Denial of Admission Due to Risk of Legal Ramifications
The family of a woman previously living independently in an assisted living center, applied to admit her to a skilled nursing facility after she had a stroke. Following the stroke, the woman had problems swallowing, and the family refused placement of a G-tube. The hospital orders stated that the woman be fed puree meals with thickener. However, further recommendation was that she not be given anything by mouth and be maintained as “NPO.” The nurse’s notes from the hospital documented that she had difficulty swallowing applesauce. Her family wants her to be fed by staff and want her designated as a “do not resuscitate” and “do not intubate.” When she aspirates, the family’s plan is to have her transferred to the hospital. After that, they want to make her a “do not hospitalize.” The family does not wish to prolong her life, but at the same time want her to be made comfortable with placement in facility that can provide personal care other than nutritional sustenance. She is unable to get out of bed and will require intensive therapy to improve. There is concern about the risks involved. The facility’s attorney advised that even a signed waiver by the family will not protect the facility from potential liability. The state of Massachusetts where the facility is located does not permit assisted suicide, and a jury might view the plan by the family in that way. The facility decided to deny the woman admission due to the risks involved, e.g., choking on food or fluids given by mouth when she is designated NPO. The facility reviewed its policies and procedures in light of this situation to ensure the avoidance of potential risk when a family requests care for their family member that is against medical advice. Staff were educated regarding the content of related policies and procedures and potentially similar events.
