Brandon - I don't have time to read up - but here is the article I meant:
"Hospitals can end life support
Decision hinges on patient's ability to pay, prognosis
By LEIGH HOPPER
Copyright 2005 Houston Chronicle
Bill Olive / Chronicle
(L-r)Mario Caballero, Spiro Nikolouzos Jr. and Jannette Nikolouzos. St. Luke's notified Jannette Nikolouzos in a March 1 letter that it would withdraw life-sustaining care of her husband of 34 years, Spiro Nikolouzos, in 10 days.
A patient's inability to pay for medical care combined with a prognosis that renders further care futile are two reasons a hospital might suggest cutting off life support, the chief medical officer at St. Luke's Episcopal Hospital said Monday.
Dr. David Pate's comments came as the family of Spiro Nikolouzos fights to keep St. Luke's from turning off the ventilator and artificial feedings keeping the 68-year-old grandfather alive.
St. Luke's notified Jannette Nikolouzos in a March 1 letter that it would withdraw life-sustaining care of her husband of 34 years in 10 days, which would be Friday. Mario Caba-llero, the attorney representing the family, said he is seeking a two-week extension, at minimum, to give the man more time to improve and to give his family more time to find an alternative facility.
Caballero said he would discuss that issue with hospital attorneys today.
Pate said he could not address Nikolouzos' case specifically because he doesn't have permission from the family but could talk about the situation in general.
"If there is agreement on the part of all the physicians that the patient does have an irreversible, terminal illness," he said, "we're not going to drag this on forever ...
"When the hospital is really correct and the care is futile ... you're not going to find many hospitals or long-term acute care facilities (that) want to take that case," he said. "Any facility that's going to be receiving a patient in that condition ... is going to want to be paid for it, of course."
Patient showed emotion
Caballero said he believes the hospital wants to discontinue care because Nikolouzos' Medicare funding is running out.
Spiro Nikolouzos, a retired electrical engineer for an oil drilling company, has been an invalid since 2001, when he experienced bleeding related to a shunt in his brain. Jannette Nikolouzos, 58, had cared for her husband at their Friendswood home, feeding him via a tube in his stomach. Her husband couldn't speak, she said, but recognized family members and showed emotion.
On Feb. 10, the area around the tube started bleeding, and Nikolouzos rushed her husband to St. Luke's for emergency care. Early the next morning, she said, the hospital called and said he had "coded" and stopped breathing and had to be placed on a ventilator.
A neurologist told her, she said, that he is not brain-dead and the part of the brain that controls breathing is still functioning. Although his eyes were open and fixed when he first was placed on the ventilator, he has started blinking, she said.
A missed opportunity
Dr. Marcia Levetown, director of palliative care at The Methodist Hospital, said moving Nikolouzos to a nursing home or other type of facility may not be an option if his body is dependent on several types of technology, such as mechanical ventilation and kidney dialysis.
Levetown said when families and hospitals take their disagreements to court, it often means the hospital has missed an important opportunity in the family's emotional healing.
Often missing from aggressive medical care is empathy for family members and acknowledgment of grief, she said.
"The acknowledgment of 'You clearly love your husband very much. You've done the good fight' " makes a difference, she said. Levetown also tells families, "Whatever might be beneficial, you've made sure he's gotten that. We all wish he could get better ... How can we best honor this man ... as we accompany him in his next journey?"
Law allows removal
State law allows doctors to remove patients from life support if the hospital's ethics committee agrees, but it requires that the hospital give families 10 days to find another facility.
A similar case is still in the courts. Texas Children's Hospital wants to discontinue life support on 5-month-old Sun Hudson, who was diagnosed shortly after birth with a fatal form of dwarfism. His mother, Wanda Hudson, wants her son's care to continue at the hospital.
On Wednesday, a judge will consider whether Harris County Probate Court judge William McCulloch may remain on the Hudson case. Caballero, who represents Wanda Hudson, filed a motion that McCulloch remove himself from the case after making what Caballero said were biased statements."
http://www.chron.com/cs/CDA/ssistory.mpl/metropolitan/3073295
And a law blog:
"March 16, 2005
Life-Support Stopped for 6-Month-Old in Houston
Yesterday Sun Hudson, the nearly 6-month-old at Texas Children's Hospital in Houston, diagnosed and slowly dying with a rare form of dwarfism (thanatophoric dysplasia), was taken off the ventilator that was keeping him alive. A Houston court authorized the hospital's action, and Sun died shortly thereafter. Today's Houston Chronicle and Dallas Morning News have most of the details.
