Different River

”You can never step in the same river twice.” –Heraclitus

Here’s another “pull-the-tube” case:

Family Wins Another Round In Court To Keep Man Alive

HOUSTON – The family of Spiro Nikolouzos won another legal round in court Tuesday in its fight with a Houston hospital to keep him alive, Local 2 reported.

Late Tuesday afternoon, the 14th Court of Appeals issued an injunction for St. Luke’s Episcopal Hospital to not touch the 68-year-old’s life support. The decision came after an appeals court earlier in the day dissolved an emergency injunction issued Saturday because the appeals court has a specific way it assigns cases to one of two courts.
…
The patient’s family has cited opinions from medical experts not associated with St. Luke’s, who say his condition does not meet the criteria for brain dead.

The family has been involved in a court battle with St. Luke’s Hospital since March 1, when doctors notified it that life-sustaining care of the husband and father would be halted in 10 days after they determined he was brain dead.
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A state law passed in 1999 gives hospitals the authority to remove patients from life support, but requires they give the family 10 days notice to find another facility.

Nikolouzos has been an invalid since 2001, when he experienced bleeding related to a shunt in his brain.

Jannette Nikolouzos had cared for her husband at their Friendswood home, feeding him through a tube in his stomach. On Feb. 10, the area around the tube started bleeding, and Jannette Nikolouzos rushed her husband to St. Luke’s for emergency care. He was then placed on a ventilator.

Why does the hospital want to pull the plug on this conscious, non-terminal patient? They are afraid Medicare will stop paying his bills.

At least, that the reason the are willing to say in public! (If that’s the reason they tell the public, could the real reason be any worse?)

A patient’s inability to pay for medical care combined with a prognosis that renders further care futile are two reasons a hospital might suggest cutting off life support, the chief medical officer at St. Luke’s Episcopal Hospital said Monday.

Dr. David Pate’s comments came as the family of Spiro Nikolouzos fights to keep St. Luke’s from turning off the ventilator and artificial feedings keeping the 68-year-old grandfather alive.

The case was finally resolved, not when a court said to keep him alive, but when the family found a facility in San Antonio to take him. (That’s about 200 miles from home.) (Hat tip: HealthLawProf.)

One of the doctors at St. Luke’s spoke to the press, and proved he can’t speak coherently:

“This has never been an issue about St. Luke’s or anyone that works at St. Luke’s wanting to take this man off life support,” said Dr. David Pate, St. Luke’s. “It’s been about what’s best for him and should we be forced to continue providing care to someone that we think is futile and we think may be hurting them and ultimately, will make no impact on the quality of life.”

So: St. Luke’s wanted to take him off life support, but his family disagreed. But it wasn’t about “anyone that works at St. Luke’s wanting to take this man off life support”? No, it was about “what’s best for him,” which, in the doctor’s view is that he should die.

The state law in question is available here.
As I read it (disclaimer: I’m not a lawyer), the law allows a hospital to withhold life-sustaining treatment even if the patient is fully conscious and requests it. And “life-sustaining treatment” is defined by that law to include “artificial nutrition and hydration.”

§ 166.046
(e) If the patient or the person responsible for the health care decisions of the patient is requesting life-sustaining treatment that the attending physician has decided and the review process has affirmed is inappropriate treatment, the patient shall be given available life-sustaining treatment pending transfer under Subsection (d). The patient is responsible for any costs incurred in transferring the patient to another facility. The physician and the health care facility are not obligated to provide life-sustaining treatment after the 10th day after the written decision required under Subsection (b) is provided to the patient or the person responsible for the health care decisions of the patient unless ordered to do so under Subsection (g).

Furthermore, if the patient manages to survive anyway, but gets sick again and ends up in the same hospital within 6 months, they don’t have to revisit the deicision.

(e-1) If during a previous admission to a facility a patient’s attending physician and the review process under Subsection (b) have determined that life-sustaining treatment is inappropriate, and the patient is readmitted to the same facility within six months from the date of the decision reached during the
review process conducted upon the previous admission, Subsections (b) through (e) need not be followed if the patient’s attending physician and a consulting physician who is a member of the ethics or medical committee of the facility document on the patient’s readmission that the patient’s condition either has not improved or has deteriorated since the review process was conducted.

Furthermore, the law specifically exempts medical staff from civil and criminal liability arising from failing to provide life-sustaining care if they think it’s “inappropriate.” No grounds are given for determining what’s “inappropriate,” so if they think it’s inappropriate to give health care to short people, or fat people, or people from Bulgaria, there’s no basis for such a person to avoid having the tubes pulled if he or she can’t find another hospital within 10 days.

I’m sure I’ll have more to say on this later. In the meantime, this law has a very strange history behind it.

Matt Drudge is reporting that Peter Jennings has told his co-workers he has lung cancer.

I’m not at all a fan of Peter Jennings, but let’s wish him a speedy recovery. (After which we wish he would come to his senses. )

Suppose your not-so-good neighbor — who once before stabbed you and left you in the hospital for two days — is standing in your apartment doorway (again) with a knife (again), and shouting “I will kill you” (again). Do you have a right to defend yourself?

New York’s highest court says “No.” Why? According to them, the right to defend yourself applies only in your home, and your apartment doorway is “a hybrid private-public space in which a person doesn’t have the same reasonable expectation of seclusion as in a home.a hybrid private-public space in which a person doesn’t have the same reasonable expectation of seclusion as in a home.”

In other words, even if you you are in your home, as long as the attacker stays inches ouside, you can’t legally do anything to protect yourself. Thus, New York’s highest course has unanimously upheld the conviction of the victim, who hit his attacker with a lead pipe, killing him. The court said the victim has a “duty to retreat” even though he is already in his own home.

Clayton Cramer has extensive details and analysis.

Moral of the story: If you live in New York, feel free to stab your neighbors whenever they are standing in, or walking through, their doorways. The courts will protect you from anything they might do in self-defense.