Posted on 03/19/2005 7:19:45 PM PST by ambrose
March 8, 2005, 12:33AM
Hospitals can end life support Decision hinges on patient's ability to pay, prognosis
By LEIGH HOPPER
Copyright 2005 Houston Chronicle
A patient's inability to pay for medical care combined with a prognosis that renders further care futile are two reasons a hospital might suggest cutting off life support, the chief medical officer at St. Luke's Episcopal Hospital said Monday.
Dr. David Pate's comments came as the family of Spiro Nikolouzos fights to keep St. Luke's from turning off the ventilator and artificial feedings keeping the 68-year-old grandfather alive.
St. Luke's notified Jannette Nikolouzos in a March 1 letter that it would withdraw life-sustaining care of her husband of 34 years in 10 days, which would be Friday. Mario Caba-llero, the attorney representing the family, said he is seeking a two-week extension, at minimum, to give the man more time to improve and to give his family more time to find an alternative facility.
Caballero said he would discuss that issue with hospital attorneys today.
Pate said he could not address Nikolouzos' case specifically because he doesn't have permission from the family but could talk about the situation in general.
"If there is agreement on the part of all the physicians that the patient does have an irreversible, terminal illness," he said, "we're not going to drag this on forever ...
"When the hospital is really correct and the care is futile ... you're not going to find many hospitals or long-term acute care facilities (that) want to take that case," he said. "Any facility that's going to be receiving a patient in that condition ... is going to want to be paid for it, of course."
Patient showed emotion
Caballero said he believes the hospital wants to discontinue care because Nikolouzos' Medicare funding is running out.
Spiro Nikolouzos, a retired electrical engineer for an oil drilling company, has been an invalid since 2001, when he experienced bleeding related to a shunt in his brain. Jannette Nikolouzos, 58, had cared for her husband at their Friendswood home, feeding him via a tube in his stomach. Her husband couldn't speak, she said, but recognized family members and showed emotion.
On Feb. 10, the area around the tube started bleeding, and Nikolouzos rushed her husband to St. Luke's for emergency care. Early the next morning, she said, the hospital called and said he had "coded" and stopped breathing and had to be placed on a ventilator.
A neurologist told her, she said, that he is not brain-dead and the part of the brain that controls breathing is still functioning. Although his eyes were open and fixed when he first was placed on the ventilator, he has started blinking, she said.
A missed opportunity
Dr. Marcia Levetown, director of palliative care at The Methodist Hospital, said moving Nikolouzos to a nursing home or other type of facility may not be an option if his body is dependent on several types of technology, such as mechanical ventilation and kidney dialysis.
Levetown said when families and hospitals take their disagreements to court, it often means the hospital has missed an important opportunity in the family's emotional healing.
Often missing from aggressive medical care is empathy for family members and acknowledgment of grief, she said.
"The acknowledgment of 'You clearly love your husband very much. You've done the good fight' " makes a difference, she said. Levetown also tells families, "Whatever might be beneficial, you've made sure he's gotten that. We all wish he could get better ... How can we best honor this man ... as we accompany him in his next journey?"
Law allows removal
State law allows doctors to remove patients from life support if the hospital's ethics committee agrees, but it requires that the hospital give families 10 days to find another facility.
A similar case is still in the courts. Texas Children's Hospital wants to discontinue life support on 5-month-old Sun Hudson, who was diagnosed shortly after birth with a fatal form of dwarfism. His mother, Wanda Hudson, wants her son's care to continue at the hospital.
On Wednesday, a judge will consider whether Harris County Probate Court judge William McCulloch may remain on the Hudson case. Caballero, who represents Wanda Hudson, filed a motion that McCulloch remove himself from the case after making what Caballero said were biased statements.
leigh.hopper@chron.com
I think our social institutions started foundering when charity was called a "right", the irresponsible were put beyond criticism, and that problems were thought ended with the formation of a government bureacracy.
Wow, real enlightened liberalism masquerading as conservatism at play ... who would have thought they had so much to offer ?
Ted Kennedy, no shirt. I shan't post it if that's OK with you...
Lazarus was brain dead.
Like my foolish Christer aunt offering up prayers for her autistic grandson. It isn't going to change anything. !7 years ought to learn her.
Pathetic.
I've lived in Germany for 12 years and watched state-run healthcare...where you are required to have a policy, which is entirely related to how much make and how many members of the family it covers. And for 75 percent of the normal procedures that you would expect...it does a decent job and you pay nothing. However....when it comes down to a major significant operation...that borders on new technology...don't count on being successful and living a fruitful life. You end up going to a state-run or church-run hospital. The doctors are great...but the absolute best doctors work privately, and your policy doesn't cover work by these guys. You will be in a room with three other patients, unless you want to cough up around $50 a day extra out of your own pocket. Your meals will be as bland as they can make them. The drugs you get...will always be generic, unless the doctor can prove they don't work...then you get the real stuff. You must stay for as long as the process takes...in the hospital. When a person checks for a procedure in the US...and stays 10 days....it'll be at least 25 days in a German hospital. They don't pre-test or schedule any operation, until after you check into the hospital...then you get on the schedule, and it may be another week before you go into surgery.
State-mandated healthcare sounds real nice...Bill Clinton had a great speech for it. A lot of Americans immedately jump up and support the idea. But it simply isn't the four-star deal that you expect.
And not to bash the German too much...but some Germans have actually gone to the US, and paid for their own surgery there....because they thought they had a higher chance of survival. That says alot.
Why don't you take matters into your own hands and starve the grandson ? I'm sure you'll find some supporters.
Even with a living will??
I live in Florida we have Manatees if I want to see a fat hairy mammal that is soaked most of the time.
*snrk* Perfect!
He is not on life support. My point is that he is not going to get better. Period. He is so strong and headstrong with no self-control that he is most likely going to kill his mother one day in a rage.
He has already thrown her across a room and broken her arm. A moment of clarity is needed with his mother, my cousin, when or if she finally realizes that she can't handle him, it isn't going to change and it is her fault for relying in prayer only and not getting him therapy. She should know better since she has been working at a hospital for many years.
Heroic is not minimal. Food and water, basic hygiene are minimal. Yes -- everyone is due minimal care. The hospital, however, should have the ability to release such patients to the care of relatives.
Neither your grandmom, Terri Schindler, nor the greek engineer mentioned in this article are killers.
Then who pays for that? In home care is not cheap and I doubt that the Schindler's are able to provide 'round the clock care for Terri.
I'm not heartless regardless of what some other posters have said. I know from experience, that my stroked out Grandmother needed more care than either I or my mother could provide. A Home was the only place for her following the "heroic measures" that she specifically did not want and that caused her to linger for four more months when she would have gladly gone home to Jesus.
Why should that matter ?
His quality of life makes him a perfect candidate for a TerriSchiavo maneuver.
Don't you want him to die in peace ?
You are missing the point. I say that you can pray yourself to death and he isn't going to get better. His idiot mother is basing his care on prayer rather than the many therapies that are available.
The point is the State can end his life and all your problems will be solved. Just sign up for Michael Schiavo's Fan Club today.
Is there a shortage? If there is should it not be addressed by creating more facilities rather then with holding care?
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