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Health Law Keyed to Furrow
Betancourt v. Trinitas Hospital
Facts
Rueben Betancourt (Plaintiff) underwent surgery at Trinitas Hospital (Defendant) to remove a malignant tumor from his thymus gland. While Plaintiff was recovering in the post-operative intensive care unit, the ventilation tube that was supplying oxygen to him became dislodged which deprived his brain of oxygen. He developed anoxic encephalopathy, a condition that left him in a persistent vegetative state. Plaintiff was then discharged and admitted to other facilities that attempted rehabilitative treatments. He later was readmitted to Trinitas (Defendant) with a diagnosis of renal failure. Plaintiff remained in the hospital until he died. When Plaintiff died, he had not executed an advanced directive under the Advanced Directives for Health Care Act. He also had not designed a health care representative and had not left any "specific wishes regarding the provision, withholding or withdrawal of any form of health care, including life-sustaining treatment." Witnesses for both sides presented different views of Plaintiff's condition, and the impact of treatment and prognosis. At the hearing, Plaintiff's attending physician, Dr. Millman, indicated that Plaintiff was suffering from multi-system organ failure and described his neurological state as "non-cognitive" with no higher mental functioning. However, he did believe that Plaintiff was responsive to pain because he had personally witnessed Plaintiff's reactions to it. Since Plaintiff was admitted, there had not been any change in his neurological condition. It was Millman's belief that the chances of Plaintiff every having cognizant function again were "virtually zero." Dr. Schanzer, Chief o Neurology at Trinitas (Defendant), corroborated most of Millman's views regarding the neurological condition of Plaintiff. He explained that Plaintiff's brain had been damaged irreversibly and, because of that, he was in a permanent vegetative state, unable to speak or respond to verbal cues, and even though Plaintiff's eyes were open and he appeared awake, he was not alert or aware of his environment. Schanzer disagreed with Millman, however, regarding Plaintiff's ability to experience pain. He believed that Plaintiff did not feel pain, and that his responses to stimuli were due to basic reflexes of the brain stem and spinal cord. Schanzer expressed his belief that there was no chance of Plaintiff ever regaining a cognitive state. Dr. Khazaei, a nephrologist, concluded that Plaintiff was suffering from end-stage renal disease and would not likely improve. She expressed that it did not meet accepted standards of medical care to keep subjecting the Plaintiff to dialysis treatments which only prolonged his dying process. Another doctor retained by Plaintiff's family, Dr. Goldstein, a nephrologist, stated that Plaintiff's current dialysis plan "comports in every way with the prevailing standards of care." He went to say that the dialysis had been effective and it was not harmful or dangerous to Plaintiff. In the end, the Hospital's (Defendant) prognosis committee concluded that treatment should be discontinued. While the Hospital (Defendant) administration attempted to get an agreement from Plaintiff's family to place a "do not resuscitate" (DNR) order and stop dialysis treatment, the family did not budge in their refusal. Efforts were made to transfer Plaintiff to another facility, but were unsuccessful. In the end, Trinitas (Defendant) acted unilaterally, placing a DNR order in Plaintiff's chart as well as surgically removing the dialysis port from his body. Plaintiff's daughter requested a temporary restraining order to continue the Plaintiff's same treatment. The trial court ordered Trinitas (Defendant) to re-establish the level of treatment that had been provided to Plaintiff before the dialysis was discontinued and also to remove a DNR order that had been placed in his chart. In a subsequent hearing, the trial court concluded that decisions regarding Plaintiff's proper course of treatment could not be made by the hospital; rather, such decisions should be made by a surrogate who could take Plaintiff's personal value systems into account when deciding what medical treatment was appropriate. The restraining order was made permanent and Plaintiff's daughter was appointed guardian. After Trinitas (Defendant) filed for an appeal, Plaintiff died. Trinitas (Defendant) next filed a motion to dismiss the appeal as moot.
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