Medical consent is systemically broken in hospitals
Mary Beach MD
This morning I am listening to yesterday’s testimony by Mary Beach MD, who is some sort of academic expert on hospital communication with patients apparently, who was hired by the hospital to offer an opinion on informed consent that cast doubt on the Schara’s testimony in the case of the wrongful death of Grace Schara by medical battery being heard in Wisconsin in these weeks.
If Dr Mary Beach really represents the standard concept of informed consent in hospitals today then medical consent is completely systemically broken. Every question about consent she seems to have come down upon the side of the hospital, strangely enough, although I suppose that’s what she was paid to do. She didn’t even think it was terrible that the nurses didn’t know Jess had power of attorney, didn’t care to resuscitate Grace when told to by someone with power of attorney, or that Grace was apparently put on a DNR without her family’s full consent.
Regarding the DNR; they are trying to imply that the Doctor was justified in putting Grace on the DNR, “if they have a conversation and they express their wishes and that serves as a primary way of communicating with the rest of the team, and it should be documented in the notes, as Dr Shokar did.” They were also very cleverly conflating DNI and DNR orders.
These are the events they discuss, apparently from Shokar’s notes: on the evening of the 12th Shokar explains that her oxygen blood concentrations have been falling. Talks about calling and speaking to Cindi Grace’s mum, who refers him to Scot, they had a family conference regarding best and worst case scenarios, if we can’t keep her oxygenated what do you want us to do? They didn’t want to decide at that time. He conveys that it’s very urgent. He goes on to say that if she’s not going to get intubated there’s futility in doing cardiac compressons if they’re not going to intubate. They said they would talk the following day.
The expert says this conversation met the standard of care. And that if Grace was put on a DNR by the Doctor they didn’t need to put a wristband on Grace saying DNR. In fact this is completely incorrect: Wisconsin law requires for the wristband to be put on the patient1.
Apparently they deliberated the day after for “half an hour to an hour” and the family said they didn’t want Grace intubated. Shokar’s notes reported that they decided they didn’t want intubation or CPR or defibrillation if she suffered cardiac arrest.
On being asked about the ‘futility rationale,’ Beach says: “It does allow for a physician to enter a DNR order based on the futility rationale, which that is, if a resuscitation wouldn’t work to save the patient, it wouldn’t achive the goals, that you wouldn’t do it.” Oh, so it would have been okay even if the Schara family had not agreed.
Beach says that this is not what happened in this case — that the DNR order was based on the consent of the Schara family.
This seems to conflict with Scott Schara’s testimony rather remarkably.
Even so in a different context her testimony seems to support the idea that the nurses should have resuscitated Grace: “You can’t wait to get consent if you’re responding to an emergency, the safer thing is to assume that someone would want you to help them if you’re having an emergency rather than wait for informed consent — the least harm done by operationalising the practice that way.”
Cross-examination by the plaintiffs’ lawyer.
Schara lawyer: “Your testimony really is that for all these drugs of daily common use, you don’t need consent once you’ve entered that hospital door, you don’t need consent for these drugs, is that correct?”
Beach: “There’s no need for separate consent for any of those drugs, correct.”
Schara lawyer: “And there’s no need for consent for a powerful opiate like morphine, correct?”
Beach: “Correct.”
Schara lawyer: “The other thing is, when you have these drugs, Lorazapam, Precedex, Morphine, they have a synergestic effect, something could happen because you’re getting these three drugs at once?”
Beach: “In theory you give three drugs that have a similar effect, they could potentiate each other and depending on what they were, cause a problem, I don’t think the three drugs here were the problem Grace had.”
Schara lawyer: “When they were able to resuscitate her on the 8th, they could have resuscitated her and used atropine or epinephrine and dopamine on the 13th as well and resuscitated her, correct?”
Beach: “No they were in a different circumstance at that point.”
What this really means is that if a person or organisation has enough money, any opinion is available for purchase. Mary Beach is costing the hospital defense $21,000 for 35 hours at $600 an hour plus $12,000 to appear. Or a total of $33,000. I wonder if this might equal the cost of an academic’s conscience these days; if so it is an astoundingly low figure, considering that it might be one’s eternal soul that is on the other side of the ledger.
Redirection afterwards
Hospital Defense: “Is the focus on the patient and what’s best for the patient?”
Beach: “Yes”
Hospital Defense: “In the situation where the patient advocate is ill or is interfering with medical treatment or causing conflict, is that in the best interest of the patient?”
Beach: “Yes”
Hospital Defense: “In that situation is it within the standard of care for the family to remove or ask that person to leave?”
Beach: “The hospital yes.”
I don’t think Mary Beach represents the standard of medical consent in hospitals, so much as she represents the arrogance and untouchability of the medical establishment. Once you enter those hospital doors, you’re their piece of meat to do with whatever they want to do. You apparently have no rights, and those whose job is to advocate for you have no rights either. This reminds me of the Pharisees of Jesus’ day, who had so excessively analysed and dissected the Jewish law, that they ended up removing their own responsibility to show mercy or save lives or to rejoice when Jesus healed people, if it contradicted their strict interpretation of the Jewish law. the Jewish law was intended to demonstrate God’s desire for his people to show justice and mercy. The hospital protocols and the principle of “do no harm” has been so completely analysed and dissected by those with an interest in protecting themselves that hospital staff now believe that they can do anything, even stand by and watch while a person dies, so long as the paperwork is in place.
This case will have international repercussions. If the Scharas lose this case, there’s no way I’m going anywhere near a hospital any time in the future unless absolutely necessary.
https://live.childrenshealthdefense.org/chd-tv/events/grace-schara-wrongful-death-jury-trial/
(a) The attending health care professional, or a person directed by the attending health care professional, shall provide the patient with written information about the resuscitation procedures that the patient has chosen to forego and the methods by which the patient may revoke the do-not-resuscitate order.
(b) After providing the information under par. (a), the attending health care professional, or the person directed by the attending health care professional, shall document in the patient’s medical record the medical condition that qualifies the patient for the do-not-resuscitate order, shall make the order in writing and shall do one of the following, as requested by the qualified patient:
1. Affix to the wrist of the patient a do-not-resuscitate bracelet that meets the specifications established under s. 154.27 (1).
2. Provide an order form from a commercial vendor approved by the department under s. 154.27 (2) to permit the patient to order a do-not-resuscitate bracelet from the commercial vendor. https://law.justia.com/codes/wisconsin/chapter-154/section-154-19/