Listen: Nurse Refuses To Give CPR To Dying Woman

Why health personnel at some independent living facilities may not be eager to administer CPR

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On Tuesday morning, 87-year-old Lorraine Bayless collapsed in the dining room of Glenwood Gardens’ independent living facility. When the nurses called 911, dispatcher Tracey Halvorson attempted to instruct them on giving Bayless CPR. The nurses, however, refused, despite pleading from Halvorson. Bayless would later die.

Halvorson pleads, “I don’t understand why you’re not willing to help this patient. Is there anybody that works there that’s willing to do it?”

“We can’t do that,” the nurse responds. “That’s what I’m trying to say.”

Halvorson tells the staff she understands that they cannot perform CPR, and asks if anyone else can, she would talk them through it. “Can we flag someone down in the street and get them to help this lady?” Halvorson says. “Can we flag a stranger down? I bet a stranger would help her.”

Even when the dispatcher tells the staff that the woman is not breathing enough and will die if they don’t start CPR, they won’t yield.

The executive director of Glenwood Gardens, Jeffrey Toomer, defended the nurse’s actions and says his staff was following the company policy. “In the event of a health emergency at this independent living community our practice is to immediately call emergency medical personnel for assistance and to wait with the individual needing attention until such personnel arrives. That is the protocol we followed,” Toomer said in a written statement, according to the Associated Press.

Industry spokeswoman Maribeth Bersani, of the Assisted Living Federation of America told CBS News that the rule was likely because the home was an independent living facility and not assisted living. “There’s no requirement that the people in the building be trained to perform CPR, so a company could state in a policy they don’t want anyone to initiate CPR,” she said, adding that the incident will likely be a wake-up call for the industry to review what services and training should be provided.

CBS News reports that Bayless did not have a “do not resuscitate” order on file, but her daughter reportedly says she’s “satisfied” with the care given to her mother.

As surprising as the facility’s policies seem, they may be in place to protect not just personnel who aren’t trained properly, but patients as well. In some cases, CPR can be dangerous for the recipient, especially when given by untrained bystanders, who can cause damage such as broken ribs and bones, particularly when the victim is elderly. Many bystanders are reluctant to administer CPR if they aren’t trained, but recently experts say that even untrained people can help those in distress with a simplified version of the potentially life-saving intervention. In 2010 the American Heart Association says even giving chest compressions alone, without the mouth-to-mouth resuscitation, can be effective in saving lives, and in December, TIME covered a study by Japanese researchers that found only giving chest compressions can preserve brain function:

Standard CPR requires alternating ventilating breaths with chest compressions in a carefully timed sequence, and the technique is intimidating for many who might want to help a person in distress but are too afraid of doing more harm. “Rescue breathing is difficult for some people to perform and might interrupt chest compressions,” said lead study author Dr. Taku Iwami, senior lecturer in the Department of Preventive Services at Kyoto University School of Public Health in Japan, in a statement. “Most victims don’t receive any CPR, so we need to encourage chest-compression-only CPR and public access defibrillation programs.”

Listen to the 911 tape released by the Bakersfield Fire Department here.

18 comments
nursing_rants
nursing_rants

I'm trying to look at this as objectively as possible and it's truly hard to make a determination.  There are too many questions that come into play.  My first thoughts are in regards to the deceased.  Was she able to make decision for herself?  Had her provider or family ever had the conversation about DNR with her.  It's an uncomfortable conversation for people and especially for the children of the elderly.  When the woman moved into the independent living facility was she or her caregiver, power of attorney (if there was one) made aware of the no CPR clause?  From the comment that the daughter made she was informed and she was satisfied with the care her mother received.  If there was a lack of conversation did that serve as a passive "let nature take its course" route, which might have been easier for the family because if the woman had successful CPR and ACLS which resulted in her being intubated, if she didn't have a DNR and was't progressing how would the family deal with having to disconnect her from life support? If the family had to make the decision to disconnect her from a ventilator would that put the burden on the daughter?  Is that ethical if there was a no CPR clause that was agreed to?

As a nurse I've had plenty of 80+ year old patients come into the ER with CPR in progress.  If we manage to get the heart started again and they are on a ventilator/ life support, it isn't always a "miracle", on an ethical level the family needs to consider the quality of living for that person.  Would grand mom want to be on a machine that breaths for her, would she want a tube in her bladder to collect her urine, would she want to be laying in her own waste, would she want to have people have to bath her, turn her, would she want a tube with formula feeding her, would she want to deal with bed sores, would she want to be bed ridden?

I am as guilty as millions of other people who don't have DNRs and tell their loved ones I want to be DNR.  My co-workers in both of the ERs I work in have been verbally ordered by me that if I can't drink a margarita then throw in the towel.  Now what I should really do is have the darn DNR done but I'm a mom and under 40 years old and I am procrastinating, who wants to deal with their own mortality? I know poor excuse.  And yes this causes a major problem when you are trying to care for someone in a critical situation.

