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By Henry A. Barrios / The Californian
BY JOHN COX AND RACHEL COOK Californian staff writers email@example.com; firstname.lastname@example.org
The family of an elderly woman whose death ignited a wave of anger after a nurse at her senior living community refused to give CPR released a statement Tuesday saying they have no plans to sue.
Lorraine Bayless' family said she "personally selected" Glenwood Gardens independent living facility in Bakersfield knowing there were not "trained medical staff" and that she wanted to "die naturally...without any kind of life-prolonging intervention."
From the Bayless family
The full statement from the Bayless family, sent to KGET Channel 17:
"Our mother and grandmother was a remarkable and intelligent woman who was blessed to have a great life of 87 years. It is the wish of our family to honor and celebrate her life at this personal time.
"Like so many seniors, it was our mother's wish to live independently. She was fully aware that Glenwood Gardens did not offer trained medical staff. Even so, she personally selected the senior living community, and our family has come to know the staff and been very pleased with Glenwood Gardens as her home.
"It was our beloved mother and grandmother's wish to die naturally and without any kind of life-prolonging intervention. Our family respects the right of all people to make their own life choices in such cases.
"We regret that this private and most personal time has been escalated by the media. Caregivers, nurses and other medical professionals have very difficult waters to tread in the legal and medical landscape of our country today.
"We understand that the 911 tape of this event has caused concern, but our family knows that mom had full knowledge of the limitations of Glenwood Gardens, and is at peace. We also have no desire, nor is it the nature of our family, to seek legal recourse or try to profit from what is a lesson we can all learn from.
"We wish to focus on our family at this time, and this will be our final comment on this personal matter."
Dr. Susan Leonard, an assistant clinical professor of geriatric medicine at University of California, Los Angeles, said consumers need to understand the different levels of care offered by facilities that cater to seniors. A nursing home and an independent living community don't offer all the same services. Independent living environments have a social component but no medical care is expected, she said.
Leonard recommended that family members chat with staff and residents at a particular community before deciding if that facility is right for their family.
"Family members should be aware if their loved one is living in one of these places to find out what kind of services (the facility) can and can't provide," Leonard said.
It's also important to talk about what a patient wants while they are still comfortable and able to make those decisions, not to wait until a crisis unfolds, physicians say. They should also put their wishes in writing.
In the absence of such paperwork, loved ones and physicians may be left to make medical decisions without good information about what a patient and his or her family wants.
"We have far too many older people that lack some kind of a document about their preferences," said Dr. Peter Boling, a professor of geriatric and internal medicine at the Virginia Commonwealth University School of Medicine
Those documents are particularly important for seniors in failing health, he added.
"If you don't do it, you wind up sometimes in a very painful and trying situation," Boling said.
UCLA's Leonard said she and her colleagues recommend patients have an advance directive.
A Physician Orders for Life-Sustaining Treatment form, known as a POLST, can address more urgent care, she added. The form details what level of medical care a patient wants starting with CPR and ranging to intubation and feeding tubes.
Judy Citko, executive director for the Coalition for Compassionate Care of California, said the form is intended for people who are medically frail or have a progressive chronic condition and the elderly.
The form not only needs the patient's approval, but also a doctor's signature.
The document should be posted prominently in a patient's home, such as on the refrigerator, so it can be found quickly in an emergency. Citko said emergency responders can follow the stipulations on the form because it is a physician's order.
The document is disseminated throughout the state and virtually every nursing home has one or more residents with a POLST, but there are still places that don't use them, Citko said. The form is available online, but Citko noted that it is meant to be printed on bright pink cardstock to make sure it is easy to spot.
Copies of the Physician Orders for Life-Sustaining Treatment are available at www.capolst.org.
-- Rachel Cook
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- Excerpts from the Glenwood 911 call
The 87-year-old's death has gained international attention and sparked outrage after the release of a dramatic 911 tape detailing a Bakersfield dispatcher's pleas to a Glenwood Gardens staff member to perform CPR on Bayless or find someone who would.
In another development late Tuesday, Brookdale Senior Living, Glenwood Garden's parent company, issued a statement saying "this incident resulted from a complete misunderstanding of our practice with regards to emergency medical care for our residents.
