Wednesday, April 26, 2006

Andrea Clark Is Not the Only One, Meet Yenlang T. Vo

I represent Andrea Clark and the family. I came to represent the family because I signed up on the registry of health care providers and referral groups that have volunteered their readiness to consider assisting families in the situation where the present attending physician and hospital ethics committee decides to withdrawing life-sustaining treatment.

As soon as I signed up, I got TWO cases. One involves Andrea Clark. Andrea's case has been getting media attention. Ms. Yenlang Vo's case has not. I would like for you to know about Ms. Vo's case.

Ms. Vo is in her 60's. She is a patient at St. David's North
Austin Medical Center here in Austin, Texas. She has been diagnosed with persistent vegetative state--but that is disputed by the family. Ms. Vo's daugher, Loann Trihn, is an emergency room doctor and she disputes the diagnosis. Such a diagnosis is very subjective and involves clinical assessments. Dr. Trihn and her father have both witnessed her mother being responsive.

The attending physician wishes to withdraw dialysis, That is not acceptable to the family--and it against the express wishes of the patient expressed before she became unable to communicate. Ms. Vo needs a new shunt surgically implanted for her dialysis. She is receiving it by a different means at the present. The physician, apparently, does not believe that her state of life justifies the surgery.

Withdrawal of dialysis with no further attempt at creating a surgical access port not only condemns Ms. Vo to a rapid and untimely death, but prevents any initiation of dialysis on an outpatient basis should her sepsis be successfully treated and maximum medical improvement be obtained. The family have all observed signs that the mother retains certain cognitive abilities which may well improve with continued treatment. Removing dialysis is a preemptive and premature act which deprives her of a more natural path toward a peaceful end of life and is contrary to her expressed wishes to fight with all her strength until her time has come. Dialysis is no longer an extreme procedure and is performed for many patients on a routine outpatient basis and can in some case be self administered. To deny such a service in a critically ill patient without family consent and access to judicial due process is ethically, morally and very possibly legally wrong. The care for this lady should continue according to the highest current medical standard.

A physician I retained to look at this opines regarding the surgical implantation of the shunt as follows:

Whether to perform surgery is always based on the risks of surgery versus its benefits in individual cases. When the risk of not performing surgery exceeds the risk of the surgical procedure, then surgery is indicated. In this case, as pointed out in the Continuation of Affadavit, the risk of death without the shunt surgery appears to be 100%, whereas the risk from surgery, while perhaps high, is unlikely to be 100%, based on the information provided. Therefore, using the risk-benefit analysis, this patient can only benefit from surgery. The fact that she is cognitively impaired should not be used as a reason to deny her surgery.

The Texas Futile Care Statute gives only the recourse of discharge from the facility within ten days after the letter from the ethics decision is given to the family. The facility has found only one facility that will take her--one in Illinois.

The family lives in Travis County and Illinois is too far--though it may end up to be the only choice. I am continuing to work on attempts to slow the process down to find more appropriate placement here in Texas.

Please help me save this lady. I need more time to help her find placement in Texas. Tomorrow, I may be in Court on this issue.