html?sec=health&res=9D00EEDF1039F931A15753C1A967948260
Massachusetts law allows the accused in a murder trial to address the jury directly in closing. The nurse took advantage of it. By reports, the nurse delivered an impressive speech, and was found not guilty. As I recall, the murder charge was followed by a malpractice trial against the hospital. A large settlement they say…..
And the trial proved to be dramatic. I know I read about it in one of the national magazines, Time or Newsweek, back in the day.
It turned into a made for TV movie. Patty Duke played the nurse.
http://www.imdb.com/title/tt0095139/
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