The 7 minute 15 second 911 call is horrifying in its apparent callousness.
Updated March 5, 8:44 pm
You can listen to the entire call here
The 7 minute 15 second 911 call is horrifying in its apparent callousness. Updated March 5, 8:44 pm You can listen to the entire call here
It transpires like this:
- An 87 year old independent living resident at Glenwood Gardens in Bakersfield, California collapses in the dining room. Someone, by the name of Anna calls 911.
- A care supervisor is also summoned (and was assumed to be a nurse in earlier news reports.
- The 911 dispatcher walks the caller through an initial assessment and about ½ through the tape a care supervisor, Colleen, takes charge.
- The dispatcher has the care supervisor check the resident’s pulse and respiration rate. The care supervisor reports the pulse as weak and respiration rate of around 5 per minute.
- The dispatcher implores the care supervisor to start CPR. The care supervisor refuses, saying it is against the policy of the senior housing community to do CPR. The dispatcher implores her to find someone else to do it. It sounds as if the “manager” of that building confirms she is not to start CPR.
- First responders arrive and the call ends.
- A short time later the woman is transported to the hospital where she dies.
Some additional “facts”:
- The senior community did not have on file a Do Not Resuscitate” order which would be likely the case in most independent living senior communities.
- According to the executive director at Glenwood Gardens the policies, procedures and admission agreement says states they will call 911 in the event of an emergency (unlike for the assisted living and skilled nursing components on the same campus.)
- The 911 dispatcher does say the EMS system will take all the legal responsibility for performing CPR.
- The daughter of the woman who collapsed and died apparently has not complaints with how the situation was handled. In fact, she has come out strongly supporting the senior communities decision.
- Politicians, the public and elderly advocates are screaming for action.
- Glenwood Gardens has at last count close to 150 ratings on Yelp, most hateful and negative.
But . . . After listening to the entire call, I find myself wondering how the care supervisor could refuse to do CPR and how apparently someone above her would confirm she should not do CPR. I am quite sure I would have started CPR if I had been there. Upon further reflection and an understanding that what happened was in accordance with the resident’s and family’s wishes, I am less certain I would have instituted CPR. And yet, I don’t think it is quite as simple as it is being portrayed. Here are some things to think about:
- The survival rate for someone in that situation even is CPR is very poor (not in and of itself a good reason to not do CPR).
- If the care supervisor or someone who worked for Glenwood Gardens had begun CPR and the woman had survived needing significant medical intervention, would the community have been on the hook for the cost of that care. I seriously doubt the EMS system would own that liability.
- While slightly different circumstances, just this week, my father-in-law is moving is being moved from an acute hospital, to skilled nursing, he his wife and my wife were very careful to make sure he has DNR orders in place. The outrage would be for someone to do CPR on him if he were to stop breathing. He is ready and wants to die.
Perhaps the worst thing the community did was to summon a nurse creating a potential conflict.
- I find myself puzzled at why city EMS officials released this inflammatory tape to the public. I wonder if they have created their own liabilities for the damages this senior community will suffer from the release of this tape.
- This one is touchy to even bring up, but I find myself wondering about the culture on that particular community where perhaps policy has become more important than the residents . . . . but again maybe there is more to it than that.
To see a good summary of the outrage: Glenwood Gardens CPR Case: Independent Living Home Defends Nurse Who Refused To Help Ailing Patient More balanced reporting here:
California woman denied CPR wanted no intervention, family says
For those of you in the trenches how do you see this? What are the issues, where did it go wrong? How would you recover from this?
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Finally: If you know anyone who is looking at emergency call systems I would appreciate the opportunity to talk with them about Vigil Health Solutions.
From LinkedIn Groups
Steve,
I also posted a on this issue. I think the media jumped to conclusions. One issue that many have missed is that you never do CPR on someone who is still breathing. This woman was breathing. I think the 911 operator overreacted. Still, the “nurse” sounds very callous and I wonder about her ethical duties.
By Lorie Eber
I am actually quite sure the protocol would call for CPR with that low a respiration rate (from my ski patrol training), but I am really incensed at how the apparently the Bakersfield EMS dispatch system tossed this into to public arena apparently without any discussion with the family and the senior community. It was irresponsible and I would not be surprised to see Brookdale take legal action against them.
Steve
From LinkedIn Groups
In my opinion, two main aspects stand out in this situation. The caregiver (nurse or not)had a clear policy and followed it. Second, the family knew the wishes of their loved one and believes the caregiver perfomed as the resident desired. If the caregiver had went against policy and the woman had ended up in a vegetative state I am betting at minimum this person would have lost her position. Kudos to the company for standing behind their employee. I think the real injustice was the release of this tape to the public. What happened to this family’s right to privacy in a very private moment? I also agree with this author concerning the 911 system. The people releasing the tape should be held responsible for this company’s loss of reputation. It is sad the press has sensationalized this situation.
By Deborah Beresford MSN, RN
Steve, I was ski patrol in my younger days,and had training as an Army combat medic. CPR is to restore heartbeat and vital circulation, and breathing was incidental. We do not know all the medical and legal issues in this case. The 911 operator was overreacting and the so-called nurse sounded heartless, and from their own standpoints they were probably both right. I would certyainly reserve judgment.
By George E. Wolf
I would suggest to the community: 1. that they practice how to handle emergency situations with the staff, to alleviate some of the obvious confusion. 2. that they have DNR’s on file if they don’t already so they can express the residents wishes from a authoritative point. (If the daughter was satisfied with the outcome than a DNR should not have been a problem, but all families are different.
The dispatched was obviously angry with the community over the confusion, she did understand facility policies of no CPR though and became frustrated. To me, her conduct was unprofessional over the phone; and whoever released the tape to the public is unprofessional as well.
Yes I believe that more facts are necessary to make any kind of educated determination in this case, but now that it has been released to the uneducated public with biased sensation seeking reports from the media, that will probably not come soon.
Part of the problem lies in the wording here of the statute. If you read this the way it’s written, it looks like you can be sued if you’re an employee, and/or if you work in a place that provides medical care.
>>>>>>>>>>>>>>>>>>>>>
1799.102. (a) No person who in good faith, and not for
compensation, renders emergency medical or nonmedical care at the
scene of an emergency shall be liable for any civil damages resulting
from any act or omission. The scene of an emergency shall not
include emergency departments and other places where medical care is
usually offered. This subdivision applies only to the medical, law
enforcement, and emergency personnel specified in this chapter.
>>>>>>>>>>>>>>>>>>>>>>>>
It’s unfortunate that legalities of our actions color even positive things we do these days, but to deny that it’s an issue is absurd. Even if the nurse was protected under Good Samaritan Law, there is nothing in it that would protect the facility if there was a problem. It’s pathetic that we are lawsuit happy in this country to the point that this would even be an issue.
I find that our rush to decide that everyone must have CPR whether futile or not is a sad depiction of our society. To decide that it is terrible to stand and watch someone die without doing CPR is wrong. One can support someone in the dying process with great kindness and compassion without do CPR. I think that 911 dispatch needs education on the elderly and facilities that they live in. Perhaps a few more questions to determine the appropriateness of CPR instead of the automatic demand for CPR are in order.