Furlong v. Catholic HealthCare West
Margaret Furlong, an 82-year-old California woman afflicted with constant pain from debilitating rheumatoid arthritis and congestive heart failure, was one of few people to actually document end-of-life care preferences. She signed four separate forms in 2001 stating her desire to not be resuscitated or provided extraordinary life-sustaining measures if she suffered a medical crisis. These forms specified that Margaret did not want CPR.
On March 2, 2002, she became very ill and was taken to St. John’s Regional Medical Center emergency room by her daughter-in-law with all her appropriate papers including advance directive, DNR (do not resuscitate) orders and a pre-hospital DNR form signed by a physician. Tragically, however, in ensuing days Margaret had multiple invasive procedures including IVs, fingerstick blood tests every two hours, numerous X-rays, blood transfusions, and insertion of a urinary catheter, feeding tube, and breathing tube she was restrained for trying to remove.
That first night in the hospital, Margaret’s heart stopped; her breathing stopped. She could have had the quick, painless death she wanted. Instead, the hospital called for emergency resuscitation. An emergency physician who didn’t read Margaret’s chart and so didn’t see her directive restarted her heart and put her on a ventilator. Margaret was moved to ICU and subjected to more unnecessary and unwanted torment.
The pain medication provided to Margaret was inadequate, and no one at the hospital suggested Margaret be transferred to hospice care, where greater efforts to relieve her pain would likely have been made. Finally, on the morning of March 12, after several days where Margaret seemed to be deteriorating, her son, Patrick, called the hospital requesting her life supports be removed, and the doctor agreed. But when Patrick got to the hospital he was shocked to find that the ventilator and all the other equipment had already been removed, and his mother, unbelievably, was gasping for breath and dying alone in her room.
In response to these tragic events, Patrick undertook efforts to see that this doesn’t happen to another patient or family. Working with Compassion & Choices legal director, Kathryn Tucker, he filed a complaint with the State Department of Health Services in March 2002. That agency found that the hospital had violated Margaret’s rights and failed to honor her wishes. The DHS issued a citation and notice of deficiency on Oct 10, 2002. But a complaint regarding the conduct of the physicians with the Medical Board of California and a lawsuit alleging elder abuse for failure to honor Margaret’s wishes and failure to adequately treat her pain were dismissed.
The California Court of Appeals ruled that the issue was not the failure to give medical care, but the giving of unwanted care. The Court concluded that the family’s allegation of elder abuse was more accurately based on professional negligence and dismissed the abuse claim.