Compassion & Choices filed a groundbreaking legal case in April against a hospital and nursing home for failing to honor a patient’s end-of-life wishes. The complaint alleges Lakeland Regional Medical Center (LRMC) violated the late Marjorie Mangiaruca’s wishes for minimal end-of-life care and subjected her to aggressive, invasive resuscitation and life-prolonging treatment despite her clear instruction to refuse such treatment.
Compassion & Choices works in courts to advance patient choice in end-of-life care. This case aims to ensure medical professionals respect their patients’ wishes. Director of Legal Affairs Kathryn Tucker and Florida trial attorney Jeff Badgley filed a civil suit in Polk County, Florida, on behalf of Marjorie and her daughter Sharon Hallada. The case contends LRMC didn’t transmit Marjorie’s end-of-life medical instructions when staff transferred her to a nursing home run by Oakbridge Healthcare Associates, and Oakbridge didn’t determine if she had advance directives. Their combined failure resulted in EMTs delivering aggressive treatment that prolonged and aggravated Marjorie’s death.
“They didn’t have to go in and cut her neck and put a ventilator down her throat,” Sharon says, “when all of this could have been avoided.”
At 91, Marjorie Mangiaruca had lived a long, full life and told Sharon she was ready die when the time came. Marjorie suffered from advanced Alzheimer’s disease but had given Sharon medical power of attorney years before. Sharon was clear about her mother’s wishes. When Marjorie was admitted to LRMC for an infection, Sharon made her mother’s desire clear to the treating physician. The physician entered a do-not-resuscitate order (DNR) in Marjorie’s medical chart. “I thought that I had all my i’s dotted and t’s crossed,” Sharon says. She adds medical staff told her, “Don’t worry; wherever she goes, this will go in her chart.”
But LRMC didn’t send a copy of the DNR with Marjorie when she transferred to Oakbridge, and Oakbridge did nothing to find out her instructions.
A few days after arriving at Oakbridge, Marjorie suffered acute cardiac arrest. This was her chance to die relatively quickly and peacefully, as she wished. Instead, EMTs performed CPR by pounding on her chest. They cut a hole in her neck to force a breathing tube into her lungs. They injected drugs to restart her heart and to paralyze her so she wouldn’t fight back. When the ambulance returned to LRMC, a doctor exchanged Marjorie’s breathing tube for another, connected a breathing machine and inserted a feeding tube.
When Sharon arrived at the hospital, she was horrified and distraught to learn what had happened. She now was put in the heartbreaking position of having to order the end-of-life support in order to respect her mother’s wishes. A few days later, LRMC followed Sharon’s direction to remove the tubes. Marjorie died five days later in a palliative care unit.
“This incident is tragic,” says Tucker. “Marjorie Mangiaruca was robbed of a relatively quick and painless death, and was forced to endure unwanted bodily invasion, traumatic aggressive treatment and a lingering death. Providers have to be held accountable in these cases. We hope this case sends a message to ascertain patient wishes and respect them.”
Sharon still finds the memory of her mother’s death painful. She says, “The one thing I promised my Mom is that she would die peacefully. She didn’t have to suffer.”
Sharon Hallada remembers her mother’s tragic death. Watch here:
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