Advance Directive: Physician, Nurses Are Faulted For Wrongfully Prolonging Life.

Advance Directive: Physician, Nurses Are Faulted For Wrongfully Prolonging Life.

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The physician had the patient intubated after deciding not to contact the granddaughter who was appointed in the patient's advance directive as her surrogate decision maker. The nurses were also at fault for not independently contacting the surrogate decision maker to be able to convey her decision to the physician before he went ahead. SUPREME COURT OF GEORGIA July 5, 2016

The eighty-nine year-old patient was admitted to the hospital with pneumonia, sepsis and acute renal failure.

Some years earlier the patient had witnessed what her husband went through when he died from pneumonia in the hospital without an advance directive. Two years before this hospitalization the patient herself signed an advance directive naming her granddaughter as her surrogate decision maker. The document itself and what she told her granddaughter made it abundantly clear the patient did not want to be intubated if it came down to that in her final time.

For this admission the granddaughter gave the hospital a copy of the advance directive along with her personal contact information, which was not placed in the front of the chart as it should have been per hospital policy. As the patient's condition deteriorated the granddaughter gave express permission for a CT scan and for two thoracentesis procedures to drain fluid from her lungs. However, each time she was asked to give her consent on the patient's behalf for these interventions the granddaughter reiterated that her grandmother did not want to be intubated.

Then at 4:00 a.m. the ICU nurses called the attending physician at home, fearing the patient was going into cardiac and respiratory arrest. When speaking with a nurse the physician said, "I'm not going to call the granddaughter at four o'clock in the morning and scare the hell out of her. I'll wait until the patient wakes up and then I'll call and let her know what happened." The physician phoned a physician at the hospital who intubated the patient. The patient passed ten days later.

The Supreme Court of Georgia ruled the granddaughter who is now the personal representative of her grandmother's probate estate can sue the hospital and the physician for wrongfully prolonging her grandmother's life. Aside from the physicians' actions, the nurses had their own legal duty to contact the granddaughter before the intubation and to call to the physician's attention the patient's advance directive along with the nursing progress notes as to what the granddaughter had had to say on the question of intubation. The lawsuit claimed damages for the patient's unnecessary and avoidable pain and suffering. Doctors v. Alicea, __ S.E. 2d __, 2016 WL 3658910 (Ga., July 5, 2016).