When my grandmother's Alzheimer's set in my mom had to get a power of attorney.  Now my grandmother was living at my mom's home at the time, not a facility.  My mother went to court, but was turned down because in our state you have to be bonded.  This meant my mother had to complete additional paperwork as well as put money up for a bond so that she could make decisions for my incapacitated bed bound grandmother.  After the power of attorney was granted and my grandmother was determined by the court not to be able to make decisions by herself, my mom then went through the process of DNR and getting an advance directive.  This was not an easy thing.  This took time and money and knowledge of the system.  Sometimes people are lacking the resources or the emotional fortitude to go though the process, and their loved ones are essentially in limbo.  

While many discussions are focusing on "the nurse" and who knows if she was a nurse, I really think the focus for me would be the policies and if the policies of the facility are ethical.   Do all of the residents know the policy before they move in?  





JohnMacintosh
JohnMacintosh

The dispatcher in interpreting the statements of the caller was correct in determining that CPR was indicated. The 2010 American Heart Association Emergency Cardiac Care guidelines call for CPR to be initiated in any UNRESPONSIVE patient who is breathing AGONALLY or INEFFECTIVELY. These sporadic, shallow breaths precede cardiac arrest and do not support life. Many bystanders are poor assessors of this type of breathing.

Any time a 9-1-1 caller volunteers statements such as "barely breathing", "gasping for breath", "turning blue," "snoring," "gurgling", "fighting for air" etc in an UNRESPONSIVE patient, CPR is indicated unless there are overriding factors such as DNR. This is a relatively new concept for many people including those in healthcare. Bystander “hands only” CPR is the new norm--gone are pulse check and ventilations for untrained bystanders who are receiving instructions from an Emergency Medical Dispatcher or not. The AHA has streamlined CPR and their research of out-of-hospital cardiac arrest supports this. Airway no longer comes first.

There is no official statement regarding whether the patient had a DNR order or not. Certainly the “nurse” did not mention this, and if she *was* a nurse she would know you do not call 9-1-1 if the patient has a DNR.

The keen dispatcher identified that the patient had collapsed on the floor, was unresponsive, and not breathing normally. Based on that criteria, CPR was indicated. Had the 9-1-1 operator NOT attempt CPR in a similar situation people would be vilifying the 9-1-1 dispatcher for failing to do her job in her part of the patient care continuum.

Also, the "nurse" caller did not object to the fact that CPR was needed! And SHE was there WITH the patient. She relied on the caller’s statements. Nurse Colleen refused to perform CPR or get someone else to do it. She never objected to the fact that CPR was needed.

LPNtoRNstudent
LPNtoRNstudent

 After sitting here for a bit collecting my thoughts on this and drinking some diet dr. pepper (yep my morning coffee) I am going to respond. In no way, shape or form do I intend or want people agreeing or disagreeing with my thoughts. They are my thoughts and that is that....

I once worked in a retirement community where they had assisted living and independent living. Although in the same connecting buildings, there were different rules/policies to follow in regards to each group of individuals residing there. What we could do with the individuals in assisted living was greater than what we could do with those in the independent living. With that being said, if my memory serves me right, someone in independent living requiring medical attention would need to have a call to 911 placed. We were allowed to respond, place the call if needed for them and at the nurses discretionhelp could be given until the proper medical personnel arrived. We did not know code status on the independent living individuals only the assisted living. Hence, why they call it independent living. We did not provide medical services such as medication management, assistance with ADL's etc... to those in independent living, only those in assisted living. Independent living individuals are still wanting and have the capabilities of living on their own, providing their own care and want to be viewed as still living in their own homes. Most of the people in independent living did have some housekeeping services and usually had their pick of how many meals were provided to them... Please keep in mind that this is the facility I worked at. I would imagine that most run the same, yet most probably have a little different policy and procedure. There are liability issues regarding independent vs. assisted living. I do not know all of these but since my curiosity is peaked now, my neighbor is a manager of one and I will ask her sometime.

Right or wrong, policy is policy.The people and their families going into independent living are very well aware of these particular policies before they ever sign the contract. It may be one of those times in life when we choose to think...” It won't happen to him/her/me." Unfortunately as in the case in California it does and will continue. From what I am reading, the family is O.K. with everything. It is now society being the judge and jury.

