One Texas Right to Life (TRTL) lawyer has posted an update on Facebook about the “rescue” of Mrs Carolyn Jones. I’m afraid that, as with the declaration that another patient was “slain,” TRTL is gaming the Medicare funding and Texas medical systems for political purposes.
Emily Cook, General Council for TRTL, wrote that she worried that “funny business clinically would happen as we moved her” from the hospital where Mrs. Jones has been admitted for over 6 months, where the docs had weaned her off the ventilator and wanted her to transfer to a more appropriate level of care facility over 2 months ago.
Emily says TRTL spent their own money (*see my last paragraph) to put her in a private ambulance and take Mrs. Jones to another hospital ER. That hospital couldn’t provide dialysis, so they in turn transferred her via ambulance somewhere else, to yet another hospital until admission can be arranged at the nursing home.
Cook-ing the system
Mrs. Jones’ Medicare funding for the original hospitalization is bound to have run out some time ago. Normally, Medicare will allow 90 days per admission, with an extra 60 “reserve” days, once per person, per lifetime. The patient is responsible for part of the bill from the first day of admission, and for the total hospital costs after the eligible days.
But there are still Medicare regulations to deal with in the case of “Medicare eligible” patients, even when they aren’t paying.
Medicare makes it very difficult and risky for everyone to navigate the private pay process. When I had a question in my private medical office about whether Medicare would cover something, we had the patient sign an informed consent agreement and an acknowledgement that the patient might have to eventually pay if Medicare denied the service. Then we performed the service, filed the charge with Medicare, waited to be denied, and then tried to Bill the patient. I gave away a lot tetanus vaccines and removed a lot of moles and warts for free to avoid the risk of “fraud and abuse” from the likes of Janet Reno.
The same risk would have applied if the hospital had privately charged Mrs. Jones’ Dialysis.
I don’t believe the first new hospital is at risk for a charge of “dumping” if they documented a legitimate reason. However, both new hospitals will be able to charge the Jones copays and co-insurance. They may also find Medicare coverage limited because of the way Mrs. Jones left the original.
“Medicaid limits 2019” (a .PDF)
I certainly don’t know the Jones’ financial circumstances, and I may have over estimated the maximum income in early speculation. However, there are strict maximum Medicaid income and asset levels. These vary according to age, disability, and marital status. (Even the government bureaucratic Leviathan doesn’t want the spouse if a nursing home patient to end up indigent.)
In my experience, the social workers and benefits experts at hospitals and nursing homes are experts at negotiating and translating the bureaucracy. In addition, the disabled Medicare eligible person will have access to a benefits specialist. I’ve never had a hospital discharge and nursing home admission blocked by this “paperwork.” Certainly not for months at a time.
I hope TRTL assists the Jones family with what is certain to be several enormous hospital bills. As long as they pay the bills directly, the funds won’t be counted as income to Mrs. Jones.
they now post that a woman, Mrs. Carolyn Jones, had to be “rescued” from hers, “racing” to another facility “in the middle of the night.”
The family were given notice that they needed to transfer Mrs. Jones in March. They’ve had another doctor and three facilities capable of providing the treatments she needs waiting to accept Mrs. Jones.
And now, TRTL – in direct competition with – and with absolutely no mention of – Mrs. Jones’ family’s GoFundMe campaign – has been raising money in Mrs. Jones’ name. They state that the funds will be used for (TRTL) lawyer’s fees in addition to Mrs. Jones’ healthcare needs and that “excess” funds will go to help (TRTL’S) efforts for other patients.
I hope that TRTL’s money will also be used to pay for the very large hospital and doctor’s bills that the Jones family will receive. While there’s a chance that Texas Medicaid will pay for three months of medical bills, retroactively, Medicare doesn’t pay for hospitalizations over 90 days and has a 20% co-insurance (co-pay).
That’s bound to have added up in over 6 months.
We’ll just have to trust that TRTL won’t lie again.
Edit, Updated information:
One of the bloggers has told us more about that “rescue.” (Or today’s story, anyway.)
TRTL put her in a private ambulance and took her to *another ER,* one that couldn’t provide dialysis, so they then transferred her somewhere else.
There were comments about the first Hospital refusing transfer — no, refusing to be complicit with “dumping” a patient. Discharging to without ( or even with) acceptance of the transfer from the docs at the other facility is highly irregular and likely illegal.
Much has been said about funding. Yes. It appears that Medicare funding ran out, so no longer paying. 90 days per admission, with an extra 60 days over, under certain conditions.
About that Medicaid funding: I don’t know the limits of the mandatory asset tests, but the yearly income level is $60,000. One way to adapt is to spend money on medical costs.
Medicare makes it difficult to navigate the private pay process. When we had some question, we got informed consent, promise to pay, then performed the service, filed with Medicare, waited to be denied, then tried to Bill the patient. The risk is always a charge of “fraud and abuse.”
The same thing would have happened if the hospital had privately charged for Dialysis.
Mrs. Jones is not dependent on the ventilator.
In fact, it sounds like Mrs. Jones has had excellent treatment at the hospital,
Mr. Jones told the Texas Senate Health and Human Services Committee that the doctors at the hospital successfully weaned Mrs. Jones from the ventilator.
He also said that three other facilities are ready for her admission.
I’m happy to see that today’s article by reporter Tony Guajardo quotes both opponents and supporters of TADA and corrected the impression that Mrs Jones is dependent on the ventilator: “She requires dialysis, occasionally needs a ventilator for breathing assistance, and uses a feeding tube.“
There’s also a quote from Mrs. Jones’ daughter, repeated from the earlier article: ““My mom is going to die on Monday because of a law that saves hospitals money.”
It turns out that money and Medicaid paperwork is actually what is keeping the family from allowing Mrs. Jones to be transferred to another doctor and facility. The family is concerned that they (rather than the hospital) will be responsible for the costs of Mrs. Jones’ care.
This is in spite of the fact that when a patient first goes on dialysis, she becomes immediately and automatically eligible to apply for Medicare and Social Security Disability.
Depending on assets and income, patients unable to work on dialysis also qualify for Medicaid and other State benefits in Texas. Medicaid will even pay bills retroactively for three months.
The good news is that she isn’t dependent on the ventilator, dialysis is not constant but only 2-3 times per week and paid by Medicare, food and water by the feeding tube can’t be withheld under TADA.
Hopefully, the Jones family will finally agree to transfer her, even if costs them more than her Medicare & Social Security Disability will pay.
Now, Texas Right to Life is blatantly lying, posting an article on their website entitled “American hero slain two days before Christmas …”
Far down in the piece, there’s this:
“Chris passed away naturally on December 23, 2015 – two days before Christmas.”
Mr. Dunn died from his metastatic pancreas cancer, on full medical treatments. His mother, Mrs. Kelly actually thanked those who cared for him at the hospital.
Every article on TRTL’s website has a “Donate” button at the top, prioritizing money over the people whose stories they use to raise money and influence the Texas Legislature. Now, we see this completely dishonest caption.
Just what is their mission and how can we trust them?
I don’t understand why TRTL repeats that a ventilator tube prevents Mrs. Jones from speaking or eating. Mrs. Jones has a tracheostomy in place (the tube we see in the pictures is a feeding tube). The tracheostomy, even when a ventilator is attached, would not interfere with her ability to speak and swallow, with training.
What a tragic story!
While I only know what I’ve seen online, in my experience, it appears that the dispute about Mrs. Carolyn Jones is over continued hospitalization at this hospital, versus transfer to care at another facility.
(See this television news report.)
