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

- Rogue Medic

The Living Will and Senate Testimony From Terry Read

Terry Read sent me an email with a scan of his father’s living will and a link to the Texas Senate Hearings (the link is also in the comments to Terry Read Comments on the Death of His Father and the Living Will).

Rogue Medic,

I say that I know what happened based on the fact that I was there and went through it.

My point is that this is a very emotional experience. People regularly make mistakes in describing events. For example, in the testimony given by you and by your mother, you contradict each other. Does that mean that one of you is telling lies?

No. It means that our observations depend on many different things, as do our memories.

You are basing your comments on your speculations. So anything that I say certainly has more weight than what you say.

Yet, I can show that your statements are inconsistent, even though I was not there.

Eyewitness testimony is unreliable.

As far as the San Antonio Fire Department not initially cooperating, why do you think this has been going on for so long?

Please provide some evidence to support your conclusion.

You claim that this took a long time. Compared to what?

You claim that the SAFD did not cooperate with someone. Whom did they not cooperate with and what evidence do you have that they did not cooperate?

The investigation took a long time because the Fire Department was not answering the DSHS investigator.

Do you have any documentation to support that claim?

Have you read HB 577. It says “
SECTION 1. Section 166.102(b), Health and Safety Code, is
amended to read as follows:
(b) When responding to a call for assistance, emergency
medical services personnel:
(1) shall honor only a properly executed or issued
out-of-hospital DNR order or prescribed DNR identification device
in accordance with this subchapter; and
(2) have no duty to review, examine, interpret, or
honor a person’s other written directive, including a written
directive in the form prescribed by Section 166.033.”

So Rogue Medic, treatment by the paramedics may still be terminated, but not by not by the Living Will.

That is not true.

EMS may still contact medical command, as they did in the case of your father, and follow medical command orders. Even the person reading the bill in the video states that specifically.

Resuscitators’ efforts can still be stopped if the patient’s personal physician is present and approves it. If the physician is not present, the medical director of EMS can make the decision.[1]

HB 577 does not state that EMS may not honor a living will.

It is offensive that you would prevent people with living wills from having their wishes followed just because of one unusual, but personal, case.

The State EMS Director admitted the person on the other end of the phone may not be a doctor during the House Committee hearing in which I testified.

An out of context description of a comment is useless. What did the person say? What did the person mean? What was the context?

If a movie reviewer describes a movie as “A tremendous waste of time.” Advertisements for the movie could quote the reviewer as calling the movie “Tremendous.”

That would be tremendously out of context and not at all helpful. You misinterpret HB 577, but you expect me to accept your interpretation of something else? Why?

Through the Open Records Act, I have requested minutes of the meeting, but have not gotten them yet. I am not sure how detailed the minutes are. But you are certainly welcome to make the same request. It was the House Public Health Committee Meeting for April 20, 2011 – for HB 577.

That would be nice.

The lead paramedics stated it would be against the law to continue when I told the paramedics not to stop treatment. Then when I tried to get to my father, the paramedics ganged up on me, wrestled me down, and threatened to have me taken away in handcuffs.

Criminal law, civil law, EMS law, company policies, something else?

Plenty of people will tell you that treating a patient in violation of a doctor’s order is practicing medicine without a licence. I disagree with that interpretation of violation of a doctor’s orders, but that may have been what the paramedic meant, assuming the paramedic actually made that statement.

As far as the Living Will, I can ask WOAI to post. But in the meantime, what would you like me to do, scan it and shoot it to you? Would you like me to photocopy it and mail it to you? If you provide a mailing address, I will do that. Would you like to meet in person and have me show it to you personally? If you do, I am sure we can arrange a meeting.

Below is the living will.


This is a scan of Samuel Read’s living will sent to me by Terry Read. I have edited it to remove the Social Security Number and to convert it to JPEG format. Click on the image to make it larger.

But I am a little curious. Will any of this satisfy you? Also, if you watch the story, what do you think that I was showing to Mireyea Villarreal? I was going over the Living Will with her.