If we all look at our employer's policy and procedures there is going to be something in there that we don't necessarily agree with. I know where I work if someone is outside of the building and needing assistance, we are not to respond. Do we? Yes, we do. When there is a rapid response called there is no thought placed onto the location, only that someone needs help. According to policy this is wrong, if they are going to fire us for responding on that day, there will be many firings. When I am on rapid response for the day and hear a rapid response in the parking lot etc.. the first things that come to my mind are that it is a patient,their loved one or a co worker, how can I not respond. Truly I don't think it really matters who it is because when there is a call for help, a sense from deep within tells me to respond. In that split second that it takes for me to respond, I know that my choice may lead to me being fired for not following policy and obviously since I respond, at some point I have accepted that.

I have no opinion on whether the Nurse's actions were right or wrong. Only she can figure that out. It truly is a situation where unless you are in it, judgment should not be placed. We all know what happens when policy is not followed. As nurses we want to help anyone that needs us, yet when we accept employment at a facility we are agreeing to abide by the facility policies and procedures. Obviously, the nurse was following policy and standing her ground. Is standing her ground and following policy the ultimate thing that is causing all the controversy? If so, then let’s not let it all weigh in on the nurses shoulders, let's have some of the turmoil placed on these facilities and the rules that govern them. We do not know all the things surrounding the Nurse’s decision. Only she does, and she is the one that has to make peace with it. As a fellow nurse I can only imagine that she has not slept much. As Nurses we tend to think that we can always make the right choices and have false visions that we will always make things better. Everyone does not get well and go home. Not everyone wants to be a full code or DNR for that matter. What would happen if the individual was a DNR and someone performs CPR? As new nurses we all have a lot to learn that only experience and time will give to us.

A lesson I think that we can all learn from this is as follows….

Only we know what we can handle and live with. So as many begin their journey of being the most amazing awesome RN’s possible, when accepting a job make sure that you can accept the policies that are being set in front of you. What can you accept and what can you not. Ultimately as Nurses we need to do a little soul searching to see where our line in the sand is drawn.

Again, just my thoughts.

LauraVasquez
LauraVasquez

I agree with Joe, RN below.  This article is incomplete.  I dislike when the term "nurse" is used, when the person may be only trained to assist in a facility (cook, clean, etc); they are not licensed or even certified (CNA).  Granted, they have an important function, but the public gets confused.  It appears the article is a bit sensationalized.  It flirts with giving the impression that the "nurse" who did not perform CPR was uncaring and irresponsible.  Let's wait for more facts before  posting snippy remarks on FaceBook and such.   -Laura, RN

DoctorJim
DoctorJim

As the health care debate rages, this only highlights the most difficult facet facing those trying to fix our healthcare mess; End of Life Care.  Nobody wants to touch it with a 10,000 foot pole.  To this point, we have never found a cure for death.  Every person born in history as well as today has a 100% chance of dying.  For eons, people simply grew old and passed away.  It wasn't anybody's fault and, unless they were intentionally killed, nobody was held responsible.  It was out of our control.  This is the central problem with today, we maintain an illusion of near infinite control and think that all people should be kickstarted indefinitely rather than just to go peacefully.  Even in this case, the family, who knew and loved her, thought it was the right thing.  Don't automatically assume there was some nefarious ulterior motive such as an inheritance.   For most of history till about 1900, the average length of life was upper 40s for women and mid-40s for men, now it’s about 76 for men and near 80 for women.  Only recently have we been able to increase this by 25-30% with modern medical care.  How far should we push this?  People die of natural causes every day and you could, in theory, pump on all of their chests, intubate them, put them on ventilators and put them in the ICU at the cost of $10,000-$15,000 per day. How on earth can we do that?  Now before you jump on me and accuse me of being the grim reaper or a death panel advocate, know that I'm an emergency physician who has devoted his life to saving the sanctity of our most precious commodity....life.  Anybody that has worked in healthcare, especially the acute care setting, knows that pulling out all the stops on the elderly and frail is not only ridiculously expensive, but frequently makes little/no difference in the ultimate outcome and, often, prolongs suffering.  With health care costs in the US exceeding the next 10 countries combined, we simply cannot bury our heads in the sand and say life is to be preserved at any cost.  The math simply does not work and ultimately gets cost shifted to someone else.   You could confiscate 100% of the income of the top 10% of income earners in the US and still not accomplish this impossible goal.  This is a most uncomfortable argument, but will be necessary if we are to save this country, because uncontrolled spending on medical care can literally spend our country into oblivion.  Studies have shown that, on average, 60% of the healthcare dollars spent on the average person over their lifetime is in the last 6 months of life; meaning people are at their end of their lives and we throw a ton of money at it to try and stop it from happening.  Those who stand to benefit financially from this care, ie hospitals, drug companies and some providers, have a conflict of interest with providing this care.  It’s easy to say, “we’re saving lives and helping people” while they gleefully cash their checks for providing very expensive care/technology/medications while they know full well much of that care is excessive/unnecessary.  It’s impossible to put a dollar value on a life; and I argue that we shouldn’t be trying.  I play “God” every day in the ER, and feel that we’ve gone mad sometimes with doing things that won’t make any difference, but do it because the family wants it or to protect ourselves and our hospitals from lawsuits.  We need to start having this discussion.  We cannot take every situation into our hands and control......  it is ultimately in the Almighty's hands.

doctorjohnwarren
doctorjohnwarren

I did a Google search and found that this company has facilities in a number of states.  I'm wondering how many people will be thinking of taking their relatives out.  Even if they have a long-term contract, I suspect that the revelation of this "let 'em die" policy would cause any competent judge to rule that a contract is not a suicide note.