Both papers report that this is the first time in the United States a court has allowed life-sustaining treatment to be withdrawn from a pediatric patient over the objections of the child's parent. (The Dallas paper quotes John Paris, a bioethicist at Boston College, as its source.) If true, the unique Texas statute under which this saga was played out contributed in no small way to the outcome. As one of the laws co-authors (along with a roomful of other drafters, in 1999) let me explain.
Under chapter 166 of the Texas Health and Safety Code, if an attending physician disagrees with a surrogate over a life-and-death treatment decision, there must be an ethics committee consultation (with notice to the surrogate and an opportunity to participate). In a futility case such as Sun Hudson's, in which the treatment team is seeking to stop treatment deemed to be nonbeneficial, if the ethics committee agrees with the team, the hospital will be authorized to discontinue the disputed treatment (after a 10-day delay, during which the hospital must help try to find a facility that will accept a transfer of the patient). These provisions, which were added to Texas law in 1999, originally applied only to adult patients; in 2003; they were made applicable to disputes over treatment decisions for or on behalf of minors. (I hasten to add that one of the co-drafters in both 1999 and 2003 was the National Right to Life Committee. Witnesses who testified in support of the bill in 1999 included representatives of National Right to Life, Texas Right to Life, and the Hemlock Society. Our bill passed both houses, unanimously, both years, and the 1999 law was signed by then Governor George W. Bush.)
In the Hudson case, the hospital ran through the statutory procedure, but decided nonetheless to get a court order authorizing withdrawal of Sun Hudson's ventilator support. The hospital undoubtedly had its own sufficient reasons for taking this additional step; the statute doesn't require a court order. Indeed, the statute was designed to keep these cases out of court, if possible.
I am no great fan of unilateral withdrawals of treatment under the banner of "medical futility." When our drafting team agreed on the key language in chapter 166, I said that I hoped the authority to unilaterally withhold treatment would never have to be invoked, but I knew then what I know even better now: sometimes good, humane medical care requires it.
Since the 2003 change that made the law applicable to minors, I have participated in two cases in which life-support was ultimately withdrawn from infants over parental objections. In both cases, the hospital extended the 10-day waiting period in order to attempt to restart discussions with the parents before unilaterally withdrawing life-support. In one case, a previous hospital's ethics committee (on which I also serve) had twice agreed with the attending physician. The hospital CEO overruled the committee the first time (before the 2003 amendment that added minors to chapter 166), and the second time the child was transferred to our hospital on the 9th day, and we restarted the statutory process from scratch. In neither case did the hospital resort to a judicial proceeding to settle the treatment dispute.
My experience on five hospital ethics committees, and as co-chair of two, is that in both adult and pediatric cases, most futility disputes never get to this last step of unilateral withdrawal of life-sustaining treatment. In most cases either the families drop their opposition along the way or the patient dies before the due-process steps required by the statute have been exhausted. Last fall, ethicists at M.D. Anderson surveyed Texas hospitals' experiences under chapter 166; I hope they will publish their results soon. It will be extremely interesting to find out how often the statutory process has been followed all the way to the end, including withdrawal of life-sustaining treatment over family objections.
There is no telling how the Houston judge would have decided this case if chapter 166 were not on the books. On the one hand, it appears that no judge in this country has ever sided with the family in one of these treatment disputes. On the other hand, the physicians, hospital, and ethics committee appear to agree that Sun's condition was fatal and that his protracted death was not without some suffering. (I don't know how to square this with newspaper reports that "[t]he hospital's description of Sun [was] that he was motionless and sedated for comfort.")
But in this case, the judge wasn't writing on a blank slate. The Legislature had already spoken, twice -- once in 1999 when it enacted chapter 166 and again in 2003 when it amended the law to make it apply to pediatric patients. All the judge had to do -- and apparently all he did do -- was to find that the law authorizes the hospital to withdraw treatment over the objections of Sun's mother, Wanda Hudson.
The papers also report than another case is making its way through Houston courts: "Another case involving a patient on life support — a 68-year-old man in a chronic vegetative state whose family wants to stop St. Luke's Episcopal Hospital from turning off his ventilator — was scheduled to be heard Tuesday by the Houston-based 1st Court of Appeals. But the case was transferred to the 14th Court of Appeals, which promptly issued a temporary injunction ordering St. Luke's not to remove the man's life support. No hearing date has been set." More on this case in a future post. [tm]"
http://lawprofessors.typepad.com/healthlawprof_blog/2005/03/lifesupport_sto.html
Was Bush governor in 1999?
) would have been better spent seeking the treatment it was intended for at the time of settlement. 