Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Representative Ruth McClendon Trying to Eliminate Patient Rights in Texas

But that answer wasn’t enough for Terry Read. He wanted to do more. And for the last two years he’s been working with State Representative Ruth McClendon to keep this from happening to anyone else.[1]

And what is that horrible thing that happened to Terry Read?

His father died. I can relate to that. My father died.

Terry Reid’s father, Samuel, had a living will. Apparently, Samuel Read’s living will stated that he did not want CPR.

My father also did not want CPR.

When my father collapsed, we honored his wishes.

When Samuel Read collapsed, Terry Read wanted him to stay alive, even though Samuel Read appears to have clearly expressed his wishes in writing. We want our parents to stay alive, but that does not give us the right to force medical treatment on them. Especially not when they have documented their wishes in front of witnesses who have determined that they have the capacity and the information to make this decision.

We are not gods. We cannot keep people alive forever. If we try to keep people alive forever, it is called torture.

Most of the relevant information is not included in the story. Because of HIPAA? No. Terry Read should have the authority to release any information he wants.

Most likely, the problem with the information is that Terry Read is not releasing it, because it does not support his story. He claims that the living will was violated, but where is the violation?

Let’s start with the errors in the story.

The Read family spoke with News 4 WOAI Trouble Shooter Mireya Villarreal and says EMS crews didn’t read the will correctly and made a big mistake.[1]

No.

That is not true.

If you disagree, provide some evidence that anything SAFD EMS (San Antonio Fire Department Emergency Medical Services) did was contrary to the wishes of Samuel Read.

Chief Grenato says paramedics on scene reviewed Sam Read’s living will with a medical expert over the phone; then decided to stop treatment. The state has reviewed this case and cleared the department of any wrong doing.[1]

The name of the Chief is Chief Granato, not Grenato.

I spoke with Melissa Sparks, Spokesperson for SAFD (San Antonio Fire Department). She confirmed the spelling of Chief Granato’s name. She also provided some other information that was not in the story.

then decided to stop treatment.

The paramedic did not decide to stop treatment. One of the medical directors for SAFD was contacted by phone. The relevant parts of the living will were read to the medical director. What is relevant is decided by the medical director, not the paramedic.

The medical director decided that stopping CPR was what the patient wanted and had clearly expressed in his living will.

 

This is the ethical thing to do.

 

To continue to treat a patient – against the wishes of the patient – is abuse.

 

It is not the job of EMS to abuse patients.

 

My condolences go out to Terry Read and the rest of his family, but Terry Read’s grief does not authorize him to deprive patients of their right to make decisions for themselves. Not even his father.

The state has reviewed this case and cleared the department of any wrong doing.

That is the Texas Department of State Health Services. In other words, there was no big mistake.

If anything, SAFD EMS deserves commendation. Could they have handled this more gently? Maybe. Maybe not. This is 2 1/2 years later, but Terry Read is still not responding to reason. Imagine how much less reasonable Terry Read was when he was faced with his father’s death?

Dealing with a cardiac arrest, regardless of whether we continue treating the patient, is a time of great stress for the family.

After pronouncement can be a great time for EMS to call a trusted neighbor, a pastor/rabbi/imam/priest, other family members, or whomever the family feel most comfortable with at the time of the death of a loved one.

What about State Representative Ruth McClendon?

She appears to be clueless about the EMS regulations and assumes that those of us in EMS are just as clueless.

“EMS personnel do not have the responsibility or the training or the knowledge to interpret legal documents,” Representative McClendon told us.[1]

We cannot understand the patient’s wishes, but we can perform miracles and bring terminally ill people back to full health?

Of course, Representative McClendon is completely misrepresenting what happened. EMS did not interpret the living will, the medical director did. Living wills are written for doctors, and other medical personnel, to interpret. Living wills are about the kind of care a patient wants. Living wills are not about arcane legal minutia.

“Emergency responders, paramedics, are not in the business of interpreting living wills. They’re in the business of doing what they’re trained to do, which is to administer emergency medical treatment,” Terry Read explained.[1]

They contacted medical command for permission to stop CPR and only stopped CPR after receiving orders from medical command.