I’m the first to say that hospitals are scary places and to sympathize with families struggling to cope with the bureaucracy and protocols. However the current news, press releases, and pro-life blogs are reporting several errors and omissions about Texas’s law and legislation up for consideration in Austin.
The obvious errors in this report include:
1. First. It’s not correct that Mrs Jones will die on Monday, even if the ventilator is turned off at the hospital. She’s not intubated through the mouth or nose. Instead, there’s a tracheostomy and a feeding tube in place. Supplemental oxygen could be provided many different ways, at home or in a nursing home.
2. Mr. Jones has testified at the Texas Senate Health and Human Services Committee meeting (EDIT: the video is here, at 52 minutes in) on 4/10/19 and elsewhere that Mrs Jones had been weaned off the ventilator, needing it only occasionally, at night.
2. She should be able to speak and swallow with training.
3. Texas Advance Directives Act doesn’t require that the doctor declare the treatment be “futile.” Instead, the doctor must declare that he refuses to follow a certain treatment decision that the patient or family demands .
4. Kidney dialysis is paid for by the Federal government, so the problem isn’t only funding.
In my admittedly limited knowledge about this particular case – it appears that Mr. Jones disagrees that it’s time to move from the hospital to home or nursing home, even after 5 months (not 10 days).
At least since 2005, legislation has been introduced at the State to increase the timeframe to as long as a month. Texas Right to Life refuses to agree to anything other than indefinite treatment, with the doctor forced to act against his will, violating his conscience and ignoring his medical judgement.
TRTL has even clashed with other pro-life organizations and Texas’s Catholic Bishops and “primaried” several conservative Legislators, although they are the only Texas pro-life group that opposes the law.
It would be good to add more time – I don’t know of anyone who disagrees. But there needs to be a limit to how long a doctor is forced to act against his conscience. One Bill that was rumored this year would change the “10 days” to 21 days and add a week to the notification period before the Ethics committee meets. Unfortunately, it never got past the Powers That Be.
For more on the ethics of the Texas Advance Directives Act, see this WingRight post.
The most urgent need is communication with families, correcting misunderstandings like those outlined here.
(Edited May 10, 2019 at 12:22 AST, to correct the Link to the testimony of Mr. Jones. BBN)
“[T]he doctor/bioethics committee thinks the patient should die.” Wesley J. Smith, Esq., Texas Senate Health and Human Services Committee, 4/10/2019 LifeNews.com
Wesley Smith is a rarity among the many lawyers who chased bioethics to the bedside late in the last century: he actually believes in the sanctity of human life and in the right of conscience. I’ve attended and reported on his debates and encounters with proponents of intentional euthanasia. And even happily defended him.
Unfortunately, Lawyer Smith was not above spinning the truth this month when he came from California to once again misrepresent the Texas Advance Directive Act (“TADA,” “the Act,” or “166.___”), an attempt to balance conflicting rights when doctors disagree with a patient or his surrogates about actual medical procedures and treatments that the doctor believes harms the patient.
On April 10, 2019 Mr. Smith gave invited testimony to the Senate Health and Human Services Committee in favor of SB 2089 (Hughes) and
SB 2129 (Creighton). LifeNews.com published part of his testimony online, under the title, “Texas Rule Allows Hospitals to Essentially Euthananize Patients After a 10-Day Notification.”
Mr. Smith doesn’t just contradict multiple Supreme Court rulings since Cruzan (1990) affirming that withholding or withdrawing treatment is not equivalent to euthanasia. Paradoxically, he echoes arguments that anti-conscience activists use to justify abortion on demand, Physician Assisted Suicide and intentional euthanasia by a third party by claiming that the principle of autonomy supercedes “First, do no harm,” or non-malevelence, and the right to conscience.
(You can watch all of Part I and Part II of the April 10, 2019 Health and Human Services Committee meeting addressing SB 2089 by Senator Bryan Hughes and SB 2129 by Senator Brandon Creighton online. Part I includes Mr. Smith’s testimony beginning at 33:00/1:01:10.)
We’ll skip Mr. Smith’s assertion that there is a right to force others to provide everyone medical care in general, not just in emergencies or at the end of life. I’ve covered these assertions and his attacks on the Texas Conference of Catholic Bishops I’m, back in 2007.
Today, let’s just look at his spin on the current version of TADA.
Lawyer Smith uses emotionally weighted terms that aren’t in TADA, such as, “life-extending,” “futile care,” “permitting the institution to force its will on patients and families,” “invidious discrimination,” and “inappropriate care.” He contrasts patient’s “rights” with doctor’s “values,” and is the first that day to raise the specter of doctors willing to kill when patients are “expensive.” And, reflected in the LifeNews.com headline, Mr. Smith flatly says that TADA allows euthanasia – intentional acts to kill patients – equivalent to the administration of injections or medications that he wrote about this week.
As I’ve stated so many times in past WingRight.org and LifeEthics.org posts, TADA doesn’t allow us to remove or withhold care for patients, only treatments that are “medically inappropriate.” There are no futile patients, only futile treatments that cause harm to the patient over and over, without any expectation of reversing organ failure after organ failure.
Mr. Smith also ignores the multiple attempts by the medical and pro-life community and Legislature to improve the law’s timeframe and communication, much as Senator Creighton’s Bill. One example from 2007, SB 439 by Senator Bob Deuell, would have required written notice and an offer of a private ethics consult to take place at least seven days before the hospital committee meeting. That Bill had a schedule for giving the patient or surrogates written information about the dispute process, copies of medical records, and lists of resources. The family would have been given access to the committee meeting, with their own advocates. When the committee agreed that the treatment requested was inappropriate, the family would have receive assistance in searching for7⅞ another doctor or facility for at least another 21 days. I believe that the Bill bogged down in the House because of opposition from Texas Right to Life to any Bill that did not include liability for doctors and the indefinite “treatment until transfer” in this year’s SB 2089.
In the last five minutes of the Part I video, another lawyer, Texas Right to Life General Council Emily Cook, gave us the best clue about the ultimate goal of her organization: “judicial review.”
Ms. Cook and Mr. Smith would have every one of these disputes settled by a Court. This is the Texas trial lawyers’ dream: a huge weapon against our State’s tort reform.
Today, the law specifically allows an appeal to a County probate judge when the Committee agrees with the doctor’s decision. SB 2129 allows a request for an injunction in any Court in the County, enabling “judge shopping.” Since it also prohibits the County from charging the patient or his surrogates any fees, the costs would fall solely on the County.
Ultimately, SB 2129 would make it much, much easier to sue the doctor and the hospital, moving Medical decision-making into the courtroom.
Most of the “stakeholders” for patient rights in Texas (including Texas Alliance for Life, Texas Baptist Christian Life Commission, Coalition of Texans With Disabilities, Texas Medical Association, Texas Hospital Association, Catholic Hospital Association, Texas Nurses Association, and the Texas Conference of Catholic Bishops and many others) oppose both of the Bills that Mr. Smith favored. Since SB 2129 would mandate that the County pick up any Court costs and that the judge make his ruling within five days, don’t be surprised if we hear objections from representatives of these parties, too.
So what’s the “joke?”
It could be the ridiculous notion that Lawyer Smith is a mind reader, able to discern the “invidious” motives for the “discrimination” he feels doctors and hospitals routinely practice:
“To fully comprehend the unjust nature of Texas law in this regard, realize that these “futile care” or “inappropriate care” decisions do not terminate treatment because it won’t work, but because it does. It is keeping the patient alive when the doctor/bioethics committee thinks the patient should die.” (Emphasis from LifeNews.com’s transcript.)
