What an incredible story today from Medpundit:
An elderly, “comfort care only” patient was transferred from her nursing home to the ER in the middle of the night because the nursing home didn’t know what to do when she developed abdominal pain. She was much too frail to withstand surgery, and since she was “comfort care only,” that wasn’t an option anyways. The emergency room doctor who drew her case just happened to have a mother who was in the last stages of terminal cancer himself. The patient’s pain didn’t respond to morphine or to other pain medication. At some point, the doctor made the decision to give her a drug that wouldn’t stop her pain, but would stop her breathing. And it worked. She stopped moaning.
This drug was succinylcholine, which is a paralytic agent used for intubation. It has no role in pain management nor comfort care, and was the cause of death in this instance. The primary care physician was not informed of what happened until five months later when the cause of death was amended.
In these cases of comfort measures only (CMO), the only priority is alleviating pain and maximizing comfort for the patient. This normally means increasing doses of narcotics (i.e. a morphine drip) until the patient’s discomfort is alleviated. As the dose of narcotic escalates, respiratory depression leading to death may follow as a side-effect. Known as passive euthanasia, this is acceptable. Succinylcholine paralyzes the breathing muscles and does not alleviate pain – this is active euthanasia and is why this story is so shocking.
The case is now closed:
Earlier this year, Akron police detectives reluctantly closed the case. And last week, Gelesh [the physician in question -Ed] settled a lawsuit with Wolf’s estate. Last year, the hospital did the same.
In all, the family and their lawyers shared a $1 million settlement.
Through his lawyer, Gelesh denies intentionally killing the woman, saying the use of the drug was a mistake, not a mercy killing.
Police still disagree.
“I think it’s fair to say that the investigating officers were upset by the prosecutor’s decision. We felt we had a good case against the doctor,” Akron police Maj. Michael Madden said. “We thought it was a good homicide case.”