Why is that so hard for Terry Read and Representative McClendon to understand?

She (Representative McClendon) sponsored House Bill 577, which was passed during this legislative session. It makes it very clear, a first responders’ first priority is to treat a patient.[1]

The only change is the strong suggestion that we should refuse to respect the wishes of the patient, just to put on a show for families who do not respect the wishes of their family members.

SAFD EMS did treat Samuel Read first, then the paramedic contacted medical command and then followed medical command orders.

C.S.H.B. 577 contains a provision not included in the original requiring the emergency medical services system’s medical director or online physician, if a person’s personal physician is not present or does not assume responsibility for the care of the person while the person is receiving emergency prehospital care, to be responsible for directing the emergency medical services personnel who are providing emergency prehospital care to the person and authorizing the director or online physician, under such circumstances, to order the termination of cardiopulmonary resuscitation only under specified conditions.[2]

That is exactly what happened. Everything SAFD EMS did for Samuel Read was in compliance with the new law.

This law is a feel good law, but it may persuade people to abuse patients, rather than treat patients with respect.

This should be titled the Encouraging Abuse of Terminal Patients Bill.

Representative McClendon should be ashamed of her actions. So should everyone else who voted for this.

Patient care is about the patient.

The patient is Samuel Read.

Samuel Read did not want to be resuscitated.

Also read the writings of Medic Madness and The Social Medic on this –

Since when is it not our responsibility?

Are We Encouraging The Abuse Of Terminally Ill Patients And Their Families?

Footnotes:

[1] EMS workers stop medical treatment after reading will in the field
Mireya Villarreal
July 27, 2011
WOAI
Article

[2] House Committee Report Analysis of Bill
HB 577
Authored by Representative McClendon
House Analysis of Bill and a lot of other documents related to this bill at the Texas Legislature information page

.

Comments

  1. I’ve always understood that, except when the patient cannot make decisions for him/her self, giving treatment against the patient’s will is assault. Whilst Mr Read Snr was in no position to make a decision there and then, he’d obviously made the decision at some previous time.

    Provided he was in sound mind when he signed the DNR, Mr Read’s decision should be respected by everyone – even his (probably distraught) son.

    Whilst this will often be upsetting to the family, a patient’s decision must be respected. However, wouldn’t it be better for everyone if patients had discussed this with their family beforehand?

    • Mark Whitehead,

      I’ve always understood that, except when the patient cannot make decisions for him/her self, giving treatment against the patient’s will is assault. Whilst Mr Read Snr was in no position to make a decision there and then, he’d obviously made the decision at some previous time.

      Exactly.

      Provided he was in sound mind when he signed the DNR, Mr Read’s decision should be respected by everyone – even his (probably distraught) son.

      It was not a DNR, but a living will that they were presented with. They initiated CPR, while a medic consulted with a medical director about the appropriate way to handle this.

      Whilst this will often be upsetting to the family, a patient’s decision must be respected. However, wouldn’t it be better for everyone if patients had discussed this with their family beforehand?

      Since, according to the story, the family presented the medic with the living will, it is reasonable to conclude that the patient had told the family about the living will. They may not have understood what Samuel Read wanted, even if he did explain the details to them. And it might be just Terry Read who has a problem with this. The rest of the family may be just keeping silent to keep the peace at home.

      .

  2. You left out a very important part of the story.

    “Since paramedics wouldn’t continue, Terry tried to save his father.

    “I was going to go back to do resuscitation and they actually grabbed a hold of me and physically, all six of them, physically restrained me from getting to my father,” he said.”

    If true, I don’t see where the paramedics had any right whatsoever to lay a hand on Mr. Read.

    In other words, once again we brought a lot of this problem on ourselves by our ignorance.

    • They were protecting their patient’s best interest. They had every right to stop him. It’s no different than a family member walking up during a full arrest and insisting that they administer a medication, do CPR, etc. The crews were protecting their patient.

      • That’s about the most absurd thing I’ve ever heard.

        • Tom,

          That’s about the most absurd thing I’ve ever heard.

