Monday, May 18, 2009
Denied Access and Info for Dying Patients: Is it just about sexual orientation?
Image via CrunchBase
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.
7 Responses to “Denied Access and Info for Dying Patients: Is it just about sexual orientation?”
May 19, 2009
Obviously impossible to judge from a news article but yes that sounds a lot like piss-poor standard operating procedure as opposed to discrimination. Not that it isn't a problem, and over-zealous interpretations of HIPAA have probably made things worse. I strongly encourage all my patients to name HCPOAs, but it's probably that much more important for same sex couples in relationships without legal recognition. This, however, seems like someone who had 'DPOA' but was still denied information about and access to her dying loved one....
May 20, 2009
As this strikes very close to my heart, I just want to point out that yes, there are lots of system failures that have to do with ignorance, and probably a certain amount of homophobia.
There was a case in Oregon recently of a registered domestic partner being denied access to their critically ill partner. This was at a hospital that has explicit policies (as well as the law) that prohibit such behavior -- yet one nurse was able to deny access. You can watch the story here: http://tinyurl.com/qvoros
I give the video because I think it is important to put a face to the situation, and his words "If I had been able to tell people that day, that we were married, no one would have misunderstood what married meant."
I know this is somewhat of a derailment of the focus of the post, but it still feels salient to the overall discussion of how we treat "family."
*It is particularly distressing to me as a nurse that it was nursing staff that denied access.
May 20, 2009
Marachne,
I am familiar with that Oregon case as well. And let me be clear in saying I do not agree with discrimination based on sexual orientation since when I re-read my post that may have not been clear.
I debated on how to write this one up, because I did not want to come off as callous towards same-sex discrimination politics, but the thing that struck me is this seemed almost too 'common' as a tragic story where palliative care could have made the situation much better. I wanted to be able to highlight that basic overall lack of good communication.
I have not personally encountered this level of overt discrimination regarding sexual orientation homophobia in my years in medicine. And I would comment that most of palliative medicine if not medicine in general seems to have a more liberal and open attitude towards homosexuality.
May 21, 2009
Christian, it was clear that you were neither expressing nor condoning any kind of homophobic behavior. I too, have not experienced or witnessed this much, and certainly not in terms of access.
I agree with your overall analysis of the situation that you described, and the huge role that communication plays in so many aspects of health care.
I just couldn't resist an opportunity to get on my soapbox.
Ultimately, no matter how much cultural sensitivity (or as I prefer, cultural humility) training an institution provides, the larger cultural paradigms take time - and reinforcement from individuals in the moment to change.
Excellent end-of-life care is one of my passions. General respect for all people is one of my core values. I know these attitudes are prevalent in this community, but we work within a larger system that still needs lots of reminders.
May 22, 2009
I truly hope that the pt's sexual orientation is not what caused a breakdown in communication. Despite what each of us believes individually, in the medical profession, we should be able to leave our personal beliefs about things such as sexual orientation out of what is best for the pt.
However, my only concern is that lately the news reports very misleading stories. So, I just wonder what else was going on. We only have small glimpse into the real picture of things.
All in all though, palliative care could have made a tremendous impact here, by facilitating communication. And, as at the facility I work out, probably all staff involved would have been most grateful.
May 22, 2009
I sincerely hope that sexual orientation did not play a part in not allowing the DPOA to have more time with the pt, as well as her children having that time. Despite the many personal beliefs that go along with sexual orientation, it would be very unprofessional to allow personal beliefs to drive an action that may not be in the pt's best interest.
With that said, however, I find the news today to report very misleading information. My thought here is that something more must have been going on that we do not have details about. And, I am sure the issue was much larger than sexual orientation.
All in all, though, palliative care could have helped tremendously with better communication. And, I am sure all staff involved would have been grateful had the resource been utilized, or if it was even available.
March 27, 2011
I sincerely hope that sexual orientation did not play a part in not allowing the DPOA to have more time with the pt, as well as her children having that time. Despite the many personal beliefs that go along with sexual orientation, it would be very unprofessional to allow personal beliefs to drive an action that may not be in the pt's best interest.
With that said, however, I find the news today to report very misleading information. My thought here is that something more must have been going on that we do not have details about. And, I am sure the issue was much larger than sexual orientation.
All in all, though, palliative care could have helped tremendously with better communication. And, I am sure all staff involved would have been grateful had the resource been utilized, or if it was even available.
Post a Comment