Saturday, September 7, 2013

Pneumona and DNRs

                 
   Ottawa April 15, 2013




A PRACTICAL ILLUSTRATION OF HOW HARMFUL DISCRIMINATION BASED ON AGE AND HANDICAP IS AND WHY WE ARE ALL AT RISK OF ENDING UP DEAD SOME DAY BECAUSE OF IT

(this is the exact step by step procedure that was followed by the Ottawa Hospital doctors in order to obtain a wrongful decision from the Ontario Consent and Capacity Board to “let my father die”)


                                                                                    
The following shows how our death can be planned and inflicted upon us when we don’t want to die:
 
1. An older person gets in a Hospital fairly ill or after a serious accident. Triage is done: based strictly on age and injury, the case is classified as difficult, therefore, the patient is assessed to go into palliative care. The idea is not to spend too much time, resources and effort on this patient. For this, the approval of the patient or his power of attorney is required. However, in this case, the patient wants very much to live and has every reason to live (with a lot of love and purpose in his life) but has no reason to want to die. In the hope of improving and returning to his family that he misses and adores, the patient requests level one care and expects to receive adequate care. The Hospital infects him with E-Coli and Klebsiella in the lungs while he is immobile in bed and the decision is made to minimize care to this patient. The family is called in by the doctor who tries once again to influence the family to let go of the patient. The doctor says that given the seriousness of the illness or injury, the chances for recovery are slim (even though the chances of recovery are not known to the doctor at this time because no medical treatment was tried out yet) and the family is asked to sign a DNR (do not resuscitate) form. Although the family is not explained the significance of such a document, at this point the family still hopes in a gradual (maybe only partial) recovery if proper care is administered, and does not want to sign the DNR form. Age is invoked  as a justification to withhold treatment and take the patient off level one care. If the patient is not an elderly, the justifications made by the doctor would be that in this particular state, the injury or the illness is too serious. The methods customarily employed to get the family to sign a DNR are: 1. To convince the family that the patient will never get better and that DNR is the compassionate thing to do, 2. When the family cannot be convinced that the patient will not get better, the doctor will ask emphatically the question “who would want to live in this condition?”, even though he does not really know what the condition of the patient would become in the future but insinuating that the patient’s final condition will be very bad. In a way, this is a self fulfilling prophecy. In every conversation the implication made by the doctor is that the patient is better off dead than alive. Meanwhile, the family wonders: “OK, so perhaps the patient cannot recover fully, but a doctor must fulfill his professional responsibility of at least trying to improve the medical condition of the patient who is in obvious need of medical treatment, no?”
 
2. The doctor provides minimal treatment, only enough to be able to claim he tried to treat this patient. Meanwhile, important but inconspicuous details of the treatment required to maintain the patient at the same level of health or to improve upon it, are left out, like: not putting on socks against thrombosis or administering blood tinners to prevent clotting, so the patient develops DVT; not giving blood thinning medication when the Blood Pressure is too high, so as to prevent strokes; not prescribing pain medication which, if left unattended to, will cause either dangerous oxygen drops or increase heart rate that may develop into tachycardia, or both. Then, the blood clots can travel and the patient either gets an aneurism or a pulmonary embolism and dies or he suffers a stroke or a heart attack. If it’s a stroke, it's easy: the patient gets to be declared vegetative and the doctors can ask the courts/boards to have the patient “let to die”. If it's a heart attack, it's only a matter of time. If the patient’s oxygen drops severely and/or frequently, he will get a tracheotomy. This may prevent the patient from talking if the vocal chords get damaged in the process. If left in for a longer period of time and if the patient is not monitored, the tracheotomy can cause congestive heart failure or become a source of infection. As well, a tracheotomy produces secretions along the trachea tube which can thicken up and form small plugs that will suffocate the patient if he is not suctioned promptly. If this happens in the absence of any witnesses, the doctor can say that the patient died from the effusion or consolidation or the arrhythmia or from a respiratory complication and no one will ever know or find out that the patient was simply not attended to because it was planned for him to receive minimal attention and minimal care.  Lack of regular and frequent suctioning of the trachea tube puts additional stress on the heart, which is beating too fast because of the unmanaged pain. The family come to visit every day and watch to ensure the patient gets suctioned so he does not die. Meanwhile, simply not taking regular blood tests will get the electrolytes out of balance, so that the arrhythmia of the heart turns into tachycardia, or bradycardia, or both. If the patient is not maintained on a cardiac monitor, the patient may die rapidly from fibrillation.
 
