Replies

http://www.chron.com/cs/CDA/ssistory.mpl/metropolitan/3094699

March 20, 2005, 10:37PM
Facility takes in man on ventilator
Change of heart by San Antonio home ends the fight between his family, St. Luke's
By TODD ACKERMAN
Copyright 2005 Houston Chronicle

A Friendswood man in a persistent vegetative state was transferred to a nursing home in San Antonio on Sunday, ending a battle between St. Luke's Episcopal Hospital and his family over whether to take him off life support.
ADVERTISEMENT

At 7:30 a.m., Spiro Nikolouzos, 68, was hooked up to a portable ventilator, feeding tube and other support lines and taken by ambulance to Avalon Place, which had rejected his application just nine days before. Facility officials confirmed his arrival about 11:30 a.m. Sunday.

"Thank God that was an ambulance taking Spiro to another health care facility, not another car taking him to a funeral home," said Nikolouzos' wife, Jannette. "I can't tell you the relief and excitement I feel that my husband is still alive."

Dr. David Pate, St. Luke's chief medical officer, said he was "very surprised" Avalon Place agreed to take Spiro Nikolouzos — more than 30 facilities had rejected him — but that he is glad the matter has been resolved to the family's satisfaction. The hospital's ethics committee had argued continued care would be futile and inhumane.

The surprise relocation capped three weeks during which the Nikolouzos family and St. Luke's looked for an alternative facility to accept him and the family's lawyer filed one temporary restraining order after another to prevent the hospital from pulling the plug. Nine days ago, one of those orders was granted just a few hours before St. Luke's planned to act.

Avalon Place officials would not explain their change of heart Sunday, but Pate and family members said they understood that someone from Avalon Place's corporate headquarters intervened late Friday to give permission.

The Nikolouzos matter and another involving a 6-month-old baby, whose mother last week failed to stop Texas Children's Hospital from withdrawing life support, shone a light on a fairly new Texas law that allows hospitals to discontinue such care 10 days after notifying family members.

The Nikolouzos controversy dates to March 1, when St. Luke's gave the Nikolouzos family notice it planned to take him off a ventilator and remove his feeding tube. Five days later, the family's lawyer, Mario Caballero, announced he would ask a judge to stop the hospital.

Nikolouzos, a retired electrical engineer who suffered brain damage in a motor vehicle accident more than a decade ago, has been in a persistent vegetative state since at least 2001, said Pate. Until Feb. 10, his wife took care of him at their home, feeding him through a tube inserted through his side into his stomach. But when the area around the tube began bleeding, he was rushed to the hospital, where his condition seriously deteriorated and he was placed on a ventilator.

Jannette Nikolouzos acknowledged at one point last week that "he was never like this" before.

Pate, able to talk about the case for the first time Sunday, said the case was particularly hard on staff because there was no possibility Nikolouzos would ever improve, even with around-the-clock care. Nikolouzos' serious complications include constant infections and ulcers that penetrate all the way to bone and muscle atrophy that has left him rigidly curled up in a fetal position. Pate said it is hard to believe that hospital hygiene efforts necessary to prevent infection don't physically hurt the patient.

"He's unaware of his surroundings, he can't eat, he can't speak, he can't move any of his extremities," said Pate. "I can't imagine anybody in his condition wanting extraordinary means of life support to be kept alive."

But Jannette Nikolouzos expressed happiness that "Spiro got out of that execution chamber that is St. Luke's."

Pate said payment for Nikolouzos' care was never an issue for St. Luke's, contrary to claims by the Nikolouzos family.

Payment for Nikolouzos' care at Avalon Place was thought to be an issue; Caballero said in court a week ago that the San Antonio nursing home turned down Nikolouzos because his Medicare was about to be reduced.

No one could answer Sunday whether that matter has been resolved.

Nikolouzos' wife and son, who plan to visit him today, said they don't know what the future will bring, beyond regular trips to San Antonio.

But they said it is preferable to the alternative.

"We're just thankful to anyone who helped my husband stay alive," said Jannette Nikolouzos.