[Ethical disclosure because this is a medical matter: my doctorate is not in medicine]

teethdood
teethdood

In the course of providing CPR, even trained professionals can cause rib/sternum fractures. Fractures will heal. No oxygen to the brain = vegetative state or death. No one has ever been sued successfully for providing CPR/BLS and causing bone fractures. Yes CPR is dangerous. Not providing CPR is abundantly more dangerous for the victim, as is the case here. Trained or not, please provide CPR or call 911 and they will walk you through it. You can save a life!

JeffKlives
JeffKlives

I am missing something.   Did the nurse say the victim was still breathing?   Isn't CPR used when someone stops breathing?   

StevenReed
StevenReed

I don't understand why the facility does not have a AED on site. That is far more effective than CPR...

ibivi
ibivi

This is outrageous.   A nurse has professional responsibilities which override such policies.  The 911 operator's disgust is evident when she wonders if anyone is walking by and that they should be asked to help.  I totally agree.  Unfortunately, many homes for the aged rely on emergency services if their residents need such assistance.     

bcrsj4
bcrsj4

I totally agree with you Laura. "Everybody" that works in any kind of medical facility is a "Nurse". Do we know if this woman involved here was indeed a licensed nurse? I've been trying to find this out since this sad story was revealed.

furiouskatiemacklininski
furiouskatiemacklininski

@DoctorJim    DOCTORS AND NURSES--- ASSISTED  LIVING--- NURSING HOMES AND HOSPITALS ARE ALL LIFE THREATENING PEOPLE AND  PLACES.  THEY SHOULD BE F SHUT DOWN AND RE OPENED WITH PEOPLE WHO MIGHT ACTUAlLY KNOW WHAT THEY'RE DOING.  DOCTORS---NURSES---CASE WORKERS---SOCIAL WORKERS---I HAVE A QUESTION FOR YOU PEOPLE---WERE THE BUBBLE GUM MACHINES OVER FILLED WITH DIPLOMAS OR DID EACH OF YOU JUST TYPE ONE OFF WHILE PRETENDING TO BE AN ACTING PROFESSIONAL?  I LOST A VERY DEAR LOVED ONE BECAUSE OF YOU WORTHLESS IDIOTS.  F ALL OF YOU AND DAMN EACH ONE OF YOU TO HELL WHERE YOU TRUTHFULLY BELONG.

JoeMaginn
JoeMaginn

@JeffKlives Many people have agonal gasping breaths. It is not effective breathing and CPR should be started. Unfortunately someone untrained or novice can mistake these for effective breaths.

wisconsin_reader
wisconsin_reader

@StevenReed 

You are comparing apples with oranges.  AED devices deal with heart rhythm problems, not necessarily the cause of the breathing problem here.

JoeMaginn
JoeMaginn

@ibivi This article is incomplete. Is this a CNA? A RN? Is she an eighteen year old high school student that took a two week nursing assistant class or a fifty year old RN with thirty years experience. Also I hate to say it, but this is a no win situation for her. If she does CPR she will probably be fired and hung out to dry with any lawsuit for breaking company policy. If she doesn't she'll still probably be fired and hung out to dry by the company for not doing "the right thing".

I'm a RN and have done CPR many times. When the stuff hits the fan some people jump into action and some people become paralyzed with fear. Until you actually are faced with the real thing, you won't know which you are I don't care how much training and practice you've had.

kbrown1905
kbrown1905

@JoeMaginn There are good Samaritan laws that would prevent the woman from being sued for providing CPR.  I listened to the 911 call this morning on the news and she was an older woman that simply refused to help.  I think at some point as a human being, you should not be worrying about whether or not you're going to be sued for saving a person's life and just REACT.  The woman seemed very calm and just repeatedly stated that her job was what stopped her from reacting.  

What would have happened if this woman had needed CPR in a grocery store or a mall?  I'm willing to bet that someone would have helped her and she may have lived.  This nurse, no matter what her level of trainng, was at the very least trained to not panic in this situation.  "Company policy" should NEVER replace humanity, regardless of the consequences.  Speaks volumes about the state of the world- and not in a good way.