3. Heart problems often turn into lung problems and vice versa. If the patient hasn’t died yet, if his heart hasn’t stopped functioning yet, then the lungs will fail. When the heart is irregular, and especially when the patient who has a tracheotomy is not frequently suctioned, water consolidates in the lungs. This is a condition that is foreseeable, preventable and treatable except for if there is no desire to attend to the patient.  When ignored, it gets blamed on the patient’s immobility (since it occurs often in immobile patients). Due to the lack of pain management and the build-up of un-suctioned secretions around the trachea tube, the heart will speed up and the patient will get tachycardia and suffer from sporadic oxygen drops that are not detected because he was taken off the heart and oxygen monitor in such way as to have no alarms or any other way of knowing when these occurrences take place. The lack of oxygen will kill neurons in the patient’s brain, thereby diminishing his cognitive functions progressively more and more. Lack of knowledge when a patient with a tracheotomy requires suctioning sets his life at risk, kills his brain cells and guarantees that eventually his lungs will fail. Without regular X-rays, without the proper diuretics to eliminate the fluid gathered in the lungs and without proper heart medication, the consolidation in the lungs increases and makes it difficult for the patient to breathe, placing the patient at risk of aspiration pneumonia. As well, this situation creates the ideal setting for congestive heart failure. Of course, it could have all been avoided had the medical care been provided in an adequate and responsible manner. If the liquid intake is adjusted properly, if diuretics and/or other medications are prescribed on time, if the patient’s pain management and electrolyte management are adequate, if the patient was monitored for heart and oxygen saturation to know when medical intervention or suctioning are necessary none of the patients complications would have occurred. But if in the doctor's opinion this particular patient’s life is not worth saving, all resources spent on his care are viewed as a waste and the patient is left to deteriorate progressively in order to die. The direct result of such neglect is pneumonia. Usually, an unwanted patient will be left to die of pneumonia.
 
4. The Hospital doctor will talk with the patient's family again in order to obtain a DNR. The doctor will insist that the patient is too ill to be cured. This is not based on any medical finding but simply on a decision made by the medical team to let this particular patient die. He says that the patient has developed complications (compliments of the Hospital induced infections and lack of medical care) and nothing further can be done. He tells the family that the lack of mobility caused the patient’s lungs to fail, and keeps blaming a pre-existent heart condition for the patient’s present heart problems (regardless of the fact that his heart functioned perfectly for many years before arriving in the Hospital and even after his arrival in the Hospital! But the doctor leaves that out, of course.). As well, the fact that the patient was allowed to aspire because of the lack of suctioning, from the accumulation of water and secretions in his lungs, is completely hidden from the family. The family maintains the hope that with good medical care the patient might still improve and pleads with the doctor for more attention and better treatment. The doctor knows that the oxygen depletion to the brain will cause brain cell death and consequently cognitive impairment. Therefore, if the family continues to decline the doctor’s request to DNR the patient, this depletion of oxygen causing decreased cognition gives the doctor the option to bring this case in front of the CCB (Consent and Capacity Board) to claim that the patient is vegetative and obtain permission to let him die (in case he does not die on his own by then!) by refusing the patient any medical treatment and then, “in case” the patient’s condition gets worse, by actually terminating the patient’s life through disconnection of the feeding tube (or, in other cases the ventilator). The patient is also left anemic for almost the entire duration of his stay in the Hospital. This too causes the heart to beat irregularly, faster and faster, get tachycardia as well as kidneys failure. If the patient survives it will be brought in front of the CCB as one more “cogent and compelling” argument why it’s in the patient’s best interest to be left to die.
 