          You may disagree with the wording, but we are stopping CPR because we are respecting the patient’s wishes. Where do we draw the line between talking to the family member and gently putting a hand on a shoulder, and something more. We have been on the scenes and seen people make a bad situation worse by using the wrong word, or the wrong tone, or just looking at a family member the wrong way. Sometimes we escalate things, rather than back off. I don’t know what happened, but I do not believe that all 6 of them dragged Terry Read off of his father.

          Where do we draw the line between consoling the family and respecting the wishes of the patient?

          Once we draw that line, we have to realize that if the family member does not behave as we would have preferred, the line has now been moved. This is a complex and unpredictable situation. This is definitely not easy to describe in a couple of sentences.

          If the medic was between Terry Read and Samuel Read, when CPR was stopped and Terry Read decided to push the people who had been providing CPR out of the way, and threaten them (which does not seem any less probable than the story from Terry Read), would it have been inappropriate to restrain him just to prevent him from hitting them? If that were the case, would that have been perceived accurately by Terry Read?

          We have responsibilities to both the patient and the family. We generally do not have good training preparing for the ways that things change due to a little miscommunication, or the refusal of someone to be reasonable.

          I think that all of us would attempt to stop Terry Read from performing CPR on Samuel Read. The alternative suggests a callous attitude of, I’m just washing my hands of this and leaving.
          I know that is not what you are suggesting. But, how much differently would you and Sean behave in the same situation with a real patient? Maybe you would behave exactly the same way. Maybe the behavior of the medics dealing with Terry Read was exactly what we would want to see from any EMS personnel, but we are just getting what Terry Read thinks he remembers. Stress messes with our memories, especially when we wish things were different. If we listen to all of the stories of war heroes and then find out that some of them only survived because they ran away, then tried to use lie detectors to tell which ones were the true heroes and which ones ran, would we be able to tell the difference? I don’t think so.

          Is Terry Read telling the truth? I don’t know, but I suspect that he remembers things the way he tells it. That does not mean that his memories are accurate. Is it false memory created to protect his beliefs? Is it a Rashomon effect? Is it something else? I don’t know.

          I do know that the only one who can be demonstrated to have provided inaccurate information is Terry Read.

          Or, Terry Read can produce the living will and show where it does not state that Samuel Read does not want CPR.

          .

      • Sean,

        They were protecting their patient’s best interest. They had every right to stop him. It’s no different than a family member walking up during a full arrest and insisting that they administer a medication, do CPR, etc. The crews were protecting their patient.

        As I described to Tom, I do not believe that this article is accurate in describing what happened.

        Where do we differentiate between restraining a family member, consoling a family member, and offering words of condolence?

        Would I have put a hand on Terry Read’s shoulder and tried to get him to realize that this is what his father wanted?

        Yes.

        Would that have been described by Terry Read as, all six of them, physically restrained me from getting to my father,” he said.”?

        Maybe.

        We don’t know. We were not there. We only have Terry Read’s description of events.

        .

    • Tom,

      You left out a very important part of the story.

      Remember that this is a story, presented from the point of view of someone who did not want to allow his father to die peacefully. He is still claiming that his father should have been treated against his father’s wishes 2 1/2 years later. How rational was he on scene on that day? How accurate are his memories? How much are his memories colored by what he saw as strangers killing his father?

      “Since paramedics wouldn’t continue, Terry tried to save his father.

      “I was going to go back to do resuscitation and they actually grabbed a hold of me and physically, all six of them, physically restrained me from getting to my father,” he said.”

      If true, I don’t see where the paramedics had any right whatsoever to lay a hand on Mr. Read.

      Is there any reason to believe that this is true?

      I don’t think so.

      In other words, once again we brought a lot of this problem on ourselves by our ignorance.

      I think that they were dealing with a distraught person, who was behaving irrationally and upsetting the rest of the family. Until I see some evidence to the contrary, I don’t know of any reason to believe what Terry Read claims happened. He also claims that the medics misinterpreted the living will. I do not believe that, either.

      Who has a history of misrepresenting what happened on that day?

      EMS?

      No.

      Terry Read?

      Yes.

      The only way we are bringing this on ourselves is by suggesting that there is something reliable in the story presented by Terry Read. I understand that he is grieving, but that does not mean that he is correct.

