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Medical Ethics: Did nurse have obligation to perform CPR on dying woman?

By Alan Lyndon

“Anybody there can do CPR. Give them the phone, please. … This woman’s not breathing enough. She’s going to die if we don’t get this started.” Those were the words of a 911 dispatcher pleading with a nurse to perform CPR on a dying woman.

The nurse refused. The woman died.

Last week, Lorraine Bayless collapsed in the dining room of Glenwood Gardens retirement home in Bakersfield, CA.  Officials have released the 7 minute, 15 second 911 call.  The dispatcher asks, “Is she breathing?”; the caller replies, “‘Is she breathing?’ Barely.”

When the dispatcher tries to guide the nurse through an attempt at performing CPR on the woman, the nurse said: “We can’t do CPR at this facility.”

Listen to the call released by the Bakersfield Fire Department.

The dispatcher tried to get someone else to help the woman: “OK, then hand the phone to the passerby. If you can’t do it, I need, hand it to the passerby, I’ll have her do it. Or if you’ve got any citizens there, I’ll have them do it.”

But the nurse continued to prevent further assistance: “We can’t do that,” the nurse says. “That’s what I’m trying to say.”

911: “We can’t wait. She can’t wait right now. She is stopping breathing. Is there anybody there that’s willing to help this lady and not let her die?”

Nurse: “Um, not at this time.”

Glenwood Gardens released the following statement regarding their 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.”

The executive director of Glenwood Gardens, Jeffrey Toomer, told KGET-TV that residents of the facility are informed of the policy and agree to it when they move in. Legal experts have said the policy is likely because Glenwood Gardens is an independent living facility as opposed to an assisted care facility.  CBS News reported that Bayless did not have a DNR (“do not resuscitate”) order on file, but her daughter was satisfied with the care provided to her mother.

Maribeth Bersani, of the Assisted Living Federation of America, told CBS News that “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.” But she says this incident may be a wake-up call for the industry. Bersani said, “I think this tragic example will make us all think more closely about what type of services and training we should provide.

“It’s inexcusable,” Arthur Caplan, head of the Division of Bioethics at New York University Langone Medical Center in New York City told ABCNews.com. “You call 911, you trigger a process to do a resuscitation.” The staffer had nothing to lose legally, according to Caplan. All states have laws protecting good Samaritans, he said.  Law enforcement officials told ABC News there is no investigation pending in Bayless’ death.

What are your thoughts?  Should facilities like Glenwood Gardens specifically prohibit their employees from providing such emergency care?  What are the moral obligations of the providers, if any?

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