5. If the patient doesn’t die from the oxygen depletion, from the irregular heart beat and tachycardia, from the congestive heart failure, the thrombosis, the aspiration pneumonia, from the infections in his lungs or from the infected catheter in his bladder, he will be left to get yet another infection, usually through the mouth or through the bladder since these are the two places were tubes penetrate into the patient’s body and can easily get infected. He gets both. He gets UTI through the catheter and bacterial pneumonia through the trachea, which can also cause death. At first, his pneumonia is treated with many insufficient runs of antibiotics that will render the patient immune to the antibiotics but that will not destroy the bacteria completely. This method of treatment could kill the patient and at the same time maintain a cover of an honorable appearance of attempt to medically treat the patient. No testing is conducted at the end of any run of antibiotics so as to not know if any infected bacteria are still present.
 
6. Since all this was still unable to end my father’s life because he was too determine to live, he was left infected with pneumonia without any treatment until he developed septicemia on several occasions when, for the sake of maintaining an appearance of legality and proper care, he was rushed back into ICU where they would apply emergency treatment and barely save his life. These septic episodes caused him drops in oxygen and tachycardia to the point where he had strokes and heart attacks. Given the recurrence of the bacterial pneumonia because of ineffective and inappropriate treatments the patient either dies or is declared colonized with the recurring bacteria (which is synonymous with total withdrawal of treatment for pneumonia). The reason invoked is that once colonized, any treatment becomes futile. In reality, this is untrue and many doctors treat it. When colonized, a patient usually needs more aggressive treatment but it is not a hopeless situation. However, doctors can do anything they want and they wanted to sit back and wait for the unavoidable. Therefore, after not being treated for his infection in May of 2013, my father was no longer rushed into the ICU. Instead, his condition and lack of treatment were painstakingly hidden from the patient’s attorney and the patient’s family.
 
7. The medical staff has become impatient. A lot of time has passed since they predicted the patient’s end of life and their predictions now look very farfetched. A lot of time had passed since the doctor told the family that the patient will die soon and asked to have the patient DNRd. The doctor has lost all credibility. 16 months longer than the doctors had intended to devote to this patient! And unbelievably enough, the patient is still fighting for his life. To everyone's total surprise, this patient is not dead yet. New methods must be found to get rid of this stubborn patient and his nagging family. The patient gets declared infected and put in an isolation room with patients who have contagious diseases, the superbugs: MRSA, VRE, C-Dif, and infectious diseases such as Hepatitis and other transmissible diseases despite the protests of the family and the fact that the patient has insurance from his previous employer for a private Hospital room. Meanwhile, the patient has no contagious illness of any kind. The family gets told once again that there is absolutely no hope and that it is unfair to the patient to be kept alive. The family knows the patient wishes to live.
 
8. New methods are introduced. The family finds the patient bruised and bleeding on his knees or lower legs when the patient is immobile and non-verbal and could not have caused those injuries to himself. The family is forced to witness the patient being tortured by not suctioning him when his secretions are choking him and he gasps for air. The family protests when the patient's hands are tied so as to not scratch himself when due to the lack of hygiene, a rash developed on his skin that itches him very hard. The family witnesses nurses walking away when the patient is soiled and saying that there is no need to clean the patient because if they would clean him, he would only dirty himself again. The family is disallowed to give any help or relief to the patient when he chokes and no one is there or responds to the alarms, to suction him. A security guard is placed at the patient's bedside to watch that the family does not suction the patient because he may not die then. First, these pains are used to coerce the family into signing the patient's release to a long term care facility with none or very minimal medical care when the patient is acutely ill. Then, the pain inflicted on the patient is used as leverage to force the family to sign the DNR (do not resuscitate), which would assure the patient dies. When the family disagrees, regardless of the Living Will and the Power of Attorney signed by the patient in favor of his trusted family member, stating clearly that this family member is the only one entitled to give consent regarding receiving changing or withdrawing treatment, the doctors decide it's time to go legal to terminate this patient’s life. Testing & treatments get stopped completely without notifying the family or without approval of the Board.
 