      From all of your experience in dealing with patients, and family members, on the worst days of their lives, what impression do you get of their ability to accurately describe details, or even general events of the day?

      .

      • Like I said, Tim…. “If true….”

        I agree with most of what you’ve written above but I have also seen (and heard of) a lot of unprofessional behavior on the part of EMTs and paramedics in the course of my career and I’m sure you have, too. Flushing fetuses down the toilet after a miscarriage comes to mind. Your comment that “the line moves” when a family member disagrees with EMS and starts bystander CPR again may be true but it strikes at the heart of our disagreement (if there is a disagreement).

        Let’s not allow the fact that we’re uncomfortable with something confuse us into believing that it’s our duty to make a citizen conform to eliminate our cognitive dissonance (and then cloak it terms of patient advocacy so we don’t have to do any soul searching).

        The very fact that Mr. Read was grieving over the death of his father gives him a certain amount of moral authority over his father’s body and as long as his actions weren’t dangerous then Mr. Read should not have been touched in an other-than-supportive manner. In fact, EMS personnel should think long and hard about restraining anyone who possesses present mental capacity and does not wish to be restrained. It’s not our job. The fact that it’s gotten this far tells me it could have been handled better.

        The article says that the department is working with the Read family to improve the way paramedics interact with families and that’s a good thing. But then, why isn’t grief counseling and conflict resolution a part of our basic education? Could it be because we get no education? Just training?

        I strongly suspect this was all preventable.

        • Tom,

          Like I said, Tim…. “If true….”

          I agree with most of what you’ve written above but I have also seen (and heard of) a lot of unprofessional behavior on the part of EMTs and paramedics in the course of my career and I’m sure you have, too. Flushing fetuses down the toilet after a miscarriage comes to mind. Your comment that “the line moves” when a family member disagrees with EMS and starts bystander CPR again may be true but it strikes at the heart of our disagreement (if there is a disagreement).

          We are obtaining all of our information from one source. That source is has demonstrated that he is not reliable.

          On the other hand, everything else about the description of the approach of EMS suggests professionalism. Which of these doesn’t belong?

          Two things. The aberrant behavior of all 6 members of SAFD dragging Terry Read off of his father and the aberrant behavior of Terry Read providing an accurate description of events?

          Or the more likely behavior of restraint on the part of SAFD and a lack of accurate recall on the part of Terry Read?

          Let’s not allow the fact that we’re uncomfortable with something confuse us into believing that it’s our duty to make a citizen conform to eliminate our cognitive dissonance (and then cloak it terms of patient advocacy so we don’t have to do any soul searching).

          I agree that dealing with death is something that we should work at, but I do not see any reason to believe that the events were consistent with the description by Terry Read.

          The very fact that Mr. Read was grieving over the death of his father gives him a certain amount of moral authority over his father’s body and as long as his actions weren’t dangerous then Mr. Read should not have been touched in an other-than-supportive manner. In fact, EMS personnel should think long and hard about restraining anyone who possesses present mental capacity and does not wish to be restrained. It’s not our job. The fact that it’s gotten this far tells me it could have been handled better.

          Why do you assume that anyone touched Terry Read?

          The article says that the department is working with the Read family to improve the way paramedics interact with families and that’s a good thing. But then, why isn’t grief counseling and conflict resolution a part of our basic education? Could it be because we get no education? Just training?

          The department is working to deal with a complaint, regardless of whether the complaint is valid. This is the response that we would expect from any department. If someone called up and stated that you wrestled with a family member, we would expect your department to release a similar statement, regardless of the merits of the claim. The same would be true if the same accusation were made about me. The statement does not add any credibility to the claim.

          I strongly suspect this was all preventable.

          I strongly suspect that this is fictional. How do we prevent false memories?

          Why do you continue to believe the complaint of the least reliable person on scene, even though we have not had any other description of events from anyone else. One very motivated person with one very subjective description. Where is the credibility? Where is our attempt to find out the truth?

          .

  3. i would highly suggest sending a copy of this to Rep. McClendon. Otherwise it’s just a blog post. (A really good one, mind you, but just that.)

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