How would I know what you were showing her?

Why would I jump to any conclusions about what you were showing her?

If they had the document, competent journalists should have provided at the very least the wording of the document, but that was not done. In the absence of evidence, the most reasonable conclusion is that the document does not support your claims.

You seem to think I have been hiding something when I have not.

I have only been asking for evidence to support your claims and making the most reasonable conclusions about the evidence available.

As far as a patient not wanting resuscitation, they still have the option of a DNR.

The rules affecting advance directives need to be dramatically rewritten.

What you mean to state is that they still have the option of an Out-Of-Hospital DNR.

If they have a standard DNR, which is not an Out-Of-Hospital DNR, the rules are the same as for a living will.

This is abusive and unfair to patients.

You are supporting abuse of patients with wishes different from your father’s.

The link below will take you to the 82nd Legislatures Senate Committee on Health and Human Services Sessions. Our Testimony is on the May 17, 2011 session. HB 577 is the second bill being testified on. My mother and I begin testimony at about the 7:40 mark.

http://www.senate.state.tx.us/75r/senate/commit/c610/c610.htm

You can hear my mother and myself both testify that the Living Will called for examination by two physicians, and my mother had power of attorney. None of those things happened. This is what we testified to before a Senate Committee. Do you think both my mother and I committed perjury?

You and your mother gave different descriptions of the events of that day. Not just slightly different, but contradictory. Does that mean that either, or both, of you committed perjury?

You still do not understand how unreliable eyewitness testimony is. You and your mother were eyewitnesses to the same event and provide descriptions that do not agree.

Do you think that a copy of the Living Will was not supplied to Representative McClendon’s office in their investigation?

Should I assume that Rep. Ruth McClendon has any understanding of advance directives?

Absolutely not. Look at the wording of this bill. This is written so that lawyers will be involved. As I stated before, in Representative Ruth McClendon Trying to Eliminate Patient Rights in Texas,

Also, do you think that the Living Will was not provided to the Department of State Health Services in their investigation?

Did the Department of State Health Services find any fault with SAFD?

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.[2]

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

If my mother and I both committed perjury on what was in the Living Will, all of these parties would know it.

Why do you assume that anything that is not perjury is the truth?

You can make the statement that you have not perjured yourself, but that does not mean that what you stated is the truth, the whole truth, and nothing but the truth.

Truth and falsehood are not clear black and white issues. Otherwise, you and/or your mother have perjured yourselves by giving different testimony.

Since all of these parties did not come to the same conclusion, there must be more to this than you understand, which is what I have been stating from the beginning.

For example, let’s compare the testimony given by your mother, where you were not handcuffed and your testimony, where you were handcuffed.

They then threatened to handcuff him and take him away and stated that that would not bother him at all.[1]

and I tried to get to my father to continue treatment myself. They wrestled me down and had me taken away in handcuffs, so I had to give up at that point.[1]

Whom should I believe? Is this perjury? Did you just make a mistake?

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

Also, note that the State EMS Director was not at the Senate Committee Meeting after having gotten questioned at the House Committee meeting.

OK, but what does that mean? Does it mean anything? Does it signify anything other than the person having limited time and many responsibilities?

One more thing, I am almost 49 years old and have a 4 year old son that my wife and I prayed many years for. And like you, I have other interest as well. Do you think I would have devoted the tremendous amount of time, energy, and emotion to this effort, as I am still doing, if I did not know that the wrong thing had really happened? I have gained nothing from this financially. The only thing I have gained is recognition that the wrong thing happened. And even now, I am still dealing with people like yourself.

Terry Read

I repeat that you are very emotionally involved in what happened and that has affected your actions. I do not know what a daughter, prayer, or time have to do with this. People do plenty of things voluntarily, but that does not mean that they are right. You are comparing things that are completely unrelated.

If the paramedic contributed more of his energy, more of his free time, and spent more of his money contradicting you, would that make him more reliable than you? He was there. What if he has half a dozen children? Would that affect what is true?

