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Author Topic: This disturbed me  (Read 8932 times)

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Offline Pumpkin Seeds

Re: This disturbed me
« Reply #375 on: January 27, 2014, 01:41:44 PM »
Because there is no reason to ignore the law.  About as simple as I can put the response.  The situation may be unusual, but there is no cause to declare death and maintain care.

Offline Sabby

Re: This disturbed me
« Reply #376 on: January 27, 2014, 01:43:50 PM »
Because there is no reason to ignore the law.  About as simple as I can put the response.  The situation may be unusual, but there is no cause to declare death and maintain care.

I ask why they should follow standard procedure, your answer is basically 'because there's no reason to divert from it'. Am I correct in that interpretation? If so, then I must simply disagree.

Offline Pumpkin Seeds

Re: This disturbed me
« Reply #377 on: January 27, 2014, 01:47:12 PM »
If you disagree with following the law because there's no reason to break the law, then that is your position.

Offline Kythia

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Re: This disturbed me
« Reply #378 on: January 27, 2014, 01:48:03 PM »
This isn't just standard procedure, sabby, this is legal obligation. "meh, decided not to" wouldn't be a valid defence when asked why they did it.

Offline Sabby

Re: This disturbed me
« Reply #379 on: January 27, 2014, 01:50:08 PM »
I've explained myself as simply as possible, and Pumpkin continues to either misunderstand or misrepresent me, so I see no reason to continue.
« Last Edit: January 27, 2014, 01:51:17 PM by Sabby »

Offline Pumpkin Seeds

Re: This disturbed me
« Reply #380 on: January 27, 2014, 01:58:32 PM »
Apparently I am not the only one misunderstanding your question. 

Offline lilhobbit37

Re: This disturbed me
« Reply #381 on: January 27, 2014, 02:07:37 PM »
What he seems to be trying to get at is that standard procedure would have been to declare her dead excluding the fact she was pregnant.

So by following the law they stopped following standard procedure citing a law which specifies a living patient.

I think he is trying to ask why it is ok to ignore standard procedure for the fact she was pregnant yet claim the law makes it standard procedure.

I don't know if I'm making any more sense than him but I believe that is the confusion. That there appears to be two completely different things being classified as standard procedure but in the normal case of a brain dead person who did not want to remain on life support, the standard procedure would have been to declare the person dead and remove life support per the persons wishes and the family confirmation.

Offline Sabby

Re: This disturbed me
« Reply #382 on: January 27, 2014, 02:12:11 PM »
See, someone gets it.

They recognize this is an unusual case. Because of that, they ignore the procedure that says to declare her dead. If they can ignore that part of procedure, which causes a lot of problems, why could they have not ignored the part that says termination of life support must follow the declaration of death.

Why is one approach valid and the other isn't?

Offline Kythia

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Re: This disturbed me
« Reply #383 on: January 27, 2014, 02:14:59 PM »
Because they're not ignoring anything, Sabby.

If a patient is brain dead then machines either go on or off depending on ADs, next of kin, etc.  If, however, the patient is pregnant then hospital believed that Texas law said machines stay on.

Nothing is being ignored.  The law is being followed (to the best of their understanding).  "Following the law" is standard procedure.  Or one would hope so at least

Offline Sabby

Re: This disturbed me
« Reply #384 on: January 27, 2014, 02:19:13 PM »
Why must the declaration of death lead to termination of life support? Why is this golden rule unbendable in a situation they recognize as unique?

Please answer only that, I can only rephrase myself so many times.

Offline Kythia

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Re: This disturbed me
« Reply #385 on: January 27, 2014, 02:22:42 PM »
Why must the declaration of death lead to termination of life support? Why is this golden rule unbendable in a situation they recognize as unique?

Please answer only that, I can only rephrase myself so many times.

Because life support costs money.  Who the hell pays for it if she's dead.  Not her insurance company, why would they pay for a dead person?  The Texas taxpayer?  Smells like socialism and goddamn pinko Obamacare to me.  The hospital?  Why should they?  Leaving aside the fact that that falls back on the taxpayer anyway.

Seriously, sabby, think.

