Texas allows doctors to sign unauthorized do not resuscitate (DNR) orders without telling you
Three things you can do to protect yourself and your family
An Illinois family recently filed a wrongful death lawsuit against a nursing home facility after the healthcare providers failed to resuscitate their 52-year-old loved one.
According to the lawsuit, the woman had indicated her desire that the nursing home “render full treatment including all resuscitation efforts medically available to her in the event of a cardiac or respiratory arrest.”
This type of advance directive decision refers to a patient’s “do not resuscitate” or DNR status.
If a patient decides against having life-saving treatment in the event of a heart attack or respiratory arrest, then the patient typically provides a written advance directive or orally shares her request with a doctor, who then places it in the patient’s medical record. It is then referred to as a DNR order.
In the Illinois lawsuit, the family alleges that, despite the patient’s advance directive asking for resuscitation or life-saving measures, a nursing home employee waited 29 minutes after finding her “lifeless” in her room. At that point, the employee notified emergency dispatch of the death of a “DNR patient.” Several minutes later, a nursing home employee called back to report that they had misread the DNR form and requested an emergency response. Of course, it was too late to save her life.
The scary state of DNR law in Texas
Several years ago, I represented the mother and step-father of a teenager who found out that a doctor at Children’s Memorial Hermann Hospital, in Houston, had entered a DNR order into their daughter’s medical records, without their knowledge or permission.
I made sure that their case got public attention because I thought what had happened was offensive and absurd.
The response of parts of the medical community was chilling. In a special report in the Houston Press, Dr. Robert Fine, of Baylor Healthcare Systems in Dallas, was quoted as saying, “A doctor can write a [DNR] order on a patient if they feel that it is appropriate for the patient. No law prohibits that.”
As a Houston medical malpractice lawyer, I know that Dr. Fine is correct. Texas law allows doctors to enter a “do not resuscitate” or DNR order in patient’s medical record without the permission or knowledge of the patient or family members.
In my experience, the fact that a doctor can sign a secret DNR order is consistently shocking to people.
For several years, there have been efforts to amend the Texas Health & Safety Code to address the hospital DNR problem, but they have never become law.
In the 2017 session, House Bill 2063 would make a DNR order valid only if, among other factors, it is consistent with the patient’s written or oral directions. As of today, the bill has stalled in House State Affairs Committee. I doubt that it will ever even get to a vote of the full Texas House of Representatives.
What you can do to protect yourself and your family
Although Texas is sadly the “Wild West” when it comes to the latitude the law gives doctors in signing DNR orders, there are some things that you can do to protect yourself and your family.
First, get an advance directive for every member of your family. The advance directive can contain instructions for healthcare providers to provide life-saving resuscitation measures. Provide a copy to the doctor or nurse and make sure they update the medical records accordingly.
Second, get a medical power of attorney for every member of your family. If a patient is unconscious or is unable to make decisions for himself, the medical power of attorney designated one or more persons who can make those decisions for the patient. Provide a copy to the doctor or nurse and make sure they update the medical records accordingly.
In my experience, doctors and hospitals take advance directives and medical power of attorney documents seriously. If a family feels lobbied or bullied by a doctor or hospital administrator into agreeing to a DNR, these documents are a persuasive defense that will often cause them to back down. Call Painter Law Firm at 281-580-8800, if you need our assistance in preparing an advance directive or medical power of attorney.
Third, ask direct questions to the attending physician. If you suspect that there may be a problem when it comes to DNR status, ask the main doctor, the attending, the direct question of whether a DNR order is in place.
If you or someone you care for has been injured because of a DNR order or other medical negligence, call 281-580-8800 for a free consultation with our experience Texas medical malpractice lawyers at Painter Law Firm.
Robert Painter is a medical malpractice lawyer at Painter Law Firm PLLC.
A physician has to supervise the care and prescriptions of nurse practitioners and physician assistants under written, signed agreements [...]read more
On 4/1/2018, the new law will end the current practice where doctors can secretly enter a DNR order against patient and family wishes [...]read more
A physician has to supervise the care and prescriptions of nurse practitioners and physician assistants under written, signed agreements
On 4/1/2018, the new law will end the current practice where doctors can secretly enter a DNR order against patient and family wishes
This article was originally published in the September/October 2017 edition of "The Houston Lawyer" magazine
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