9. After two months of untreated pneumonia, left with high fever and in agonizing pain in his chest and head, the patient becomes less responsive and less interactive. At this time, pain management is delivered religiously via pain medication and sedatives but all other testing, preventive or active treatments are withdrawn without the patient’s family knowledge or consent. The lack of treatment to the patient is kept secret in classified documents that are refused to the patient or the patient’s family. A security guard posted in the patient’s room ensures that no information is given to the patient’s family by any of the Hospital staff. While waiting for the Board Hearing, the doctor had already changed the plan of treatment for the patient without consent from the patient’s attorney. The doctor is not a specialist in neurology but he testifies in the Board Hearing that the patient is vegetative because in his opinion, the patient “meets the clinical criteria of a persistent vegetative state” because he had observed the patient for ten minutes before the Board Hearing and the patient was unable to interact in a meaningful way with his environment. The Consent and Capacity Board does not question the doctor at all, why he did not bring any evidence, why the diagnosis was reached without any neurological testing, why the Patient’s Chart was not brought to show what medication the patient is on, such as the pain killers or sedatives, why no lab results or vitals were presented to give an idea of the patient’s physical condition, nor does the Board have an issue with the fact that a neurological diagnosis was made by a generalist with no background in this highly specialized field and that he reached a diagnosis after only 10 minutes of observation when the article from the medical journal he cited in the Hearing was stipulating that it could only be reached after a lengthy period of observation of several weeks.
 
10. The Board does not question the doctor at all but prevents the patient’s attorney from entering into evidence any of the documents she had prepared including the patient’s medical Chart and interrupted and denied her the right to make her arguments by cutting off half the day that was dedicated to this Hearing and that was specifically the time allotted to the patient’s attorney closing arguments. Even then she was prepared to rush through but the doctor’s attorney took twice the time that she said she would so there was no time left for the closing arguments. The doctors asked the Board to have their power substituted for the power of attorney given by the patient to his family member that he trusted. Meanwhile, in the patient’s Chart results from EEGs, MRI of the head, and CT scans taken at various times throughout the patient’s Hospital stay, do not support the theory of a persistent vegetative state as advanced by the doctor although in the article he cited, it is specified that the supporting scientific neurological tests should be used with any clinical diagnosis. Since every one of the neurological tests, some as recent as one month prior to the application made by the doctor to the Board, are not supporting the clinical diagnosis made by a doctor who is not a specialist in the field, the diagnosis was wrong.
 
11. The Board dismissed every one of the testimonials from the attorney or the family and ignored the fact that the independent medical opinion requested by the Board was disallowed by the Hospital doctor. A man who was not vegetative was now effectively declared vegetative for the purpose of having his life terminated. A death sentence was handed out on a false pretense but still, it saves money: 0.1 penny per Ontario citizen a year and 0.00005% of the Ontario deficit yearly (had he been able to live for a year and had he been still in the Hospital for that long). The doctor gets appreciation for improving the efficiency of the Canadian Health Care system. The newspapers write about this judicial breakthrough where Hospitals are finally doing something right and where “no more heroic measures” are taken in order to save the life unworthy of living of a vegetative patient. The public cheers. The patient dies. The family appeals immediately the wrong decision of the Board but the Superior Court of Ontario grants the Hospital a motion to moot the Appeal based on the fact that the patient is dead. The patient is dead and justice is dead with him as are all his rights that were crushed in the process.

