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Dr. L, 45, a pulmonologist, was summoned to a hospital emergency department (ED) because of the severity of a particular case. The patient, Mr. Y, 78, was suffering shortness of breath.
He also had a long list of serious medical conditions, including a recent intracranial hemorrhage. A computed tomography scan revealed massive blood clotting in Mr. Y’s lungs, affecting the flow of blood to his left leg. The scan also showed congestive heart failure. Dr. L determined that the only option was surgical, but the patient’s odds were poor.
Mr. Y was alert, able to talk, oriented to place and time, and understood what was happening. The only option, Dr. L said, would be to surgically insert a filter in Mr. Y’s groin. He told the patient there was a good chance he would not survive the operation. Dr. L asked Mr. Y if he thought about whether he would want “heroic measures” taken if he went into cardiac arrest. The patient sat up straighter in bed, shook his head strongly, and said, “No, I don’t want that. I’ll have the operation, but if something happens, just let me go.”
“Do you understand what he’s saying?” Dr. L asked the family.
“Yes,” one of the children answered. The others nodded.
Dr. L wrote the following in the patient’s chart: “Do Not Resuscitate. I discussed with the patient whether he would want CPR, heart defibrillation, or mechanical ventilation. He was quite clear that he did not wish this. I then addressed with the family members in attendance why I did this and whether they understood, and all expressed their agreement.”
The procedure itself went well, but hours later when walking to the restroom he suddenly stopped breathing and collapsed. A nurse’s aide began CPR and called code while the horrified family looked on.
Dr. L was in the hallway when he heard the code. He rushed to Mr. Y’s room to find the aide performing CPR.
“Stop!” he instructed the aide. “He has a DNR order.”
The aide stopped performing CPR, and Dr. L tried to get the family out of the room. Mr. Y’s daughters were crying hysterically, but his son was shouting.
“Do the CPR!” yelled the son, frantically. “Give him CPR! I’m his health care proxy! I’m telling you to do it!”
Dr. L had to call several nurses to pull the son out of the room. The physician tried to speak to the son about the DNR order, but the son furiously kept insisting that his father should be resuscitated. During this time, the patient died.
A few months later, the family of Mr. Y hired a plaintiff’s attorney and ultimately sued Dr. L for the wrongful death of Mr. Y. The physician met with his defense attorney who felt that the case was strong. Eventually, the case proceeded to trial.
At trial, Mr. Y’s family testified about the shock of witnessing their father’s death, and how they had unsuccessfully begged the nurses to continue CPR. The son testified that he was the healthcare proxy for his father, that his father had a living will that had been created two years prior, and that the living will stated that he did want CPR or other resuscitation measures in the event he needed them.
Dr. L testified about his conversation with Mr. Y, and how he had clearly, and in front of his children, told them that he did not want to be resuscitated. The defense introduced medical experts who testified that Mr. Y’s prognosis was grim, and that it was very unlikely that he would have left the hospital alive, even in the best of circumstances.
The jury deliberated only briefly before finding Dr. L not liable for the patient’s death.