He repeatedly comments that physician’s decisions about medically appropriate treatment are subjective and that they (we) might “project their fears and their desires onto the patient” based on our “values,” rather than medical judgement based on repeated, at least once a day examination of the patient, reports by the nurses and staff and our education and experience.
The joke might be that Lawyer Smith volunteered that the indefinite, repeated evaluation and medical decision-making against the medical judgement of doctors would not be “slavery.” I would like to know what Lawyer Smith calls the legal requirement to use one’s body and brain to carry out actions, including writing orders for nurses and other medical staff, against your will.
It might be tragically funny to watch “judicial review” end up with the two sides hiring expert witnesses – doctors – to give the judge opposing views. There’s dark humor in the realization that ultimately the judge would order the original doctor to use her medical judgement to provide treatment – against her best medical judgement.
But the real joke is that “judicial review” risks the unintended consequence of decisions made by judges like the late t Judge George Greer, who Mr. Smith wrote about in this article.
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Mama had surgery for Thymic carcinoma back in 2004. She voted early and scheduled the surgery for the day after the election, so her daughters could work as election clerks.
Today, I came across a poll of likely Texas voters, conducted by the University of Texas and Texas Tribune that said that for Texans, health care is a distant third in importance, behind border security and immigration. This was in contrast with frequent news reports in the last week that an unnamed “recent poll” had found that health care is the number one issue in the 2018 election for voters. That first, UT/TT, poll was more consistent with other recent news coverage and the issues that I keep seeing pop up on Twitter and Facebook.
So I did some research….
It turns out that the first poll (“KFF,” download pdf file,with results) was conducted by the Kaiser Family Foundation, a nonprofit based in San Francisco, California. In fact, approximately 30% of the respondents listed health care as their number one issue and were designated “Health Care Voters” by pollsters. 70%, designated “non-Health Care Voters,” chose other issues, including the economy and jobs (21%).
The demographics of those polled were heavily slanted toward Democrats, with registered Democrats and “Independents” who are identified as “Independent Lean Democrat” adding up to 68% of the “Healthcare Voters.” “Non-Health Care Voters” came in at 49% Republican or “Independent Leans Republican.”
While KFF is considered one of the “Least Biased” polling bodies, they are still subject to sampling errors. It appears that this might be one of those times.
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From the Mayor of the home town of La Joya Independent School District, the “independent” school system in Hildalgo County, Texas with the water park, a 22K sq ft natatorium, tennis courts, a planetarium, and a golf course,enabled with money from Texas taxpayers:
“My position was why should the city of La Joya, or any city in the Valley, detain any ICE illegals when ICE already has cages for them?”Salinas said Sunday. “Maybe they have a better place for them than we do and, of course, we’re totally against what they’re doing; I think we should unite the families, not divide them.”
“If it hadn’t been for that I would not have reacted this way,” he said, “but I’m a Mexican-American and I support my people.”
It’s not just “that.”
Edited to correct spelling. BBN
“”1 Most people with the capacity to become pregnant identify as women. Historically, both jurisprudence and public health data have focused on women when addressing reproductive rights and health. But there is an emerging recognition in the law and society more generally that not all people who may become pregnant identify as women. See generally Glenn v. Brumby, 663 F.3d 1312, 1316-19 (11th Cir. 2011)(holding, consistent with the weight of authority, that the Equal Protection Clause prohibits discrimination on the basis of “gender nonconformity”) (collecting cases); Robin Marantz Henig, How Science Is Helping Us Understand Gender, National Geographic (2017), https://www.nationalgeographic.com/magazine/2017/01/how-science-helps-us-understand-gender-identity/. The Constitution protects the rightof all individuals to end an unwanted pregnancy, regardless of gender identity.”
“Lawyers have told a judge that he had been biologically able to become pregnant but had legally become a man when the child was born.
“Explaining their unusual parenting arrangements, Amy said: “We went through a lot of fertility treatments, until we finally reached a point where we needed to make a decision as to whether we were going to do more medical intervention or if we were going to switch bodies. (emphasis mine)
“We were fortunate enough to have two uteruses. So, after a lot of thought and emotion and difficulties we switched to Chris.
“And while Chris lived as a man and didn’t feel female, he was willing to use his womb for the good of their family.”
I am writing to ask you to vote against censure by the Convention of named Republican, elected, officials.
How often have we complained about the elites who get in power only to ignore us to follow their own agenda? How many of you are at the Convention because you got tired of the establishment working against you?
Well, guess what? If you make it to the State Convention, you’re the elite establishment! Don’t be that kind of elite establishment.
For the first time in years, I couldn’t participate in the 2018 Republican Party of Texas Convention process. I still follow your efforts and have read the resolutions submitted to the Platform Committee. One Senate District has submitted resolutions demanding that the RPT State Convention censure specific legislators.
I appreciate the work you’re doing this not just this week, but over the last few months. Having served as a Delegate to the Republican Party of Texas State Convention and on both the Platform and the Rules Committees, I know you have a week of long walks to simply get to your meeting rooms, heated discussions, long waits, and many re-votes, one after another. The Committees and sessions start early and go late. (Wear comfortable shoes and take snacks!)
Through all of this, please don’t forget that you are in San Antonio as the grass roots embodiment of our Nation’s representative democracy, our Republic. You are not simply individuals expressing your own will and opinion. You are there as representatives of your constituents: the Republican voters from your Counties, Congressional Districts, and Senate Districts.
In the same way that you expect legislators to represent their voters, your voters expect you to represent us.
While it may be appropriate for the local SD Convention to censure their own legislators, especially before the Primary or run-off, many people in our Party disagree. But now, these are elected candidates. I don’t believe that it’s appropriate for the State Convention to censure them in opposition to the local electorate’s wishes.
When the votes on censure of any Republican elected official comes up, please take a look at their constituents’ votes, especially in the last Primary. Did he or she win? Was it by a substantial margin? Was he or she unopposed in the Primary because no one even challenged them?
These men and women deserve your respect, just as President Donald Trump should be given the respect he deserves after being elected President. In the same way that it was wrong for Hillary to deride Republican women as voting the way their husbands told them to, it’s wrong to dismiss these voters as illegitimate.
In addition, as this is an election year, you are writing the campaign ads for the Democrats.
Please do not oppose the voters you represent by voting in favor of public censure of Republicans.
Beverly B. Nuckols, MD
Comal County, SD 25 and CD 21
(Edited because some of the formatting got lost.)
I’ve been having a long Facebook discussion with representatives of organizations, people who claim that I support coercion and killing patients because I defend the Texas Advance Directives Act, 166.0046. (TADA).
I want to respond as fully as I can. ( I’m bandwidth deprived today and will gradually add more links when I reach better signals. See here, here, and here for more explanations from earlier WingRight posts. Links to the law, the press, and previous blog posts by others can be found in those articles.)
It was easy to follow this case. There was a video published by Texas Right to Life (TRTL), a lot of press, statements to reporters by family, lawyers, and TRTL staffers, as well as a couple of lawsuits. I spent the better part of two days once again reviewing the public records.
(Edited 03/11/18 for typos, to add a link, and to clarify points originally made on Facebook in a long debate. BBN)
Last week, in a story about another baby boy, there was a a beautiful memorial to the “Bubble Boy,” David Vetter, too.
My granddaughter’s mother is one of those heroes, helped by doctors and nurses, my son and an extended family of friends. (I can’t help my prejudice that gives the mother most of the credit.) And then, there was a baby boy and his generous mother.
