Dogs for Ethics Committees and Ethics Consultants

This month’s ABA Journal reports on the growing interest in the use of dogs in courthouses.  Perhaps the same can be adapted for use by hospital ethics committees.

If Duval County, Fla., Judge Emmet Ferguson has his way, there will be a dog in every courthouse across the country.  “Dogs put smiles on people’s faces, and there usually aren’t a lot of smiles in a courthouse,” says Ferguson, who works out of Jacksonville.  Ferguson is working to establish a service dog program in the Duval County court system. His effort reflects a small but growing international trend of using trained dogs in a variety of courthouse settings to reduce the tension inherent in the adversarial process.

Advocates say the dogs are used most often to calm witnesses and victims, especially children. But, they say, having a dog in the courthouse helps everyone.  The mere presence of dogs can be highly effective.  When you have opposing counsel down on his or her knees patting the dog before negotiations, that starts everything off in a friendlier way.

Health Law in U.S. Law Schools

Check out the AALS Law and Medicine Section Newsletter, for a snapshot of what has been going on lately with U.S. law school professors teaching and writing in health law, public health law, and bioethics.

Yarick v. Pacificare - to Save Money, Docs Pressure Surrogates to Stop Life Support

Yesterday, the California Fifth District Court of Appeal published an opinion in Yarick, v. Pacificare of California, No. F057032.  The appellate opinion holds that the plaintiff’s state law claims against a federal Medicare Advantage program were preempted by the 2003 Medicare Prescription Drug, Improvement and Modernization Act, 42 U.S.C. Section 1395w-26(b)(3).  But what is even more interesting are the pending claims against the healthcare providers.

In early January of 2006, Mr. Yarick, who “was over 85 years of age,” was admitted to defendant San Joaquin Community Hospital because he had fallen and broken his leg. Mr. Yarick had surgery to repair his broken leg and, three days later, was transferred to Rosewood Health Facility, operated by defendant American Baptist Homes of the West, for rehabilitation and custodial care.

Over the next three weeks, Mr. Yarick's condition deteriorated in various ways. Nevertheless, Rosewood Health Facililty and defendant Bakersfield Family Medical Group, despite the objection of Mr. Yarick's family, discharged Mr. Yarick. When the family arrived to receive Mr. Yarick upon discharge, they found him “slumped in a wheel chair and not responsive.” The family called an ambulance, which transported Mr. Yarick to Mercy Hospital, operated by defendant Catholic Healthcare West.

Mr. Yarick was diagnosed with multiple conditions, including pneumonia and congestive heart failure. Over the next two weeks, according to the complaint, doctors of defendant Bakersfield Family Medical Group first counseled, and then pressured, appellant to terminate efforts at curing Mr. Yarick and to substitute, instead, “comfort” or end-of-life care. Although plaintiff continued to insist on curative care, as a result of the efforts of the various defendants, Mr. Yarick died on February 18, 2006.

The fourth amended complaint alleges that all of the foregoing events happened because of the financial pressures and incentives that arose from the care providers' contracts with respondent. The complaint alleges respondent's contracts with providers offer insufficient payment to permit the providers to make decisions and to provide care based on patients' reasonable medical needs, requiring the providers to substitute a standard of financial expediency. It alleges some of the contracts provide financial incentives for the refusal to provide reasonably necessary medical care. It alleges respondent has failed to implement and utilize necessary quality control mechanisms that would require providers to give good medical care despite the financial incentives not to do so.

Does Grady Memorial's Cessation of Outpatient Dialysis Constitute Tortious Abandonment

Grady Memorial Hospital closed its outpatient dialysis unit in early October, citing expenses. The hospital has paid a separate dialysis clinic to provide three months of additional care for those patients with no health insurance, no government assistance and no place else to go.  But that extended care expires Jan. 3, and the approximately 30 patients receiving this care -- virtually all low-income illegal immigrants -- worry that their health will spiral downward after that.  (Atlanta Journal-Constitution)

Patient advocates have an ongoing lawsuit to force Grady to reopen the outpatient dialysis clinic.  But the judge has been cool to the arguments that Grady has denied these patients their rights under the state constitution.  A group called Grady Advocates for Responsible Care plans to argue that Grady's closure of the clinic constitutes "medical abandonment" of the patients.

The abandonment argument seems very tough given, among other things:  (1) the global, non-patient-specific nature of the decision, (2) the significant notice, and (3) the significant assistance that these patients have been given.  Indeed, the famous 1982 Payton v. Weaver case seems to be on point and seems to support the hospital.

Still, the question of whether a healthcare provider can ever stop life-sustaining treatment for patients who have no other alternative lies at the heart of futility disputes.  And it is hardly a settled question, as illustrated by the appellate briefing on tortious abandonment in Betancourt v. Trinitas.  

Palliative Care Grand Rounds 1.11

Palliative care grand rounds is up at Death Club for Cuties.  Through the author's entertaining narrative, the reader is guided through various recent relevant blogs and will probably find 1 or 2 news ones valuable and worth following.


The author, Jerry, is "a nurse practicing in the busy neurosciences intensive care unit of a large urban teaching hospital."  His specific clinical interest is "caring for patients and families at the end of life."  He is an ELNEC trainer and a graduate student.