"Glenwood Gardens is conducting a full internal investigation, which we are fully supporting, and the individual is on voluntary leave during the process."
The company is conducting a companywide review of policies involving emergency medical care, the statement said.
The statement appeared to contradict earlier statements from the facility. Jeffrey Toomer, Glenwood Gardens' executive director, said in a statement last week that "our practice is to immediately call emergency medical personnel for assistance and to wait with the individual needing attention until such personnel arrives" if there was "a health emergency at this independent living community."
"That is the protocol we followed," the statement said.
Bayless' family reiterated in their statement that they had no qualms with the care Bayless received.
"We understand that the 911 tape of this event has caused concern, but our family knows that mom had full knowledge of the limitations of Glenwood Gardens and is at peace," the statement from Bayless' family read.
"We also have no desire, nor is it the nature of our family, to seek legal recourse or try to profit from what is a lesson we can all learn from."
Lawmakers await information
The extraordinary 911 tape and its portrayal of a nurse who refused to administer CPR continued to prompt reaction from politicians.
State legislators, including those from Kern County, contacted before the family and company's statements were issued Tuesday, said they were awaiting further information before deciding whether to introduce reforms aimed at preventing similar incidents.
Several lawmakers said they simply need to know more about the circumstances surrounding Bayless death. Even so, they expressed concern about the situation, which has prompted a national discussion of end-of-life care as well as a Bakersfield police investigation and a county inquiry.
A spokeswoman for Assemblywoman Shannon Grove, R-Bakersfield, wrote in an email that Grove was "stunned" by the 911 recording in which the nurse was heard refusing to perform CPR on Bayless, apparently because she understood that the facility has a policy against it.
"There are a lot of questions that still need to be answered here, and our office anticipates that more will come to light regarding what legislative proposals would prevent situations like this when we know information such as the contents of the agreement the facility had with residents and their families, what the facility's standard operating procedures entailed, etc.," spokeswoman Kristina Brown wrote.
The Bakersfield Police Department has opened an investigation into possible criminal misconduct by Glenwood employees. Separately, Kern County's Aging and Adult Services Department is also gathering information to determine whether elder abuse took place.
The California attorney general was "aware" of the incident, a spokeswoman, Lynda Gledhill, told the Associated Press.
Sen. Jean Fuller, R-Bakersfield, wrote in an email Tuesday that she understands "the feeling to rush and find new laws that could prevent this from happening again."
"But I think we must first learn more details that might not be apparent on the emergency call tape, and also recognize that in California, there already exists (a) Good Samaritan (law) that would have likely released the nurse from liability," she wrote.
Assembly Minority Leader Connie Conway, R-Tulare, who represents part of Kern County, said that she, too, prefers to wait before proposing legislative action.
"We need to closely examine the facts of this incident and wait for the investigations to be completed before determining whether steps need to be taken to prevent this type of tragedy from happening in the future," Conway wrote in an email Tuesday.
Assemblywoman Mariko Yamada, D-Davis, chairwoman of the Assembly Committee on Aging and Long-Term Care, wrote in an email that she will take action but not yet.
"We will take the appropriate actions -- whether they be regulatory or legislative reform -- after we have a full accounting of the facts," she stated.
Senior advocates undecided
Senior care advocates said they would monitor the situation as well, but that as of Tuesday they had no specific recommendations.
"I think one of the issues, of course, is that this is an independent senior living community, and they're not licensed by the state," said Pat McGinnis, executive director of California Advocates for Nursing Home Reform.
"I'm just not sure what they would do at the state level, to tell you the truth."
Gary Passmore, vice president of the senior advocacy group Congress of California Seniors, said his organization will be watching to see if anything arises from the incident at Glenwood Gardens "that needs to be dealt with in state laws and regulations."
"We are aware of the incident. We've been reading about it," Passmore said. "I think we may be talking to some other senior and health care advocates to see if there is a need for state law to change."
He pointed out that there typically isn't a high level of medical care at facilities like the one where Bayless lived. An extreme way to look at the incident is that it was no different than seeing someone on the sidewalk or a public place go into distress, he said.
"It's more complicated from a policy perspective than it might seem," he said.
-- Government editor Christine Bedell contributed to this report.