In addition to a very low white blood cells count, her bone marrow didn’t make enough red blood cells or platelets, either. She’s healthy and well, today, after one of the first cord blood bone marrow transplants in the world at the age of 15 months.
Although no matches were found for Sebastian, the baby in today’s story, Texas has a strong system for the registration of both bone marrow and umbilical cord blood donors. The Texas Cord Blood and MD Anderson Cord Blood Centers collect, store s and manage the distribution of donated cord blood collected at birth from moms and babies all over the State.
Families who store their baby’s cord blood privately are very unlikely to ever need it, except when there’s a known problem. The odds are less than 1:200,000. But if they donate to a public bank, the blood is much more likely to save a life and/or be used in life-saving research.
Bravo to all the parents and caregivers in children’s lives and prayers for Sebastian. There’s a Go-Fund-Me account for Sebastian’s expenses, if you are interested.
Edit: there’s a wonderful update: Sebastian was able to go home!
The TexasGOPVote website chronicles the complaint by a “Conservative, Christian” mom that her male to female (supposedly) transgender 6 year old shouldn’t be treated differently. I agree with the underlying sentiment that it is not the child’s fault.
The child is treated differently – by parents, peers, school nurses, and any educator, doctor or other professional or official who is complicit with this abuse of a 6 year old child – because the child *is* different. Medicine, physics, and the rest of the observable, measurable and verifiable universe don’t change because a child declares that cold is hot, up is down or boys don’t feel like “she” feels (at the highly experienced age of 6).
It is disturbing to read about the apparent mistreatment of depression that this mother describes in her earlier blog. So disturbing that I’m inclined to ignore – or at least put off to another post – commenting on the stereotype in the description of “girly girl, Kai, in pink and sparkles” or of the suggestion in mom’s earlier blog about Joseph as “gay” (at 2!) for displaying supposedly “flamboyantly feminine mannerisms and love for all things girly.”
How could anyone so misinterpret the repeatedly voiced desire of a 4 year old to be taken away to heaven because another 4 year old said her father called him a freak as equivalent to hating hair cuts ( or more “feminine mannerisms“)? How can she compare her “secret” research with the proper treatment her son needed?
Unfortunately, a 6 year old claiming to be transgender is different because he or she has had his or her perceptions of the world colored by the same adults who would not allow a child they loved to play with fire or jump off the highest point of the school building.
The fact is that genetic and phenotypically female girls will always be “different” from Joseph. From the first penetration of the zona pellucida by a sperm bearing a Y chromosome, to the differentiation of the Wolffian duct, to the first time he urinated over someone’s shoulder into the air after birth, Joseph has been a male. Stereotypes aside, he will remain a male, however he acts or is medically or surgically manipulated. The genetic and phenotypical reality of his body will always affect any future medical or surgical treatment.
Hopefully, no one will be complicit with medical or surgical castration or other mutilation until this child is legally competent to consent. In that case, his body will still be phenotypically male, entering puberty, when he enters middle school, whether as as Joseph or Kai. Now, that will be a “difference” evident to all the girls, including the ones who have never seen male genitals.
It will be very evident to the survivors of sexual abuse. Hopefully, they called the police after they were abused.
Contrary to the claim in the blog, Lt. Governor Patrick and the “Bathroom Bill” didn’t start the trans debate. School districts in Texas were changing policies, entire cities have passed ordinances, and the last President issued an Executive Order that threatened Federal education dollars.
And preditors are taking advantage of the increased access available due to the transgender debate: men like Paul Witherspoon, Levandus Gacutan, Christopher Hambrook, Richard Rodriquez, Jason Pomare, Sean Patrick Smith, or the many unnamed men who have been not reported to the police when they enter previously gender-segregated areas like poolside changing rooms, shower rooms or gym locker rooms. (I’ll let you research those names.)
Thanks to “Conservative, Christian” mom, the world is being misrepresented to other children who are encouraged to consider pathological behavior as not “different.” Because of “feelings” the rest of us are repeatedly told to ignore the difference – and observable, measurable, and verifiable facts.
And this specific child is being abused.
Beverly B Nuckols, MD.
A Facebook friend, Michael Smith, made an excellent comment about the contrast between “separate but equal,” and “equal, but special.”
I spent some time yesterday at the Texas State Capitol Reagan Building discussing House Bill 2899 by Simmons, which would prohibit local governments and other regulatory authorities from creating a new “order, ordinance, or other measure to protect a class of persons from discrimination; to reduce or expand a class of persons protected under state law from discrimination.”
The consensus of a group of people waiting for the House State Affairs Committee to begin was that the Bill is a thinly veiled “attack” on the LGBT community and transgender persons in particular. The comment that made me go into my Don Quixote tilting windmills mode was about just wanting to “peeing in peace” and the false claims of fears for safety of women and children.
I pointed out that that it is reasonable for women to have fear when confronting a man in a closed space and that we all expected privacy and security in bathrooms, locker rooms and other public places where people disrobe. (Yes, I used the term “disrobe.” And “intimate spaces.” I’m a nerd.)
I was told that I was speaking from “privilege” (!) for my example of caution when entering an elevator with a strange man and objecting to the stereotype that the brains of men and women are different and the assertion that men and women simply think differently. I heard that segregation of the sexes in public bathrooms is a new phenomenon and that the Roman baths, such as those in Pompeii were completely different matters, mainly due to the religion of the time. And of course, several of the group told of the danger of violence against gays or trans but that there has never been any crime against other people by transgender person
Two of the people claimed to be transitioned from male to female. While demanding “respect,” they told stories of having coworkers fired for refusing to use their preferred pronouns. and engaged in very real “hate speech,” mocking and assigning hateful motives and emotions to me. The same person who pointed out that little boys can be molested in men’s bathrooms then said that *I* was the one who must obviously consider anyone with a penis a predator.
The group was secure in the belief that the fears of violence and abuse of the LGBT community outweigh not only the fears of victims of sexual abuse or parents of children and thousands of years of social norms.
Cities, but claiming to write non-discrimination ordinances create environments where some people are “equal, but special” – or a specially protected class of persons. George Orwell put it another way: “Some animals are more equal than others.”
If only we doctors – or legislators, lawyers and probate judges – really had the power to “keep the patient alive” as this article claims two new Bills ( HB 4090 & SB 1213) in front of the Texas Legislature will (force doctors to) do.
The article is misleading in its claim that a committee or a hospital decides whether or not a therapy is given: Texas doctors practice medicine in Texas. Even the Bills make it clear that the “attending physician” makes the decision whether or not to follow the patient’s (or more likely, the surrogates’) medical request.
We – Texas doctors, hospitals, and legislators – have tried repeatedly over the last decade to amend the law, Texas’ Advance Directive Act, to increase the time frame. Last Session, we helped to ensure that food and water can’t be withheld. The lawyers and those who would have Estate (probate) judges involved in every dispute – even at the bedside of the dying – have blocked effort after effort because the Bills did not include liability for the doctor.
These Bills are just the camel’s nose under the tent of Texas’s tort reform. Worse yet, we’d end up with medical expert testifying against medical expert in court, with the judge eventually telling the doctor how to practice medicine. It would also severe the “ethicists” who actively seek to undermine conscience protections for health care professionals.
If you’ll notice, the Bills also remove the requirement for the patient to pay for any transfer, too. I don’t suppose that the tort lawyers will pay for the ambulance or plane ride.
Do you want Texas law to force doctors to practice against our consciences?
How long and how far should any man or woman be forced by law to act against his or her will?
(Photo of the men’s bathhouse at Pompeii, in contradiction to the claim that gender-segregated facilities are a modern concept.)
