In April 1999, while Elizabeth and Carole were out of town, Elizabeth exhibited symptoms of “hemoptysis and hypoxemia.” She was admitted to Santa Rosa Memorial Hospital overnight in order to stabilize her condition.

On May 29, 1999, Elizabeth lost about two or three cups of blood, via either a nosebleed or vomiting, and was again admitted to Alta Bates. She was seen by Dr. Harish Murthy. With Carole’s concurrence, Elizabeth was given only conservative treatment, including saline hydration and a blood transfusion. A chest x-ray revealed that Elizabeth’s aortic aneurysm “look[ed] somewhat more prominent” than it had in February 1999. Dr. Murthy’s notes indicate that “As per the discussion with [Carole], I will make the patient DNR at this point.” "DNR” is a medical abbreviation for “do not resuscitate.” By June 3, 1999, Elizabeth’s condition had stabilized sufficiently for her to be discharged from Alta Bates. Dr. Kwan requested an evaluation of Elizabeth’s ability to transfer in and out of her wheelchair, and the physical therapist found that Elizabeth required maximum assistance with such transfers, which Carole could not demonstrate that she had the ability to provide. Linda Bradford, a social worker at Alta Bates, recorded in her notes on June 3, 1999, that Carole could not take Elizabeth back to their home in El Cerrito, because the house was not wheelchair accessible, and that Carole had been looking but had “not been able to find a place to take her mother.”

Bradford concluded that the safest placement for Elizabeth was a skilled nursing facility, Shields-Richmond Nursing Center; Bradford’s notes indicate that she discussed the transfer to Shields-Richmond with both Elizabeth and Carole, and that “[t]hey are accepting of plan, [but] hope it will be short term.” Pending a final discharge plan, Elizabeth was kept at Alta Bates for one more night.

During the morning of June 4, 1999, Elizabeth was accepted for placement by Shields-Richmond. Just prior to Elizabeth’s discharge from Alta Bates, respondent assumed Elizabeth’s care for a few hours and was asked to authorize her transfer from Alta Bates to Shields-Richmond. Respondent reviewed Elizabeth’s chart, evaluated her, and spoke with Dr. Kwan, Bradford, and Elizabeth. Respondent believed that Elizabeth was competent to make medical decisions, and that Elizabeth understood she was going to be transferred to a skilled nursing facility. Because Elizabeth did not voice any objection to the plan to transfer her to a skilled nursing facility, respondent understood her to have impliedly consented to the transfer to Shields-Richmond. Respondent believed that the placement at Shields-Richmond was appropriate, and was unaware that Carole had any objection to the transfer plan. Respondent prepared a discharge summary and orders for the transfer of Elizabeth to Shields-Richmond, and noted Elizabeth’s DNR status and her condition on both documents. Respondent was not involved in Elizabeth’s care at any time after her discharge to Shields-Richmond on June 4, 1999.

On June 7, 1999, while at Shields-Richmond, Elizabeth again began bleeding from her nose. The night nurse could not find her pulse. The paramedics were called, and despite Carole’s protests and the DNR notations on Elizabeth’s record, they insisted on administering CPR. Elizabeth died shortly thereafter.

Last Updates

Please provide corrections as needed....
Jim Radja
Vienna, Virginia, US of A

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