Why a Nurse Refused to Give a Dying Woman CPR

55 Comments

Should a medically-trained staff member at a senior living facility watch an elderly woman pass out and do nothing to revive her?

This is a question the entire elder care community has grappled with in the years since the shocking death of 87-year-old Lorraine Bayless. She collapsed in the dining room at Glenwood Gardens, an independent living facility in Bakersfield, California.

After Bayless lost consciousness, a staff member called 911 and was connected with emergency dispatcher, Tracey Halvorson.

For seven minutes and 16 seconds, Halvorson pleaded with the employee, who was also a nurse, to begin CPR to keep Bayless breathing.

“She’s going to die if we don’t get this started. Do you understand?” Halvorson says to the nurse after being told, “We don’t do CPR at this facility.”

“Can we flag someone down on the street? And get them to help this lady?” Halvorson asks in desperation, offering to teach anyone willing to help how to perform CPR. “As a human being I don’t…you know…is there anybody that’s willing to help this lady and not let her die?”

The answer to Halvorson’s question was no. No one performed CPR on Bayless. Emergency medical personnel took her to the hospital, where she was later pronounced dead.

Senior Living Facilities Don’t Have to Offer Medical Care

It may sound surprising to some, but the nurse’s claim that her facility wasn’t required to perform CPR on Bayless was perfectly legitimate—from a legal standpoint at least.

Independent living facilities in certain states (California being one of them) are not licensed to provide medical care to elderly residents. Glenwood Gardens is one such facility. Residents and their families are supposed to be informed about such policies before they agree to live there.

Jeffrey Toomer, executive director of Glenwood Gardens, released a public statement defending the actions of the employee. “Our practice is to immediately call emergency medical personal for assistance and to wait with the individual needing attention until such personnel arrives,”
says Toomer. “That is the protocol we followed.”

Glenwood Gardens conducted a full internal review of the case surrounding Bayless’ death. But, Bayless’ daughter, herself a nurse, has reportedly said that she is satisfied with how the independent living facility responded to her mother’s collapse.

Drawing the Line Between Policy and Compassion

The incident at Glenwood Gardens sparked controversy and left medical ethicists and long-term care experts deeply divided.

“It is totally unethical for anyone, no less medical personnel, to stand by and watch a person die,” says Carole Lieberman, M.D., psychiatrist and best-selling author of “Coping with Terrorism: Dreams Interrupted.”

“I think the nurse who let her [Bayless] die should be fired and criminally charged, along with a civil suit being filed against the home,” Liebermann continues. “This is incredibly unethical and disturbing.”

Many agree with Lieberman’s stance, proclaiming their incredulity that a woman with medical training was willing to stand by and watch someone die. Others are taking a different stance.

Reports vary as to whether or not Bayless had a Do Not Resuscitate order (DNR) stating that, in the event that her heart stopped or she ceased to be able to breathe on her own, she did not want to undergo CPR.

But, even if CPR had been performed, her chances of surviving the ordeal were probably slim. “CPR is unlikely to restore the patient to their pre-arrest condition and unlikely to be successful at all,” notes Kathleen Powderly, C.N.M., Ph.D., director of the John Conley Division of Medical Ethics and Humanities at SUNY Downstate Medical Center.

Only about 5 percent of people who undergo CPR for a cardiac arrest outside of the hospital survive. Those are not very promising odds, and they get even smaller if the person is older and frail. According to Powderly, for a patient who has expressed the desire to not be resuscitated, dying after a failed CPR attempt constitutes a loss of dignity.

She also says that the medical community (and the public as a whole) should avoid finger pointing, as many of the extenuating circumstances surrounding Bayless’ death are still unknown.

Powderly does question why emergency medical personnel were called by Glenwood’s nurse if no emergency response was desired. “If that was the case, it seems to me that a licensed health care professional is obligated to use their skills,” she says.

Ultimately, Powderly feels that this sad story underscores the vital importance of having advance directives in place for elderly family members. “It is important to know what a person would want us to do, and that’s what should drive the emergency response,” she says.

Setting up advance care directives (i.e. living will, power of attorney, DNR) represents an important step in planning for a loved one’s future care.

The following articles can help guide you through the process of setting up advanced care directives:

This incident also highlights the need for seniors and their caregivers to ensure that they are fully aware of a senior living community’s policies and ability to provide emergency medical care before signing a contract.

If your loved one is already residing in a facility and you aren’t quite sure of the rules regarding emergency resuscitation and other forms of medical intervention, be sure to call and get your questions answered by a staff member who is familiar with the regulations.

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55 Comments

I have to say that I am on the side of the facility in this instance. If Bayless, the lady who passed away, signed the DNR order then no one has the right to complain or demonize the facility. This was the choice of the resident.

And while I cannot speak to the exact circumstances here, I know that when my mother was admitted to her nursing home she was asked about a situation like this...and she signed the DNR.

So if one of the nursing home staff does not perform CPR on my mother if something similar happens to her...is that wrong? This was her wish.

And the article goes on to say that the daughter of Bayless, herself a nurse, has no problem with the way things were handled.

The only lack of ethics in this instance is to not follow the wishes of the patient...as long as that patient was not suffering from any cognitive issues when they were signing the DNR.

I think there are some facts that we are not privy to. At no time did the nurse tell the dispatcher that the patient had a DNR, just that it is their policy to not perform CPR. If someone has a DNR, I don't believe 911 should be called because the paramedics WILL try to resuscitate unless either given the DNR or the patient physically signs a form refusing care. Had 911 not been called and instead attention been directed towards comforting the patient in those last few minutes, we wouldn't be discussing this now. I agree a DNR must be adhered to, it is the patient's choice.
Why is this an "unbelievable incident"? I certainly believe it. It was the policy of the facility and it was the patient's wish. Why should it be unbelievable that the patient's wish was followed?

What is the point of a DNR order if a facility is expected to ignore it?

Before my husband's last hospitalization I called the administrator and made certain they did indeed honor DNRs. I knew how strongly my husband felt about that, and also that as frail as he was CPR would probably fracture his ribs.

I think it is absolutely unethical to perform CPR on a person who is known to not want it and who has signed an advance directive to that effect.

There certainly is a time and place for CPR. It is not in a senior facility on a person who does not want it done.

(Neighbors performed CPR on my husband many years ago. We were certainly grateful then. I am not against CPR. I am against it when the person himself or herself has made a thoughtful, careful evaluation of their circumstances and chooses not to have it.)