The Texas Senate State Affairs has another long day ahead, as testimony will be heard today on SB6, the so-called “Bathroom Bill.”
Here’s a rebuttal that I wrote in response to a facetious op-ed that appeared in the Austin American Statesman last month. The Opinion editor told me a shorter version would be published, but I haven’t seen it.
Obviously, John Kelso isn’t a survivor of male on female sexual abuse or harassment.
Many survivors (like me, at 3 years old) have strong reactions to the idea – the threat – of a man in the enclosed space of even a “public” bathroom. Just as as I worry about the safety of children, I also want a “safe space,” where I am not likely to be confronted by a male.
If the transgendered individual doesn’t trigger that fear – and I have no doubt that I’ve shared bathrooms with some who didn’t – then no problem. However, their ability to do so is no justification to engage in sweeping social experiments.
Representative Schaefer and Lieutenant Governor Patrick didn’t start this controversy. Individuals making policy decisions in cities, school districts and the Federal government did, sometimes with the weight, fines, and penalties of law.
The fact is that at least 1 in 5 women have been sexually abused before the age of 18. (In my experience as a Family Physician, I would have expected the percentages to be higher.) More than 90% of those assaults are committed by males who prey on females. While “only” 20% or so are perpetrated by strangers, isn’t that enough?
And yes, some of us do consider innocence a value to be protected and wish to protect girls from involuntary exposure to the physical characteristics of anatomical males. Thus, our objection to co-ed bathrooms and the Obama Administration’s Department of Education guide lines that included locker rooms and overnight accommodations on school trips.
Significantly, Kelso claims to be ignorant of multiple abuses of by straight males, dressed as females or otherwise, who take advantage of the opportunity to exploit newly accessible, formerly same-sex, hygiene facilities. I suggest at least a bit of online research.
How dare commenters mock women’s “worry” and “FEAR(sic)?” Isn’t fear of assault the reason most often given to justify “gender neutral” policies?
Shocking Bill from Texas’ Jason Villaba, Republican State Representative from Dallas’ District 114 : HB 1938 would make organ donation after death “opt out” for anyone applying for a driver’s license in Texas.
Texas would be the first State to pass such a law.
Organ donation is a public good for those who wish to do so. However, there is no ethical or legal precedent for treating human bodies – living or dead – as public property or commodities.
From the Bill as introduced:
(2) for an applicant who is 18 years of age or older: (A) specifically ask each applicant the question, “Would you like to refuse to join the organ donor registry?” and state, “If you answer ‘no’ to the previous question or do not answer the previous question, you consent to join the organ donor registry by performing either of those actions.”; and (B) if the applicant does not affirmatively refuse to be included in the registry under Paragraph (A), provide the person’s name, date of birth, driver’s license number, most recent address, and other information needed for identification purposes at the time of donation to the nonprofit organization contracted to maintain the statewide donor registry under Section 692A.020, Health and Safety Code, for inclusion in the registry.
Read the Texas Secretary of State information page on Presidential candidates, here. (http://www.sos.state.tx.us/elections/candidates/guide/president.shtml )
I’m not a lawyer, but it appears to me that Texas election laws will prevent Trump from placing his name on the ballot as a 3rd Party candidate in 2016.
Any lawyers disagree?
About 300 delegates to the RPT weren’t Republican.The Platform of the Republican Party of Texas is online under “Platform,” here: http://www.texasgop.org/2016-convention/ . The numbering in this version of the Platform is awkward, but the plank-by-plank votes are reported at the 3rd link, below.
110 even voted against Principle #5, “Personal accountability and responsibility”
Just under 300 voted consistently against what should be non-controversial issues, such as the plank against human trafficking.
(Numbering appears to be a typographical error, hopefully soon corrected. The hard copies we had were much clearer.)
If Ted Cruz wins Presidency, it leaves a huge blank if Cruz resigns before Obama is out.
A special election will be called for the next uniform election day or 32 days after election is called.
We’ll need Cruz to resign as soon as elected or wait until inauguration to prevent aggression by the “Office of the Lame Duck President.”
Posted from WordPress for Android. Typos will be corrected!
By 7 PM, there was a line of people setting up to spend the night in front of the Supreme Court of the United States building. They hope to be able to watch the Court proceedings on Wednesday when the Texas abortion law, HB2.
Here’s the coverage from Brian Rosenthal of the Houston Chronicle, about Texans, like me, who travelled to DC for the hearing. I’m quoted as ‘helpful about the future of the law in the last few paragraphs.
Beverly Nuckols, 60, a New Braunfels family doctor who flew in for the arguments, said she was happy that a long and just process finally could be coming to an end.
Nuckols said was hopeful about the ruling because she was confident in the law.
“I believe we will get a tie,” she said.
Huge endorsement from Texas’ Governor Greg Abbott. This is one I had been wondering about.
In a video announcing the endorsement, Abbott said,
“Unlike far too many in Washington, the Ted Cruz we’ve seen in the Senate is the same Ted Cruz we elected and he’s the same Ted Cruz I served with when I was attorney general,” Abbott said.
I was very impressed and very proud of Ted Cruz back in 2009, on the day when Kay Bailey Hutchison announced that she would run one more time as Texas’ Senator. Within minutes, Cruz withdrew his bid for Attorney General, rather than run against General Abbott. Although later I became opposed to his campaign tactics, that moment showed integrity.
( I’m just barely cynical enough to think it also showed good political sense. In fact, that only just occurred to me. Doggone it! I want to believe it was character, not simply savvy politics.)
Cruz needs mentoring – to *accept mentoring* – from both Governor Perry, who has also endorsed Cruz, and from Governor Abbott. I hope that he will.
Someone named Rich DeOtte has written a Facebook piece attacking friends of mine. Rich mocks Dr. Joe Pojman as “a rocket scientist” and “knucklehead” (needless to say, that’s not popular in the Nuckols household) and takes a slap at Kyleen Wright, of Texans for Life Coalition and the Texas Medical Association.
Dr. Joe Pojman, Ph.D., is indeed a “rocket scientist,” who gave up his original career path of aerospace engineering to sacrifice as founder and Executive Director of Texas Alliance for Life, an organization I’m proud to support and serve as a Board member.
Joe wrote the op-ed that Rich attacks in direct response to the “misrepresentations” in another, political op-ed piece by Emily Kebedeaux Cook on the Texas Right to Life Website. Joe only wrote about issues, and did not engage in name calling or derision. The only reason Emily and TRTL are mentioned is because she’s the author of the political opinion piece about the “decline in the Texas Legislature’s efforts to protect human Life.”
As Joe points out, the very document to which Emily refers refutes her position: Texas was named one of three “Life List All-Stars” for 2016 by the Americans United for Life.
Joe laid out the case that our Texas Legislature’s pro-life laws are most definitely not at a standstill: we are ahead of the Nation. Joe’s position that Texas leaders gave us many successes in the 2015 84th Legislature is supported by the similar list of “Wins” reported by the Texas Catholic Conference, representing the Bishops of Texas. In an earlier letter, TCC notes that many of the criticisms Emily makes in her February 8th blog post were not previously scored “equitably” by TRTL. For instance, Senator Bob Deuell received no credit for authoring much of what became HB2.
In fact, Texas’ Legislative leadership in passing pro-life laws is why many of us are going to Washington, DC on March 2nd to bear witness when the Supreme Court hears testimony on the abortion facility regulations in HB2.