On political issues, people on differing sides contribute a tremendous amount of time, energy, and emotion to this effort, but that does not mean that both sides are right, or that one side is right and the other side is wrong.

You ask me to read your mind. Mind reading is what scam artists do. I look at evidence.

Time, energy, and emotion do not determine the truth.

Your justifications only discourages trust in your judgment.

Is it true that EMS personnel are not capable of interpreting a simple document?

Or is it that the lawyers write unnecessarily complicated documents to discourage others from interpreting these documents.

What if we educated EMS personnel (and nurses and doctors) about the application of advanced directives and simplified them. For example, my suggestion for a living will clearly state at the top of the page what minimum requirements need to be satisfied (based on those from Samuel Read’s living will). This is just one possible way of improving the communication of the patient’s wishes.

All of this could have been prevented by requiring that these documents be written much more clearly, not by arbitrarily assuming that more treatment is better.


Click on the image to make it larger.

If EMS is incapable of interpreting well written advance directives, then EMS clearly cannot provide complicated treatments to any patients. The most complicated EMS treatment algorithms are used for treating cardiac arrest.

Should we only provide treatment that is simple and easy?

Would patients be better off with less treatment, so that we don’t have to think? Mr. Read, in his testimony, states that more treatment is better.

That is not true. What we need is more appropriately applied treatment.

Defending the incompetence of the legislature in writing rules for advance directives is not good for patients.

We need to stop lowering our standards to accommodate those who least understand.

Footnotes:

[1] Video of May 17, 2011 testimony
Texas Senate
Page with link to video in Real Media format

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

.

Comments

  1. Paragraph #3 of the Living Will told me all I need to know about this whole situation. A grown man determined that it was his intent for his family to honor his wishes to withhold life-sustaining treatment. This grown man’s son decided that his father could not make decisions for himself, and decided to usurp the wishes of his father, and the order of the on-line physician medical control.

    The rest of the son’s rant only serves to support the position that he didn’t care what his father wanted, and doesn’t want to hear intelligent rebutals to his insolent arguments.

    • CCC,

      Paragraph #3 of the Living Will told me all I need to know about this whole situation. A grown man determined that it was his intent for his family to honor his wishes to withhold life-sustaining treatment. This grown man’s son decided that his father could not make decisions for himself, and decided to usurp the wishes of his father, and the order of the on-line physician medical control.

      I disagree. This part is the part that should be a prerequisite for anything else.

      “If at the time I shall have an incurable injury, disease or illness certified to be a terminal condition by two physicians who have personally examined me . . . .”

      The problem is that the way the living will is written, it is easy to miss that. This is why I think that the best solution, for those who want patients’ wishes to be respected, is to demand that all advance directives be written more clearly – not to try to prohibit EMS, or doctors, from interpreting them.

      The rest of the son’s rant only serves to support the position that he didn’t care what his father wanted, and doesn’t want to hear intelligent rebutals to his insolent arguments.

      I think that he was correct in his interpretation of what his father wanted. It is the fault of the state legislatures that these documents are written in ways that we can read the same document and come to different conclusions.

      We need to demand that the lawyers stop complicating things.

      We need to put the wishes of the patients first, not come up with different forms of advance directive.

      Clear documents that a 5 year old could interpret – of course, then we will have to have 5 year olds on the ambulances. 😉

      .

      • Well, you are right. We certainly came to different conclusions, even after we read the same document.

        In my state, this document wouldn’t hold any water. A situation like this here would involve me on the phone with a physician, (like this medic) with the decision made there. Later, a written order would have been obtained from my physician.

        Is Terry Read asserting that the medics contributed to his father’s death? From what I can understand, he was dead (albeit not declared dead) once they arrived.

        There are plenty of 5-year olds in ambulances here.

