Family alleges failure of care at SF hospital

June 2, 2010 7:38:31 PM PDT
A family from Boston says their loved one died at St. Mary's Medical Center in San Francisco after staff broke their own code of ethics and refused to provide basic care.

The members of the Murray family were home in Boston on Thursday, May 6 when an urgent call came from St. Mary's in San Francisco -- their Uncle Don had suffered a stroke. On their visit to the city just last month, the 90-year-old had seemed alive and active.

"He was very inquisitive, always wanting to learn new things," Don's nephew Don Murray said.

"Sharp as a tack, interested in everything, he kept his brain going," his grand-niece Tegan Murray said.

"We dropped everything and took a plane that night," his niece-in-law Jean Murray said.

One of Don Holley's old neighbors in the Richmond District was acting as his durable power of attorney. A doctor told her the prognosis was not good and she agreed that Don should receive what is called "comfort care," meant for patients near death. They placed him on a morphine drip and cut off all nutrition and hydration. Without water, the doctor said Don would be dead in two days.

But, there was something wrong. When the Murrays arrived that Friday, Don appeared to be improving.

"It looked as if he hadn't had a stroke; we'd been told his mouth would be sagging a little bit to the left, but it didn't look that way," Jean Murray said.

"And he said, 'Hi,' like that, he was obviously very thrilled to know that we were there," Don Murray said.

"I could tell in his voice he knew we were there and it really meant something to him that we were there, and I said, 'Squeeze my hand,' he squeezed my hand, I said, 'Squeeze it harder,' and he lifted his hand in the air squeezing my hand," Tegan Murray said.

The Murrays scrambled to tell anyone who would listen -- why take Don's life by cutting off his water when it looked like he was recovering from the stroke?

The answer -- the family would have to take their case to the hospital ethics committee.

"And we were told that couldn't happen until Monday, and I said, 'I don't think he has until Monday.' We had no other recourse," Don's grand-niece Tara Murray said.

The Murrays were left with the impossibly painful role of watching Don slowly die -- not from the stroke or any disease or injury -- but from water being withheld.

Anita Silvers chairs the philosophy department at San Francisco State University. She is also on the ethics committee at San Francisco General Hospital. She questions taking such extreme measures with a patient who had suffered a stroke just four days before.

"Lots of people have strokes and lots of people have very, very serious strokes and recover; he might not have recovered fully, but the standard is not that you have to recover fully," she said.

Silvers also points out that St. Mary's is a Catholic hospital, supposedly governed by the U.S. Conference of Catholic Bishops and their "Ethical and Religious Directives for Catholic Healthcare Services." Directive 58 states, "There is an obligation to provide patients with food and water...This obligation extends to patients in chronic and presumably irreversible conditions (for example, the persistent vegetative state)."

Don Holley was not that bad off.

"Catholic hospitals have an obligation to provide hydration and nutrition because it's not a treatment, it's an obligation that we all have to each other, to support life and each other," Silvers said.

That Friday evening, without water, but with oxygen being administered, Don developed a severe nose bleed.

"There was blood dripping down his face and blood pooling in the back of his throat," Tegan Murray said.

The nurses began to use suction to clear his throat so he could breathe.

"Proper suctioning would make him be able to fall asleep calmly or to communicate or to be comfortable," Tara Murray said.

That routine continued for the next day. The Murrays say Don's vital signs remained strong, until 4 p.m. Saturday, when a shift change brought a new nurse.

"She came in and didn't seem to want to suction him," Tegan Murray said.

The Murrays watched the new nurse fail to clear Don's throat of blood.

"And she pulled back and I said, 'Why aren't you doing something?' And she said, 'I can't,'" Jean Murray said.

The nurse would not let Don's great-niece suction him. Tegan Murray had experience back home with an aunt and the nurse on the previous shift had allowed her to work on Don.

But, the nurse on duty tucked the suction equipment in a drawer, turned off the machine and left the room.

As the minutes ticked by, Don showed more and more stress.

"And I did raise my voice, I started saying, 'Do something, he's dying, this is unethical, what are we supposed to do, call 911 in a hospital,'" Tara Murray said.

The family yelled and pleaded. Finally, the nurse returned and handed the suction device to Tegan Murray. It was too late.

"I was crying and suctioning at the same time, and he was lifeless," Tegan Murray said. "They still seemed unconcerned. It didn't faze them."

The nurse in question has 17 years of experience and no record of discipline with the state. When the I-Team reached her by phone, she said, "[She was] very deeply sorry. I did what I could. I did my best as a nurse."

"The four of us were there pleading for help, he was desperately looking at us and at the nurse for help, she held the equipment that would have saved him in her hands, the equipment was hooked up, it was working and she didn't do it," Tegan Murray said.

The Murrays have filed a complaint with the state Department of Public Health.

St. Mary's president and CEO Anna Cheung refused to be interviewed, even though the family was willing to sign a release permitting the hospital to discuss the case. Cheung's public relations staff issued a statement saying, "Privacy laws prohibit us from confirming or denying if the person in question was a patient at St. Mary's Medical Center." They would not address the decision to withhold water from Don Holley or the way he died.

"Yeah, I'm angry, I'm upset my uncle died that way, his last moments of his life, he was tortured," Don Murray said.

"It doesn't matter if you're a one-day-old baby or an elderly person, or dying or living, I think everybody should be treated with respect and get the basic care that should be provided for them and not to die a suffering death if it's not necessary, and it certainly wasn't necessary here," Tara Murray said.

Legal experts tell the I-Team the hospital is supposed to follow the directions of the person acting as power of attorney unless there is evidence the patient's condition is improving. At that point, the hospital has a duty to re-evaluate the case.


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