Emily and Rich focus most of their criticism on the efforts of pro-life groups, including doctors like me, to reform end of life care and the Texas Advance Directive Act (TADA). Session after session since it was passed, we in the pro-life community have had our efforts repeatedly blocked by the “death panel” accusations Rich makes and the demands in Emily’s op-ed.
I was one of the doctors appointed to the Texas Medical Association ad hoc committee that evaluated last sessions’ end of life Bills for TMA approval. Our group of doctors agreed to and helped fine tune HB 3074, what Emily called a “modest protection”: prohibiting the removal of Artificially Administered Nutrition and Hydration, including food and water by invasive medical methods like IV’s and “Total Parenteral Nutrition.” We were called anti-life and pro-“death panel” (Rich’s words) for including medical exceptions for the rare circumstances when the patient can’t process the AANH and/or when it actually caused harm.
Those “three strongest Pro-Life bills” that Emily mentioned were included in the “Wins” listed by the TCC. The Bills not only would have forced doctors to continue to indefinitely perform acts that we believe are not medically appropriate as long as a patient or his family demands it. They would have forced all disputes between the doctors practicing medicine and patients or their families into court and add “liability”(civil and criminal penalties) for the doctor.
Forget if you can, that if all disputes go to court judges would be required to determine medical care – to practice medicine – probably based on the testimony of dueling, paid medical expert doctors. Malpractice rates will go up for doctors taking on the most vulnerable patients – the elderly, the trauma victims and the victims of cancer. Those doctors will spend more time in courts, rather than in the ICU. And so will more grieving families.
We found out what happens when malpractice goes up in Texas, before tort reform was passed. Because of the malpractice crisis, there were no neurosurgeons west and south of San Antonio and Houston – none at all in El Paso or all of South Texas. We were losing obstetricians and family doctors willing to deliver babies and offer prenatal care, all over the State.
I don’t know how to translate past physician shortages directly into the possible shortage of doctors providing end of life care. However, I will predict that fewer family doctors, internists, pulmonologists and the ICU intensivists will be able to afford to practice in the ICU. Just as a patient had to be flown to Dallas, San Antonio or Houston from most of Texas for a head injury, only the tertiary medical centers in those cities will be able to staff their ICU’s properly.
Physicians, not hospitals – and certainly not courts – practice medicine in Texas. Doctors must be allowed to practice medicine according to our medical judgment, which is a combination of education and experience, under the watchful eye of the community; not “death panels,” but fellow physicians, nurses, ethicists, lawyers (who may be any of the former) and lay people. In the end, if you force the hands and minds of doctors against their judgment, you will end up with doctors practicing without judgment, and humans with inalienable rights forced to act against our will and in violation of our conscience.
And, now, back to Rich’s Facebook post. Think twice when you read political posts full of personal attacks and name calling. We should be able to discuss politics without, as Emily said in her blog post, “unnecessary, vicious, and vindictive fights inside the Republican Party.”
Edited to fix a name glitch – BBN
Rights impose duties on third parties, privileges do not.
Abortion, especially elective abortion of healthy babies in healthy mothers, is not a right. It is an illicit privilege granted by an act of law. No one has a duty to enable or act to cause an elective abortion at the request of a woman.
It is an “illicit” privilege, since the right not to be killed is an inalienable right. Each of us in society has a duty imposed by that right to prevent its infringement.
Edited 1/27/16 to clean up grammar and add links. BBN
Death, lies and video
Supported only by his imagination, what he saw in videos produced by Texas Right to Life lawyers, and a news article,Dr. Phillip Hawley, Jr., M.D., wrote “A Tragic Case of Modern Bioethics; Denying Life-Sustaining Treatment to a Patient Who Wanted to Live” about the truly tragic, but inevitable death of Chris Dunn. Hawley erred by pretending to read the minds of doctors and hospital representatives and calling complete strangers “utilitarian” “murderers.” Before discussing the ethics of his accusations, it’s necessary to explain the meaning of the documented facts, available in news sources, blog posts and court records:
It is very unlikely that Chris understood his condition, the questions the lawyers were asking or the consequences of his “prayer.” That he was unable to make medical decisions is supported by the fact that his parents had been making his medical decisions. The Harris County judge agreed with the hospital’s request that a single legal guardian be named by a separate court.
“Life-sustaining treatment,” “medically inappropriate” and “Artificially Administered Nutrition and Hydration” are legal terms defined in the Texas Advance Directive Act (TADA), which outlines the exact procedure and language for communications between doctors, the hospital committee, and patients or their surrogates. The use, monitoring and adjustment of a mechanical ventilator is in the definition of “life-sustaining treatments.” TADA specifically excludes “Artificially Administered Nutrition and Hydration” (AANH) in the definition of “life sustaining treatments,” which would argue against the accusation that his doctors planned to withdraw “food and water.”
The only legal reason under TADA to remove any “life-sustaining treatment” is that it is deemed “medically inappropriate” by the attending physician and then only if the hospital medical or ethics committee “affirms” that decision. If and when they are withheld, the Act specifically prohibits “mercy killing” or otherwise intentionally intervening with the intent to cause death by artificial means.
Additional demands by Chris’ mother, Mrs. Kelly, and the lawyers in blogs and news articles would have also fallen under the legal definition of “life-sustaining treatment.” These demands included a biopsy in order to determine a definitive tissue diagnosis for the clinically apparent pancreatic cancer and liver lesions, a surgical tracheostomy and the removal of the ventilator (to be fair, I believe they meant the tube through the vocal chords), less sedation, searches for and trials of treatment of the cancer, and the non-standard use of an indwelling drain for the ascites (large exudates in the abdomen due to high pressures in the liver and the failure of the liver to make necessary proteins). These are invasive, potentially painful and, based on the reported size and effects of the mass, the extent of liver damage visibly evident in the videos as temporal wasting and copper-colored skin, ascites and the GI bleeding – they were very unlikely to lengthen his life, much less cure his cancer. In fact they could be very likely to hasten – or be the immediate cause of – his death.
Chris died in the ICU on full life-sustaining treatments, including the ventilator and intravenous AANH.
The doctors are on record as basing their decision on the suffering caused by the treatments to their patient, Chris. This is consistent with the known side-effects of the ventilator and even reports from Chris’ mother, who told reporters that Chris suffered from the treatments and fluid building up in his lungs despite the ventilator. And yet, Dr. Hawley made sensational statements such as:
“For patients with terminal illnesses, this standard often leads to the utilitarian question: Is the patient’s life still worth living?
“In Chris Dunn’s case, the committee’s answer was “no.” Relative strangers with little or no knowledge of his values and beliefs weighed his “quality of life” and decided that he no longer deserved to live.”
“. . . How did these committee members who had only recently met the patient—if they ever met him at all—know that it was in his best interest for them to end his life?”
“. . . But, somehow, we are to believe that these committee members were able to deduce existential truths about what was in Chris Dunn’s best interest?”
The physicians who cared for Mr. Dunn for over a month had certainly met him and members of the Methodist Hospital Biomedical Ethics Committee met with the family several times. Court documents are clear that the doctors believed the life-sustaining treatments were causing suffering and that the committee agreed that the treatments were medically inappropriate. There certainly is no evidence that the doctors or the committee members sought to intentionally “end” Chris’ life. “Medically inappropriate treatment” is not an “existential truth” and never in the patient’s best interest.
(Some may remind us that suffering can have benefits. However, Mr. Dunn couldn’t consent to suffering, much less benefit from the suffering, whether as a medical treatment or a willing religious self-sacrifice.)
