Saturday, August 12, 2006

Hospital Ethics Committees and Conflicts of Interest

This is an issue that I testified about at the Public Health Committee Hearing this past week. As I wrote here, the Texas Legislature is revisiting the Texas Futile Care Statute. I testified within the context of a family I helped where the hospital was going to withdraw life-sustaining treatment. You can read about it in this article. (free registration required)

I am blogging about this because of the comments about the mother's testimony in this case made by another pro life blogger--who with me--is a member of the Texas Advance Directives Coalition. She is also a physician. She said the following about the testimony of the mother, Cynthia Deason, who testified at the hearing:

I'm afraid that most of the problems that I heard about were "acts of God"
(the woman who was found with her ventilator tube dislodged) or angry people
reacting poorly.

First, though the tube may have dislodged through an act of God, it was not an act of God that Kalihla was put on a ventilator which was not capable of alarming when the patient received too little oxygen. Second, she was conscious and recovering prior to this anoxic event.

Less than ten days after the anoxic event, the attending physician was already diagnosing persistent vegetative state and taking the case to the ethics committee for a futility review. Note that the literature says that the diagnosis of PVS is a clinical diagnosis which should take at least 3 to 6 months.

In other words, the ethics committee of the very hospital where this "accident" occurred was going to make the decision to end the life of the patient, and when that was going to happen. That, my friends, is what is called an apparent conflict of interest.

If medical negligence occurred in Kahlila's case, the very hospital that makes the decision to withdraw treatment will financially benefit because--under tort reform--a live, disabled patient is worth more in a law suit than a dead one. That is because the hospital would have to pay for future care. If they don't have to pay for future care, their damages are limited. It is unconscionable for a committee made up of doctors and hospital staff to be allowed to make such a decision in the face of unresolved questions about possible negligence on the part of the hospital. I am not saying that this was the intent of the ethics committee in her case. I am saying that there is such a conflict of interest here, that a hospital committee has no business making such a decision--whether they can be fair or not. Have you heard the phrase: "Appearance of Impropriety"?

It has been amazing to me that the physicians on the Texas Advance Directives Coalition, either fail to understand or refuse to acknowledge, the conflicts of interest that a hospital ethics committee can have that necessarily taint a decision of "futility". Their stubborn refusal to see that this law can be abused by those with less than stellar motives disqualifies them from having all this power, in my opinion. Especially when there are no checks and balances to ensure fairness by the ethics committee.

Further, in the video of the public testimony that I wrote about here, Dr. Vince Friedewald, a retired cardiologist, who works as a consultant with an ethics think tank out of Notre Dame, testified to the financial conflicts of interest that hospital ethics committees have due to the expense of these kinds of patients. (I agree and it seems to me that in most of these cases, the hospital has about run out the insurance and public benefits just before the futility review) You can view his testimony if you move the clip cursor to about 6 hours 48 minutes, you will hear his testimony about this. Click on the Public Health Committee Hearing link.

I am disappointed in the very common tendency of physicians to consider the families in these cases as being merely emotional and angry--and without credibility.

I guess the blogger writing the above comments, hasn't yet listened to the testimony of the wife of Jimmy Givens. He was a conscious man, from whom the doctors intended to withdraw life support. As a result of the intervention of an attorney, Brian Potts, he was moved to a nursing home where he had an additional week to say goodbye to his family. He died surrounded by his family, holding his wife's hand and telling her that he loved her. Had he not been given the additional time to find a transfer, he would have been subjected to a doctor coming into his room to turn off his pacemaker against his will. Can you imagine the terror and anger that death under such circumstances would have caused? Further, another cardiologist looked at the chart and has expressed that there are other questions about the case that should be answered before a rush to judgment about the inevitability of the outcome of Mr. Givens' death.

Going back to my case involving the Kalilah, the hospital told us that she would never wean off the respirator. They were wrong. She has been off the respirator for over 2 weeks as I write this.

I have to say, that before I became involved in these cases, I was disgusted and disillusioned by the profession of law because of the excesses by some lawyers. Participation in the Texas Advance Directives Coalition and these cases has changed my mind.

If it weren't for lawyers, we might have doctors deciding what rights we have and what due process should look like. Given that doctors seem incapable of comprehending what a conflict of interest is, that is a scary thought.