12. In the autopsy result it is shown that the patient was not vegetative and that his condition and death was due to asphyxiation because he was left with an untreated pneumonia for too long.. Heavy death of neurons new and old indicate that he suffered from lack of oxygen in the past, when he was left unsuctioned, and recently, when he died because of his compromised respiratory system due to untreated pneumonia. Also, he was moved out of the Ottawa Hospital one week prior to his death into the Montreal Jewish General. Here, they did treat and test him. After the cultures were ready (it takes four days or so for cultures to develop), it was shown that he had "ample growth of E-Coli bacteria in his lungs" just as he did all along during the 19.5 months in the Ottawa Hospital. where he was minimally treated, just enough to remain infected but to give the appearance that he was treated and then, when he was no longer treated at all it was hidden so no one would find out in the hope that perhaps so he would die "on his own". When the results came back from the blood cultures, unlike in the Ottawa Hospital, the Montreal Jewish General Hospital treated him immediately with the strongest broad spectrum antibiotic available and three days later when the autopsy was carried out, the results show that his lungs were cleared and that he had no more infected pneumonia and no bacterial growth in his lungs. Only very few remnants would show a trace of infection indicating that he had suffered from pneumonia. Hence, had he been treated from the start he would have been healed and out of the Hospital in two months instead of being tortured and dead after 19.5 months.

CONCLUSION:
A man is wrongfully killed due to a wrong decision of a Board that has no tests for elimination of false testimony presented by a medical professionalwho is not specialized in the field he is testifying in.
A Board fails to apply due diligence to find out why no medical test results are presented in the Hearing, why the patient was diagnosed vegetative only 10 minutes before the Hearing. The Board did not care to find out that while this patient was diagnosed clinically vegetative he was sedated and left untreated while infected with pneumonia until he got septic. The Board did not request to see any medical documentation regarding the patient’s actual physical condition or the medication he was given that might have caused him to become unresponsive and makes the wrong decision to let him die. The Supreme Court of Ontario finds that this case is moot because the patient died. The patient is denied all his rights, his rights to life, security and freedom. his rights to not be discriminated against based on age or handicap, his rights to receive the health care, insurance that he paid for with heavy tax dollars, denied his rights to a second independent medical opinion, denied his rights to leave a Hospital when he wants to do so, his rights to access his medical records which are kept hidden from him, as well as his rights to justice that are denied because he had the poor inspiration to die when the Board allowed the doctors to “just let him die”. The judge deemed it not necessary to spend his and his family’s tax dollars to deliver justice to him or to his family. It was deemed “not in public interest” because presumably he was not a citizen whose life was of a value equal to that of any criminal that gets stabbed to death in the process of committing a crime so this patient did not deserve justice. His life was of no value to the public and preserving it was of no value to the public therefore, the judge decided that it was not in the public interest to pursue this matter because he had already died. A man’s deliberate life removal was irrelevant to our justice system.
 
 
NOTE: when the medical establishment and the judicial establishment join hands for the purpose of imposing their will to terminate a human life on the person to whom that life belongs, a person who is often weaker and completely defenseless, such as the elderly and the handicapped, we end up with a society that has the values and behaviors of the Third Reich. The T4 program started with a legal entity equivalent to the Ontario Consent and Capacity Board, authorizing doctors to destroy their mentally ill patients in order to legitimize murder of patients by their doctors in the name of public interest. It was all done in a covert manner, with the appearance of propriety, with the authority of legal, medical and scientific professionals and under the compelling banner of compassion for the patient in whose interest they were acting. The scale was different but the similarities are staggering.
I am attaching a Petition that I would appreciate if you could print, sign and scan back to email to me at df1333@hotmail.com. Out of respect and/or love for my father or for me, please sign this Petition and help change a system that, if not changed, will some day, most likely, kill you or one of your loved ones too. Please distribute this petition to anyone you can think of that might sign it. Please follow me on twitter at Diana Ford@Snowsplendour  
dford1@rogers.com
 
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