Robert P. George is one of my heroes a conservative tenured professor of law and ethics at Princeton and one of the founders of the Witherspoon Institute, an organization known for its defense of Judeo-Christian ethics based on natural law, and the parent organization of Public Discourse. He has helpfully outlined a “key” to evaluate the withholding or withdrawing of life-sustaining care:
“[T]he key is the distinction between what traditionally has been called “direct killing,” where death (one’s own or someone else’s) is sought either as an end in itself or as a means to some other end, and accepting death or the shortening of life as a foreseen side effect of an action or omission whose object is something other than death—either some good that cannot be achieved or some evil that cannot be avoided without resulting in death or the shortening of life.”
George and Hawley each point to a value in medicine that is higher than autonomy or even preserving life at all costs: the duty of physicians to care for the patient. “Cure when possible, but first, do no harm.”
The lawyers didn’t just sue to maintain “life-sustaining treatments,” or even Mrs. Kelly’s right to force the doctors to treat Chris the way she wanted them to. The lawsuit, blog posts and public statements document the ultimate goal to have TADA declared unconstitutional and to force all doctors to give patients and surrogates the right to demand any and all desired treatment indefinitely. The power of State courts, law enforcement and licensing would be used to force Texas doctors to carry out acts against our medical judgment, education, experience and conscience.
What justification can the lawyers and Dr. Hawley give for not believing the physicians who care for patients daily and hourly when those caretakers document that the patient is suffering?
What kind of physicians will we end up with if the State can force us to act without judgement or conscience?
What kind of State would we have?
Based on a video and his imagined conversations between “malevolent” and “utilitarian” doctors and hospitals, Hawley declares Texas a “morally impoverished society.” Ignoring sworn statements from the physicians and misrepresenting TADA, he distorts the purpose of the Texas Advance Directive Act, which is to address the problems encountered when patients and surrogates disagree., Only by assuming evil intent is he able to force doctors to prove a negative and distract from any possibility of a conflict between the equal and inalienable rights of the patient and the doctor.
While the video of Chris apparently praying to be allowed to live wrenched at our emotions, it was used to tell a false story upon which Dr. Hawley built his harmful assumptions. We would all do well to remember my Mama’s advice: Don’t believe anything you hear and only half of what you see.”
Edited for grammar and decrease wordiness and formatting (1-15-16). BBN
I’ll admit that I’m not a lawyer and have to do my homework to even attempt to understand lawyer-speak. (For example, see this definition of “Abatement”) How I wish more lawyers would admit they aren’t doctors, especially when they accuse doctors and entire hospital committees of killing patients.
Earlier this week, I reviewed the latest sensationalized case involving lawyers and lawyer-lobbyists playing doctor in the media and courts to overturn Section 166.046 of the Texas Advance Directive Act (“TADA”).
TADA outlines the process to settle disputes between an attending physician and the patient (or the family of a patient) when the medical judgment of the doctor about what is medically appropriate for the patient conflicts with the demands for treatment that the patient or family wants *that* particular doctor to perform.
Texas law prohibits the removal of “artificially administered nutrition and hydration” and pain medications unless the doctors determine they will cause further harm. However, a ventilator, intubation tubes in the throat, cardio-version (CPR), surgery and invasive procedures or tests are not ordinary or comfort care and are considered “life-sustaining” treatment that may be removed or withheld from a patient with a terminal disease if the patient’s doctor determines that are not medically appropriate. There is certainly no provision in Texas law to intentionally stop a patient’s breathing or to otherwise cause certain death.
The lawyers lobbying and suing against TADA admit in both public statements and legal complaints that they will settle for nothing less than “Due Process,” lawyer-speak reference to the Fourteenth Amendment clause, “due process of law.” They demand that every dispute about medically appropriate care between doctors and patients be argued – by lawyers – in court, preferably with a risk of “liability” for the doctor, any committee member who reviews the case under TADA, and the hospital where the patient is under care. Judges, and possibly juries, would determine the local medical standard of care, which medical procedures are appropriate for which patients, and liability. Lawyers and judges would essentially practice medicine instead of doctors.
To summarize this latest case, court records document** the affidavit from the attending physician of a 46 year old Pasadena, Texas man, Chris Dunn. Mr. Dunn was admitted to the ICU at Houston’s Methodist hospital unresponsive after a major gastrointestinal bleed due to metastatic pancreatic cancer led to his emergency transfer from a hospital in his hometown. Mr. Dunn was on a ventilator and suffering from liver, kidney, and respiratory failure. He had fluid in his lungs, necessitating higher and higher pressures on the ventilator. He had fluid leaking into the abdominal cavity due to the liver failure, ascites, that required intermittent draining. He also suffered from hepatic encephalopathy, a form of variable dementia and delirium. His doctors and his father agreed that the repetitive, invasive treatments necessary to maintain the ventilator and treat the multi-organ failure should be stopped because they were causing Mr. Dunn harm, while comfort care would continue.
In their lawsuit against the hospital, a group of lawyers brought in by Mr. Dunn’s mother and Texas Right to Life sued the hospital in Mr. Dunn’s name, although there was a question about both Mr. Dunn’s ability to legally consent and the legal status of either parent alone to make medical decisions on Mr. Dunn’s behalf. In fact, the court ruled an “Abatement” or suspension of the lawsuit on December 4, 2015, until the legal guardianship for Mr. Dunn could be settled in another court. And, sadly, in spite of continued treatment in the Intensive Care Unit, on a ventilator, with IV and tube feedings, and all the repetitive blood tests, suctioning, and invasive procedures these treatments required, Mr. Dunn succumbed to his disease before that other court could meet to name a guardian.
In their lawsuit against the hospital, the lawyers even accuse “the facility” (not the attending doctor) of planning to actively euthanize Mr. Dunn by the deliberate use of injections intended to cause his death, rather than to relieve his pain:
“Defendant scheduling . . . and Defendant administering, via injection, a combination of drugs which will end his life almost immediately, thus warranting immediate intervention by this court.” (**p.2)
The lawyers further declared that the doctors and the Methodist Biomedical Ethics Committee – and every doctor or hospital committee – would be corrupted by their affiliation with the hospital:
“The statute does not provide adequate safeguards to protect against the conflict of interest inherently present when the treating physician’s decision is reviewed by the hospital “ethics committee” to whom the physician has direct financial ties.
“Texas Health and Saftey [sic] Code violates Plaintiff’s right to procedural due process by failing to provide an adequate venue for Plaintiff and those similarly situated to be heard in this critical life-ending decision. The law also fails to impose adequate evidentiary safeguards against hospitals and doctors by allowing them to make the decision to terminate life-sustaining treatment in their own unfettered discretion.” (**pp. 5,6)
“Under Tex. Health and Safety Code 166.046, a fair and impartial tribunal did not and could not hear Dunn’s case. “Ethics committee” members from the treating hospital cannot be fair and impartial, when the propriety of giving Dunn’s expensive life-sustaining treatment must be weighed against a potential economic loss to the very entity which provides those members of the “ethics committee” with privileges and a source of income.” (**p. 7)
Lawyer-speak notwithstanding, I can’t figure out – and the lawyers don’t tell us – how to ensure that “unfettered” pancreatic cancer presenting with multi-organ failure followed “due process” in Mr. Dunn’s case. Other than lawyers from each side hiring and paying even more doctors to re-examine the patient and re-view the existing medical records, repeated clinical exams and nurses’ notes, lab work and non-invasive scans of the liver and abdomen, what would a judge or jury consider “evidentiary safeguards against doctors and hospitals?”