Offline Oniya

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Re: This disturbed me
« Reply #386 on: January 27, 2014, 02:25:46 PM »
Because life support costs money.  Who the hell pays for it if she's dead.  Not her insurance company, why would they pay for a dead person?  The Texas taxpayer?  Smells like socialism and goddamn pinko Obamacare to me.  The hospital?  Why should they?  Leaving aside the fact that that falls back on the taxpayer anyway.

Aye, it looks like a bean-counter issue to me.  Accountants like things black and white (or rather, black and red, with as little red as possible).  They don't have much patience for those grey areas like the difference between brain-dead and dead-dead.

Offline Kythia

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Re: This disturbed me
« Reply #387 on: January 27, 2014, 02:28:00 PM »
Not to mention that calling it a "golden rule" is grossly mischaracterising it.  It's the law.  That's why its unbendable. 

Offline Sabby

Re: This disturbed me
« Reply #388 on: January 27, 2014, 02:31:36 PM »
Seriously, sabby, think.

I'm trying, I'm just having difficulty following you and Pumpkin here. I feel like you're addressing everything related to my questions, rather then the actual question. It may just be a communication error, but it's making me very frustrated. I ask why Procedure X can't be suspended in light of circumstances, when Procedure Y can, and your response is about the cost of Procedure X?

How is that answer relevant?

Offline Kythia

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Re: This disturbed me
« Reply #389 on: January 27, 2014, 02:33:42 PM »
You are asking why procedure X - the official declaration of death - can't be/wasn't suspended.

You have been given the answers:

1) There are cost implications to suspending it that aren't present if its not suspended
and
2) Procedure X is legally mandated.

Both seem highly relevant to me

Offline Sabby

Re: This disturbed me
« Reply #390 on: January 27, 2014, 02:39:14 PM »
You are asking why procedure X - the official declaration of death - can't be/wasn't suspended.

You have been given the answers:

1) There are cost implications to suspending it that aren't present if its not suspended
and
2) Procedure X is legally mandated.

Both seem highly relevant to me

No x.x No, no, no. How did you get that backwards? I'm at a complete loss as to how you continually mangle what I've gone to ridiculous lengths to simplify. I won't risk patronizing you by using even more simplistic wording. I'm just not going to bother any more.

Offline Kythia

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Re: This disturbed me
« Reply #391 on: January 27, 2014, 02:44:00 PM »
Why must the declaration of death lead to termination of life support? Why is this golden rule unbendable in a situation they recognize as unique?

I ask why Procedure X can't be suspended in light of circumstances, when Procedure Y can, and your response is about the cost of Procedure X?

So procedure X wasn't the declaration of death?  Because comments like the first quote there really make it look like it was.

Offline Oniya

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Re: This disturbed me
« Reply #392 on: January 27, 2014, 02:45:03 PM »
If the patient is declared dead, then the cost of continued treatment will assuredly not be covered by insurance.  If the patient is not declared dead then there is a chance that the cost will be covered by insurance.  The hospital has a greater chance of recouping the cost of treatment if she's not declared dead.

Offline Sabby

Re: This disturbed me
« Reply #393 on: January 27, 2014, 02:46:20 PM »
If the patient is declared dead, then the cost of continued treatment will assuredly not be covered by insurance.  If the patient is not declared dead then there is a chance that the cost will be covered by insurance.  The hospital has a greater chance of recouping the cost of treatment if she's not declared dead.

Finally, someone actually answers my question. Thank you Oniya.

Offline Kythia

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Re: This disturbed me
« Reply #394 on: January 27, 2014, 02:48:54 PM »
Whatever

Offline lilhobbit37

Re: This disturbed me
« Reply #395 on: January 27, 2014, 02:49:40 PM »
I think the confusion here is that your explanations seem to be saying they did not declare her dead so they could get money even though they knew she legally should have been declared as such.

So if legally she should have been and would have been except they didn't want to pull life support because of the fetus, then they should have followed procedure and declared her dead as they should have in the first place. Then if they left her on life support to "follow the law" it would have been obvious it was because they believed they were supposed to not because of money whereas by breaking procedure and refusing to make the declaration of death seems like a cop out to keep her on support per their wishes.

