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The refusal of a retirement home employee to administer CPR to a dying resident has gained international attention and sparked debate about both the legal responsibilities of independent living facilities and the efficacy of CPR itself.
When Lorraine Bayless, 87, collapsed in the dining room of Glenwood Gardens, an independent living facility in Bakersfield, California, 911 was called. The phone was handed to an employee, whom the 911 dispatcher asked to perform emergency cardiopulmonary resuscitation (CPR) while paramedics were en route. The employee, who described herself as a nurse, refused, saying that it was against the facility’s policy to give CPR to residents. The dispatcher’s repeated pleas to the employee to perform CPR or find someone who could were unavailing.
"I understand if your boss is telling you you can't do it," the dispatcher said. "But ... as a human being ... you know … is there anybody that's willing to help this lady and not let her die?"
"Not at this time," the employee answered.
Paramedics finally arrived and Ms. Bayless died at a local hospital. The incident came to light after authorities released a tape of the seven-minute 911 call surrounding the February 26, 2013, death. (To hear the tape, courtesy of KGET-TV, click here.)
Glenwood Gardens officials maintain that their policy is to call 911 immediately after an emergency and wait until medical personnel arrive, and that the facility’s residents are fully aware of this policy when they move in. Ms. Bayless’s daughter told KGET that she is satisfied with Glenwood's handling of the situation.
Unlike nursing homes, independent living facilities are not required to provide medical care or to have nurses on staff. They are essentially apartment complexes for seniors, although residents may get services like prepared meals and home maintenance in exchange for their rent. Assisted living facilities occupy a third category between nursing homes and independent living facilities. Glenwood has all three, but the nursing home and assisted living facility are physically separate from the independent living facility.
If Ms. Bayless’s medical directive had a “do-not-resuscitate” clause, then Glenwood’s refusal to perform CPR would be more clear-cut, but Ms. Bayless had no such order, according to news reports. The facility’s no-CPR policy may stem from a fear of liability if the CPR goes awry, although the frantic dispatcher assured the employee that the emergency medical system would take responsibility if anything went wrong. The employee told the dispatcher she was a nurse, but Glenwood says she was serving in the capacity of a resident services director, not as a nurse.
Behind Glenwood’s seemingly callous no-CPR policy may also be evidence that the emergency procedure is rarely effective on older individuals and, if successful, could leave the patient in a vegetative state.
In a column written following the Glenwood incident titled “The myth of CPR,” Elizabeth Leis Newman, Senior Editor of McKnight’s Long-Term Care News, cites studies showing that CPR's rate of effectiveness in helping a person to fully recover is slim. A study recently published in the Journal of the American Medical Association found that about 18 percent of those who had CPR and epinephrine administered achieved a momentary reprieve, but fewer than 2 percent survived for a month with good or moderate cerebral performance. Although she notes that in some cases CPR can be “absolutely lifesaving,” Newman says “[w]e do a disservice to not only families and residents, but also employees, when we join in a CPR hallelujah chorus.”
The Bakersfield Police Department is not seeking criminal charges, and the Bayless family has said they will not file a civil lawsuit, according to the Pasadena Star-News. But the company that owns the Glendale facility, Brookdale Senior Living, now claims its employee failed to follow proper procedures.
For more on the legal issues involved in the incident from FindLaw, see: “Nurse's CPR Refusal Reflects Legal Concerns,” and “Nursing Home v. Independent Care: Legal Differences.”