But in news article after blog post, lawyers (but no doctors) claimed that “the hospital wanted to kill” Mr. Dunn. Lawyers (but no doctors) claimed there were un-named additional tests and treatments which could have changed the diagnosis, treatment or prognosis. Lawyers (but no doctors) disputed the medical judgment of the very doctors from whom the lawsuit demanded continued intensive care.
In their lawsuit, the lawyers also declared that, “Members of a fair and impartial tribunal should not only avoid a conflict of interest, they should avoid even the appearance of a conflict of interest, especially when a patient’s life is at stake.” (*p. 7) But that didn’t stop them from including an ironic and self-serving demand that Methodist hospital pay their “Attorney fees and costs.” (p. 12)
**(Protected “.pdf” “Images” of the original legal documents quoted below can be found online, here. The document images aren’t link-able and can’t be copied or printed, so I will have to type up and share quotes. See Family case number 2015-69681. The quotes above are from document number 6796448.pdf, “Plaintiff’s Original Verified Petition and Application for Temporary Restraining Order and Injunctive Relief.”)
Here’s Section 166.046 of the Texas Advance Directive Act, the part of Texas Law that is in the news, these days. This part only applies when there is a disagreement between the doctor (whom the patient wants to continue treatment) and the patient or his surrogate about treatment decisions.
Sec. 166.046. PROCEDURE IF NOT EFFECTUATING A DIRECTIVE OR TREATMENT DECISION. (a) If an attending physician refuses to honor a patient’s advance directive or a health care or treatment decision made by or on behalf of a patient, the physician’s refusal shall be reviewed by an ethics or medical committee. The attending physician may not be a member of that committee. The patient shall be given life-sustaining treatment during the review.
(b) The patient or the person responsible for the health care decisions of the individual who has made the decision regarding the directive or treatment decision:
(1) may be given a written description of the ethics or medical committee review process and any other policies and procedures related to this section adopted by the health care facility;
(2) shall be informed of the committee review process not less than 48 hours before the meeting called to discuss the patient’s directive, unless the time period is waived by mutual agreement;
(3) at the time of being so informed, shall be provided:
(A) a copy of the appropriate statement set forth in Section 166.052; and
(B) a copy of the registry list of health care providers and referral groups that have volunteered their readiness to consider accepting transfer or to assist in locating a provider willing to accept transfer that is posted on the website maintained by the department under Section 166.053; and
(4) is entitled to:
(A) attend the meeting;
(B) receive a written explanation of the decision reached during the review process;
(C) receive a copy of the portion of the patient’s medical record related to the treatment received by the patient in the facility for the lesser of:
(i) the period of the patient’s current admission to the facility; or
(ii) the preceding 30 calendar days; and
(D) receive a copy of all of the patient’s reasonably available diagnostic results and reports related to the medical record provided under Paragraph (C).
(c) The written explanation required by Subsection (b)(4)(B) must be included in the patient’s medical record.
(d) If the attending physician, the patient, or the person responsible for the health care decisions of the individual does not agree with the decision reached during the review process under Subsection (b), the physician shall make a reasonable effort to transfer the patient to a physician who is willing to comply with the directive. If the patient is a patient in a health care facility, the facility’s personnel shall assist the physician in arranging the patient’s transfer to:
(1) another physician;
(2) an alternative care setting within that facility; or
(3) another facility.
(e) If the patient or the person responsible for the health care decisions of the patient is requesting life-sustaining treatment that the attending physician has decided and the ethics or medical committee has affirmed is medically inappropriate treatment, the patient shall be given available life-sustaining treatment pending transfer under Subsection (d). This subsection does not authorize withholding or withdrawing pain management medication, medical procedures necessary to provide comfort, or any other health care provided to alleviate a patient’s pain. The patient is responsible for any costs incurred in transferring the patient to another facility. The attending physician, any other physician responsible for the care of the patient, and the health care facility are not obligated to provide life-sustaining treatment after the 10th day after both the written decision and the patient’s medical record required under Subsection (b) are provided to the patient or the person responsible for the health care decisions of the patient unless ordered to do so under Subsection (g), except that artificially administered nutrition and hydration must be provided unless, based on reasonable medical judgment, providing artificially administered nutrition and hydration would:
(1) hasten the patient’s death;
(2) be medically contraindicated such that the provision of the treatment seriously exacerbates life-threatening medical problems not outweighed by the benefit of the provision of the treatment;
(3) result in substantial irremediable physical pain not outweighed by the benefit of the provision of the treatment;
(4) be medically ineffective in prolonging life; or
(5) be contrary to the patient’s or surrogate’s clearly documented desire not to receive artificially administered nutrition or hydration.
(e-1) If during a previous admission to a facility a patient’s attending physician and the review process under Subsection (b) have determined that life-sustaining treatment is inappropriate, and the patient is readmitted to the same facility within six months from the date of the decision reached during the review process conducted upon the previous admission, Subsections (b) through (e) need not be followed if the patient’s attending physician and a consulting physician who is a member of the ethics or medical committee of the facility document on the patient’s readmission that the patient’s condition either has not improved or has deteriorated since the review process was conducted.
(f) Life-sustaining treatment under this section may not be entered in the patient’s medical record as medically unnecessary treatment until the time period provided under Subsection (e) has expired.
(g) At the request of the patient or the person responsible for the health care decisions of the patient, the appropriate district or county court shall extend the time period provided under Subsection (e) only if the court finds, by a preponderance of the evidence, that there is a reasonable expectation that a physician or health care facility that will honor the patient’s directive will be found if the time extension is granted.
(h) This section may not be construed to impose an obligation on a facility or a home and community support services agency licensed under Chapter 142 or similar organization that is beyond the scope of the services or resources of the facility or agency. This section does not apply to hospice services provided by a home and community support services agency licensed under Chapter 142.
Added by Acts 1999, 76th Leg., ch. 450, Sec. 1.03, eff. Sept. 1, 1999. Amended by Acts 2003, 78th Leg., ch. 1228, Sec. 3, 4, eff. June 20, 2003.
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 3.0503, eff. April 2, 2015.
Acts 2015, 84th Leg., R.S., Ch. 435 (H.B. 3074), Sec. 5, eff. September 1, 2015.
I am glad that the rules are explicit about the duty to report sexual or physical abuse.
Here’s a statement from Texas Alliance for Life, with links to the ruling:
Austin, TX — Today the Texas Supreme Court released rules for how courts handle judicial bypass proceedings regarding secret abortions on minors girls without parental notification or consent. The rules were created in response to HB 3994, authored by Rep. Geanie Morrison (R-Victoria) and sponsored by Sen. Charles Perry (R-Lubbock) and strongly supported by Texas Alliance for Life.
The following statement is attributed to Joe Pojman, Ph.D., executive director of Texas Alliance for Life:
We are pleased with the Supreme Court’s strong rules regarding the judicial bypass process for abortions on minor girls. These bring to fruition a 10-year effort by Texas Alliance for Life and a coalition of pro-life organizations to protect minor girls in Texas from abortion. In 2005, the Texas Legislature passed a bill requiring doctors to obtain the consent of a parent before performing abortions on minor girls. In 2015, the Legislature passed, and Gov. Abbott signed into law, HB 3994 to reform the judicial bypass process by which a judge can allow abortions on minors without parental consent. The reforms closed loopholes and increased protections for the minors from abuse. The Texas Supreme Court has faithfully implemented House Bill 3994 in a way that will best protect the well being of minor girls.
Here is a link to the Texas Supreme Court’s order issuing the rules: http://www.txcourts.gov/media/1225647/159246.pdf.
HB 3994 was one of five major pro-life bills and numerous other pro-life provisions passed in 2015. Here is a summary.