Hospitals can end life support; Decision hinges on patient's ability to pay, prognosis

Hospitals can end life support Decision hinges on patient's ability to pay, prognosis

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.

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."

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.

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?"

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.

Forgive me if this has already been posted on this thread; I'm just responding to freepmails and pings and saw this post of yours.

I too was shocked and not pleased when I saw the president (then governor) signed that legislation in Texas and asked a few questions. This is what was sent to me:

This is the White House response to that article from White house.gov.

McClellan being Scott McClellan, the President's press secretary. The question coming from a reporter in the gaggle.

"Q Scott, you may remember this from your Texas days. A member of Congress in Florida, Deborah Wasserman Schultz, got on the floor yesterday and said that the President, when he was Texas Governor, signed a piece of legislation into law that, she said, would allow -- when there's a dispute, would allow a feeding tube to be removed and that -- she was a little bit murky on exactly what the law was, but, essentially, she was saying that the President signed something into law that's contradictory to what he is doing now.

MR. McCLELLAN: That's absolutely incorrect. The legislation he signed is consistent with his views. You know, this is a complex case and I don't think such uninformed accusations offer any constructive ways to address this matter. The legislation that he signed into law actually provided new protections for patients. He had previously vetoed legislation in 1997, when he was Governor, which essentially would have sanctioned current law in Texas that allowed hospitals to stop providing life-sustaining treatment -- because under Texas law, prior to the passage of the '99 legislation that he signed, there were no protections. And so this legislation was supported by many; it enjoyed strong bipartisan support; concerned citizens, various groups came together to support this legislation and put in place new protections for patients.

The legislation was there to help ensure that actions were being taken that were in accordance with the wishes of the patient or the patient's family. And let me give you an example. Prior to that legislation being passed I think there was a 72 hour period where if the hospital notified a patient -- or the family that represented the patient that they were going to deny life-sustaining treatment, then they had just that 72 hour period to find a place to transfer the patient, that would provide the treatment.

This legislation, some of the new protections it put in place were --included, the ethics committee review by the hospital, in working with the families as well, making -- you know, to discuss those decisions, determinations. And it also provided a 10-day period, so they had 10-day notice to be able to transfer the patient to another health care provider. And it also authorized court proceedings to extend that 10-day period in order to extend that transfer, if necessary.

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