  2. Rogue Medic,

    As far as the one contradiction you point to about being taken away in handcuffs, I noticed that myself when watching the video. Keep in mind that I had three minutes to get through my testimony and they had a clock right in front of me. They actually did cut off the person who spoke before us (an MD, no less). So I was rushing to get through my testimony and misspoke on that particular sentence (just like you made a mistake in referring to my son as “a daughter”). But if you watch the video, you will see that I clarified that myself later on and stated that they threatened to have me taken away in handcuffs (right at the 14:00 mark), which is consistent with all of my other postings, and my mother’s testimony.
    The SAFD did not initially cooperate with Patrick Campbell, who works for DSHS and was doing the fact gathering. You may contact him, but I am not sure what information he may give out. He is a very nice person. But he does work for DSHS. And remember, while someone in his position might verbally say that one party is not cooperating, they are not going to say that in writing. However, I will send to you a scanned image of a letter Patrick Campbell sent to my mother in April, 2009 stating that I had contacted DSHS in March 2009. I am also sending scanned copies of letters my mother sent to DSHS in August and September 2009 wondering what the status of the investigation was. And I am sending a scanned copy of the outcome of the DSHS investigation dated November, 2009. So the investigation took eight months. And it is not because we (my mother and myself) were holding any information back. You are welcome to request records yourself through the open records act and see what you can get.
    As far as what I was showing Mireya Villarreal, if you watch the video, you can see that it is my father’s living will. They do not focus on it long enough to read it, but you can tell what it is. It is a mute point anyway because I sent the scanned image to you directly.
    I will also forward to you the thread where I made a request of the House Committee meeting minutes. The second one came back “undeliverable”. So I cannot say what the problem is, or why I have not gotten my request honored. But as I stated, you can make the same request.
    As far as your scenario of the paramedic who was there contradicting me, he would have the motivation of protecting himself. I do not have any motivation at all for fabricating a story. I certainly do not have anything against paramedics. As a member of the 502d Civil Engineer Squadron at Fort Sam Houston, I work right alongside the Fire Department. The Fire Inspectors literally work just on the other side of my cubicle. The Fire Chief Office is just a few steps from my cubicle. As I have stated, the only thing I have gained from this personally is getting the truth out.
    As far as additional training rather than a law, that probably would have been the outcome had the DSHS acknowledged that the wrong thing happened. But they would not acknowledge it. That is why I kept pushing the matter. As a matter of fact, it never would have gotten to DSHS had the city of San Antonio acknowledged me. If they had just said, “We are sorry for the loss of your father. We will look at our procedures.”, that would have been enough for me at that time. But the city manager and mayor both just completely ignored me. So if you do not like the law, blame DSHS and the city of San Antonio.
    CCC – Like the paramedics on the scene, you missed paragraph two. Even Rogue Medic acknowledges that. That is why you cannot be trusted with Living Wills.

    Terry Read

  3. I agree with you 100% that the forms need less lawyer speak and to be simplified. In NY, we do not honor living wills, DNIs, etc. prehospital. EMS is only approved to honor out of hospital DNRs and a new form called “Medical Orders for Life Sustaining Treatment (MOLST). We still can contact medical control for discretion in withholding treatments based on the other forms. The MOLST form is simple, to the point, and allows the patient to dictate exactly what treatment is received. This seems like something that should be adopted by other states to simplify the whole process and avoid situations like the Reads faced since the law dictates we must honor it.
    http://www.health.ny.gov/professionals/patients/patient_rights/molst/

  4. Rogue Medic and others,

    Here is the link I found to our House testimony. Representative McClendon introduces HB 577 at 1:13:50. The questioning of the State EMS Director starts at 1:30:10. You can check it out for yourselves.
    http://www.house.state.tx.us/video-audio/committee-broadcasts/committee-archives/player/?session=82&committee=410&ram=11042008410

  5. Hey there just wanted to give you a quick heads up.

    The text in your content seem to be running off the screen in Safari.

    I’m not sure if this is a format issue or something to do with browser compatibility
    but I thought I’d post to let you know. The style and design look
    great though! Hope you get the issue solved soon.
    Kudos

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