Monday, May 18, 2009

Denied Access and Info for Dying Patients: Is it just about sexual orientation?

Image representing New York Times as depicted ...Image via CrunchBase

Tara Parker-Pope writes in the New York Times today about a Federal Case from Florida in which a same-sex partner holds that she was denied access and information about her partner who was dying based on their sexual orientation. Hospitals and other health care organizations are invested in the outcome of this case because it could greatly alter medical staffs interaction with the friends and family of patients.

Many barriers to good patient-family-staff communication exist within medical facilities the greatest of which is lack of time. You add on top of that 'medical passwords for information', staff documentation, a lack of quality reimbursement structure to encourage better communication, an greater volume of clinical data and information, the loss of primary care representation in the hospital, the fractioning of physician specialists time on service, the presence of trainees, the micro-specialization of every service in the hospital, and the fact that medical staff have historically as a whole been poor communicators about the critically ill and dying patient, and you could see why lawsuits exists regarding communication.

So for health care staff to erect more barriers because of sexual orientation of the partner seems almost ludicrous, especially in these cases where health care proxy statements were completed. But as I read the story, I was wondering if this was just really more of a poor example of dying in American hospitals or outright discrimination. Not that I am trying to give the defense an argument. One might imagine in this outrageous defense: "Your honor, we were not discriminating based on sexual orientation, we were just providing poor communication about a dying patient per standard of care." Read the story and tell me if you see shades of both. Here is one example that just sounds like it is begging for a palliative care consult:
"The medical chart shows that the documents (ed. DPOA) arrived around 4:15 p.m., but nobody immediately spoke to Ms. Langbehn about Ms. Pond’s condition. During her eight-hour stay in the trauma unit waiting room, Ms. Langbehn says, she had two brief encounters with doctors. Around 5:20 a doctor sought her consent for a “brain monitor” but offered no update about the patient’s condition. Around 6:20, two doctors told her there was no hope for a recovery.

Despite repeated requests to see her partner, Ms. Langbehn says she was given just one five-minute visit, when a priest administered last rites. She says she continued to plead with a hospital worker that the children be allowed to see their mother, even showing the children’s birth certificates."

Palliative care teams do a great job at taking a social history and finding out who needs the information and help build trust and open channels of communication with family, patients and medical staff. But they can't be everywhere and until this issue is settled in a court of law palliative care will just have to keep doing the best when we are consulted.

In addition, there are studies showing no significant harm by allowing family members in the room during codes and trauma situations so this statement from the hospital:

“The primary legal point is that the amount of visitation allowed in a trauma emergency room should be decided by the surgeons and nurses treating the patients,”
doesn't necessarily hold well.

Read the 145+ comments and counting on the Well Blog at the NYT for more public opinion.

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