End-of-Life Choice, Palliative Care and Counseling

Court Action Targets Kaiser for Failure to Honor Treatment Instructions Doctor Forces Breathing Tube on Dying Girlby Jay

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PORTLAND, OR – Compassion & Choices, the nation’s oldest and largest
nonprofit organization working to improve care and expand choice at the
end of life, today announced its intent to seek accountability from Kaiser
Permanente (Kaiser) for failure to honor a patient’s end-of-life treatment
directive. Legal Director Kathryn Tucker is consulting counsel with California
trial lawyer James Geagan, who is bringing the case. Today’s filing seeks
monetary damages and an order that Kaiser, one of the nation’s largest notfor-
profit health plans, institute policies to ensure their providers respect
patients’ treatment instructions.

The case concerns Emily DeArmond, who lived with brain cancer for most of
her young life. As she approached her final months, her parents met with her
oncologist, her neurosurgeon and a medical ethicist to discuss Emily’s care in
light of her rapid decline. Together they completed a Physician Orders for
Life-Sustaining Treatment (POLST), which documented her parents’ decisions
in official physician instructions.

The POLST is considered the strongest, most explicit form of patient directive
for care. According to the Coalition for Compassionate Care of California,
which runs California’s POLST Paradigm Program:

“In some cases, emergency physicians and admitting physicians have
been reluctant to follow POLST orders without first reassessing the
person’s values in the current clinical situation. However, California
law AB 3000 (Statutes 2008, Chapter 266) requires that POLST be
followed until a review is completed by the accepting health care
professionals. The POLST form must be followed even if the physician
who has signed the form is not on medical staff of the facility.”

Several weeks after completion of the POLST, Emily’s parents found her
unconscious in bed. They rushed her to a nearby emergency room affiliated
with Kaiser, Emily’s provider. They told the staff about her POLST, which
included the order: Do Not Intubate; they did not want Emily to endure any
painful, invasive procedures in her final days. The emergency physician
failed to honor the order and forced a breathing tube down Emily’s throat.
She endured the presence of the tube until she was transferred to another
Kaiser facility, where doctors withdrew it and allowed Emily to die.

“Emily’s POLST should have ensured that providers followed these
instructions regarding treatment,” said Tucker. “But tragically it made no
difference. The doctor’s decision to ignore Emily’s POLST was
unconscionable, throwing aside the careful choices her parents had made in
consultation with her team of doctors. The unwanted insertion of a breathing
tube caused suffering for both Emily and her parents.”

Compassion & Choices brings cases like this to raise awareness of critically
important healthcare issues, to improve end-of-life experiences and create
needed social change. These cases establish important principles of end-oflife
care and choice.

For more information please visit www.compassionandchoices.org.