Offline vtboy

Re: This disturbed me
« Reply #396 on: January 27, 2014, 02:54:42 PM »
Harkening back to an earlier point:

As for a safe harbor provision, there is no such thing in this regard.  If the family stated wanting her on life support, but the physician went ahead and declared her dead so that the hospital had to remove care.  Also if Texas has a law on the books stating that removing life support is illegal and the physician made a move to do so leading in death to the patient and fetus, then he is liable.  The criteria is simply being established in that law, not being used to shield the physician.  There is not much safe harbor in death.

Here, in pertinent part, is the safe harbor clause from the Texas statute you cited:

" 671.002. Limitation of Liability (a) A physician who determines death in accordance with Section 671.001(b) [i.e., the section that authorizes determination of death on the basis of irreversible cessation of spontaneous brain activity]... is not liable for civil damages or subject to criminal prosecution for the physician's.... actions or the actions of others based on the determination of death."

The language is fairly plain. Assuming the physician diligently followed ordinary medical standards for determining Ms. Munoz's brain death, how exactly could he or she be held liable, civilly or criminally, for declaring her dead, without abrogation section 671.002?

The safe harbor provisions aside, assuming you are correct that Texas law requires the termination of life support following a declaration of brain death (even where the decedent is pregnant), how could a physician, who has merely declared a medical fact defined by statute, possibly be held legally responsible for consequences which the law then mandates? And, if  termination of life support is not mandated in the case of a pregnant decedent, something more than the physician's declaration of death would be required before the plug could be pulled. In either case, I can't for the life of me see how a doctor would run any legal risk by merely doing his or her job and pronouncing the patient dead.

Kythia may be correct that the hospital's answer to the "to be or not to be" question turned on the availability of payment for the treatment it was giving to Ms. Munoz's brain dead body. It is difficult to imagine a clearer instance of gaming, however, than avoiding a declaration of death, which would otherwise be made in due course, so that the hospital could demand compensation for a course it chose on its own.         

Offline Kythia

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Re: This disturbed me
« Reply #397 on: January 27, 2014, 03:00:33 PM »
Kythia may be correct that the hospital's answer to the "to be or not to be" question turned on the availability of payment for the treatment it was giving to Ms. Munoz's brain dead body. It is difficult to imagine a clearer instance of gaming, however, than avoiding a declaration of death, which would otherwise be made in due course, so that the hospital could demand compensation for a course it chose on its own.         

I still disagree.  Sure, the law you posted grants safe harbour to the physician, but there's a conflict there.  Law A says leave the machines on (or, at a minimum, "If we assume the hospital acted in good faith then the hospital believed law A said leave the machines on") Law B says you won't get in trouble if you switch them off.  Yes, granted, the hospital could have chosen to interpret Law B as taking precedence instead of Law A but they didn't.  Whether and to what extent right to life politics influenced that I couldn't say.

Offline Oniya

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Re: This disturbed me
« Reply #398 on: January 27, 2014, 03:09:10 PM »
Okay - expanding on my answer: 

1) Does the law apply to a brain-dead person?
 a) Yes - life support is needed.
 b) No - life support is not needed
 c) Unknown - maintain life support until a) or b)  (reversible error)

So, life support was mandated under reversible error.  If the law didn't apply, they could and did turn it off.  If the law did apply, they couldn't 'turn it back on.'  That brings us to the second part:  Declaring death.

2) Will insurance pay for this...
 a)If patient is declared dead? No.
 b)If patient is not declared dead? Maybe.

They were already stuck with the cost while waiting for the resolution of the first question.  There's also the fact that if they declare someone dead, the expectation is that the ICU bed and the life support machines are deemed 'available'.  (Computers are also kind of bad at the whole 'grey area' thing.)

Offline Kythia

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Re: This disturbed me
« Reply #399 on: January 27, 2014, 03:20:25 PM »
Ha, it honestly seems like if you take as your first premise "The hospital acted wrongly" then all subsequent actions support that, if you take "The hospital acted correctly" as your starting premise then that's equally supported by every action.

For my part, I prefer to be optimistic.  But I think, based on the above, that I may well be done here.