Question: "We have been following the story about the nurse who refused to give CPR to a dying woman at a California independent living home. The story has sparked great debate here in our Senior Living Community. Can you tell us whether she was legally right to refuse giving CPR?"
Answer: This unfortunate story is disturbing on many levels and raises important legal and ethical questions for debate and review. Whether the ‘nurse’ could legally refuse to give CPR depends on several circumstances. Was she a licensed nurse acting in that capacity? Did the resident have a DNR (Do Not Resuscitate order) in place? Was the facility an independent living facility or an assisted living facility?
Starting with the issue of the facility type first, Glenwood Gardens is an Independent Living facility. Independent living facilities may consist of fully contained apartments or even stand-alone residences and are sometimes called retirement communities. Some facilities have a communal dining rooms and provide housekeeping and laundry services, and while many have emergency call buttons in the apartments, typically there are no nurses or medical professionals on staff. The residents are presumed to be able to fully care for themselves.
In California, Independent Living facilities are not licensed and not subject to any of the Department of Social Services or Community Care Licensing regulations for assisted living. Even if Glenwood was an assisted living facility, there are no regulations that require CPR, even in assisted living. The facilities are therefore free to create their own policies regarding handling of emergencies.
There is conflicting information regarding whether the facility employee is a licensed nurse or not. If she is a licensed nurse her duties and obligations may be different than if she is not. In addition, her obligations may also depend on whether her position with the company was specifically as a nurse who was expected to render medical care to residents. Since this is an Independent Living facility it is unlikely that the course and scope of her position, even if she was a nurse, would include rendering emergency medical assistance.
California, like many states, does have “Good Samaritan” laws (California Health and Safety Code 1799.102 9)) to protect those who render emergency medical or nonmedical care at the scene of an emergency from civil liability resulting from any act or omission. However, these laws do not compel medical personnel to act in such situations, but simply provide encouragement to act.
Finally, the issue of a DNR. If there was a DNR the nurse’s actions may have been appropriate to carrying out the wishes of the resident. However, it was determined that the resident did not have a do-not-resuscitate order – thus, one would assume that she wanted to be resuscitated, but that is a big assumption, since the deceased's own daughter said she was "satisfied with the care provided."
This sad incident brings to light many ethical and legal issues. Choosing the best senior living situation can be tricky. Understanding the different types of facilities, their licensing, and the services provided is paramount to meeting the resident’s and family’s expectations. When choosing a facility it is important to understand the facility’s policies on emergency management.
Starting with the issue of the facility type first, Glenwood Gardens is an Independent Living facility. Independent living facilities may consist of fully contained apartments or even stand-alone residences and are sometimes called retirement communities. Some facilities have a communal dining rooms and provide housekeeping and laundry services, and while many have emergency call buttons in the apartments, typically there are no nurses or medical professionals on staff. The residents are presumed to be able to fully care for themselves.
In California, Independent Living facilities are not licensed and not subject to any of the Department of Social Services or Community Care Licensing regulations for assisted living. Even if Glenwood was an assisted living facility, there are no regulations that require CPR, even in assisted living. The facilities are therefore free to create their own policies regarding handling of emergencies.
There is conflicting information regarding whether the facility employee is a licensed nurse or not. If she is a licensed nurse her duties and obligations may be different than if she is not. In addition, her obligations may also depend on whether her position with the company was specifically as a nurse who was expected to render medical care to residents. Since this is an Independent Living facility it is unlikely that the course and scope of her position, even if she was a nurse, would include rendering emergency medical assistance.
California, like many states, does have “Good Samaritan” laws (California Health and Safety Code 1799.102 9)) to protect those who render emergency medical or nonmedical care at the scene of an emergency from civil liability resulting from any act or omission. However, these laws do not compel medical personnel to act in such situations, but simply provide encouragement to act.
Finally, the issue of a DNR. If there was a DNR the nurse’s actions may have been appropriate to carrying out the wishes of the resident. However, it was determined that the resident did not have a do-not-resuscitate order – thus, one would assume that she wanted to be resuscitated, but that is a big assumption, since the deceased's own daughter said she was "satisfied with the care provided."
This sad incident brings to light many ethical and legal issues. Choosing the best senior living situation can be tricky. Understanding the different types of facilities, their licensing, and the services provided is paramount to meeting the resident’s and family’s expectations. When choosing a facility it is important to understand the facility’s policies on emergency management.
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