"DNR" - "Do not resuscitate" so wrote the doctor on my husband's hospital chart when he was admitted to a hospital in Vero Beach, Florida on September 29, 1994. My husband and friend for over 50 years, Lloyd Wayne Gregory, died 3days later because the doctors and hospital, in my opinion, decided it was his time. Why they thought they had the authority to make that decision when he had signed a form advising them that he had not executed a living will is beyond my understanding. Was it murder? No one seems to think so, but his family.
Lloyd and I had reached the stage of life when we could retire on the fruits of many years of hard work. We owned a farm in Illinois and a motor home that let us go back and forth between Florida in the winter and our farm in the summer. Lloyd had been diagnosed with multiple myeloma in 1986, and he had other health problems including lung cancer. None the less, he was not in any pain and we maintained an active and useful life. He had undergone radiation therapy for his lung cancer in the spring of 1994, and he was taking a drug called Theo-Dur to help his lungs.
Like many drugs that are taken over a long period of time, Theo-Dur can cause serious side effects if the blood saturation level is not closely monitored. The theophylline level in Lloyd's blood had become toxic by the summer of 1994. No one noticed because no blood studies were performed by the doctor in Illinois who treated Lloyd that summer. That was the first in a series of mistakes that led to his death. When Lloyd failed to get better under the care of a doctor in Peoria, he and I decided to return to Florida so that he could be seen by the doctor who had supervised his treatment in the spring. She suspected theophylline poisoning and arranged to have Lloyd admitted to the hospital. On the day he was admitted, she boldly wrote the DNR order in his chart without consulting me. She must have known that Lloyd did not have an advance directive and did want life prolonging treatment administered.
After admission to the hospital, the second mistake was made in Lloyd's care that contributed to his death. Ativan is a sedative known to cause severe respiratory failure and death if too much is taken. The admitting doctor ordered 1mg on the night he was admitted and another 1mg dose at 10:45 the next morning. Then the consulting cardiologist ordered 2mg that night and another 2mg for the next afternoon, October 1st. At about 1 PM on October 1st the cardiologist met with my husband and me and admitted that he had given Lloyd too large a dose of Ativan. He then cancelled his order to administer the afternoon dosage. That's when the third and final mistake was made. The nurses overlooked or ignored the cancellation order and gave the afternoon dosage anyway. The next day, the day of Lloyd's death, my daughter and I were in his room wondering why we could not wake Lloyd when we overheard the consulting pulmonary specialist tell the cardiologist, "You're killing him with that Ativan. You not only put him to sleep, but you also put his lungs to sleep and that can't be reversed." That was when I first realized that my husband was in such serious condition. Since it was apparent that Lloyd was having difficult breathing, I asked the pulmonary doctor, to put him on a respirator. To my amazement and disbelief, he said that, even though a respirator might keep him alive indefinitely, he could not order a respirator because of the DNR order in the chart. Lloyd was pronounced dead a short time later.
Despite the three mistakes that I feel caused Lloyd's death before it was "his time," the thing that angers me most is that nothing was done to sustain his breathing with a respirator. Are doctors and hospitals allowed to make that decision on their own without regard to the patient or his family? I have studied the law regarding advance directives and I could find nothing that authorizes doctors to withhold treatment at their discretion. Yet the State Attorney refused to investigate when I showed him the DNR order and the statement Lloyd had signed saying he had no advance directive. The Agency for Health Care Administration also declined to investigate the hospital, stating in a letter dated January 24, 1997, that, "we do not believe an investigation is warranted at this time." All the lawyers I consulted about filing a malpractice lawsuit said it was too expensive to prove. Even the American Medical Association, responding to my complaint to them, stated in a letter dated February 18, 1997, that they are not aware of "any statutory or regulatory requirements that mandate placing a patient on a respirator at the request of the patient or the patient's spouse." Apparently, they haven't read Florida law.
Section 765.102(3) of Florida Statutes says that it is the law of Florida that an advance directive may be made to instruct physicians "to provide, withhold, or withdraw life-prolonging procedures…" In section 765.401 which deals with the patient who has not executed an advance directive, the law states that the patient's spouse may act as the patient's proxy and that "any health care decision made under this part must be based on the proxy's informed consent and on the decision the proxy reasonable believes the patient would have chosen had the patient been competent."
Why did Lloyd's breathing so quickly fail after he entered the hospital? I am convinced the Ativan caused it. Did the doctors let him die to try to cover-up that mistake or to avoid the expense of keeping him on a respirator? Under Medicare, the hospital probably would save money by letting him die. I know my husband wanted to be put on that respirator because he had been on one before and had recovered. Had he been given that opportunity to live, he would probably have been able to decide for himself whether he wanted to continue the procedure. A doctor in Sebring, Florida was recently arrested for suspicion of murder in the death of a patient who may have been given medicine to hasten his death. What is the difference between giving medicine to hasten death and withholding treatment to hasten death.
Is justice, selectively applied, justice at all? I shall continue to demand an answer to that question while I have life and breath.