Why not perform CPR?

There has been a lot of discussion this week in the national media about this story: http://www.ajc.com/ap/ap/health/police-investigating-death-of-woman-denied-cpr/nWgbh/ If you are not familiar, the synopsis is an elderly lady living at an assisted living facility went into cardiac arrest. The nurse on duty would not perform CPR on the lady, despite the pleas of the 911 operator, because it would be a violation of the policy of that facility. Much of the discussion has centered on medical and legal ethics. However, no one has talked much about why a facility would such have a policy preventing its nursing staff from performing CPR.

CPR is actually a very dangerous medical maneuver for a person to receive. Broken ribs are a very common result of CPR- especially in elderly patients. These broken ribs can puncture lungs, spleens, and livers leaving the person with many more problems, which are especially hard to recover from in an elderly patient. If you do not break ribs, there is a good chance the forced air flow is going to cause aspiration into the lungs, which can create air flow problems and pneumonia. If the patient survives all of that, they will very likely have brain damage since the average human breath is only about 2/3 of the amount of oxygen the brain needs to receive to survive. All this being said, I am not advocating against CPR, I am merely pointing out that it is dangerous and has potentially life threatening side effects, which leads us to why the facility would have such as policy. They likely want to limit their legal liability from the side effects, or the argument that if the CPR was done more effectively the patient would have survived.
You see the Medical Malpractice System in the US has created a culture where someone is always wrong or at fault. Facilities are being forced into these seemingly ridiculous policies in order to limit their liability from a lawsuit. In fact, their insurance companies may refuse to cover them, or cover them at a much higher rate, if they agree to allow for complex medical procedures. Medical Malpractice Defense is not only driving these ridiculous polices, but also is driving up the cost of care.

In 2005, GA led the charge in this area by passing one of the most comprehensive Medical Tort Reform bills in the country. The Georgia bill is not perfect. It has been heavily litigated since passage. However, it is a start to end, not only these ridiculous results, but also the heavy cost associated with defensive medicine. We will never adequately reform Healthcare without having this discussion. What negative effects of Medical Malpractice Defense have you noticed in your facility or community?

One comment Add your comment

Theresa

March 17th, 2013
10:45 am

Excellent article. I work with elderly people, most of whom are 80 and older, and in talking to them, most realize extraordinary measures such as CPR are not what they want. What they do want is a peaceful death, surrounded by their loved ones if possible. In the case of a heart attack or other painful condition, it is possible to make them comfortable. We forget that death is a part of life. Health resources should be spent more responsibly.