Question about No Resuscitate Orders and Advanced Directives

[Nancyg56]

I'm so very sorry your family is going through this, I hope your MIL passes peacefully.

Do you have any concerns about your FIL maybe not being truthful about any of this? The fact that he had control of her meds and only backed off when your DH threatened to check up on him seems very odd behavior.

I am so sorry.

I very seldom would even judge another but this seems off on more than one level. I would ask the ambulance service how they got a copy of the directive adn how they happened to have the time to dig it out prior to responding to your MIL. My Mom had a DNR and she also wore her bracelet. No one else but teh VNA had copies of her directives but us.

 

[C.Ann]

Do you have any concerns about your FIL maybe not being truthful about any of this? The fact that he had control of her meds and only backed off when your DH threatened to check up on him seems very odd behavior.

In all honesty, this question crossed my mind as well.. First of all, my DD has fibromyalgia - a severe case of it - and oxycontin was never prescribed for that particular type of pain.. Secondly, the FIL had "control" of this drug and was said to have doled it out when "necessary".. Then when the family began to ask questions - and threatened to call the MIL's doctor - the FIL suddenly said he was trying to wean her off "per the doctors orders".. I really, really hate to be so cynical - especially at a time like this - but something just doesn't sound right here..

Whatever the case may be, I hope the MIL doesn't suffer and passes quickly and peacefully..

 

[matt98378]

Did your MIL have a Medical Power of Attorney? If so, was your FIL the agent on it? That could potentially cause some more issues....

 

[themilesfamily]

Do you have any concerns about your FIL maybe not being truthful about any of this? The fact that he had control of her meds and only backed off when your DH threatened to check up on him seems very odd behavior.

I am having concerns.

That same scenario happened again when MIL was admitted to the hospital -- my husband told FIL that he wanted to speak with her doctors to get a more first-hand account of her medical issues. FIL blew up and got very agitated -- questioned why my husband wanted to do that. I just don't understand why that would be a problem if everything was above-board.

FIL has always treated MIL in a very infantile way. He's encouraged others to see her as silly. Rolls his eyes at everything she says. He really plays up his role as her "caretaker" - going out of his way to make sure everyone knows how much he's had to do for her.

After she got started on that oxycontin, (which was years ago), MIL would get up, take her oxycontin and go back to bed and that's it. She was always out of it, always sweating profusely, almost always in bed. FIL had a very flexible job -- he would come home, give her the pills and leave again. He was never home. He started taking solo trips to Las Vegas and one time MIL found pics of him with a female co-worker in Vegas. He claimed he'd just "coincidentally" run into her on the plane. He supposedly had no idea she was going to Vegas, as well -- and they'd hung out together. The family found nothing odd about this, but I was flabbergasted. So I would say that, yes, he has a history of being untruthful.

I guess I'm concerned that he's moved on and doesn't have MIL's best interest at heart.

That was Monday. It's Wednesday night now and her heart is beating very well, she's lying there breathing on her own -- it's just a matter of when the dehydration and lack of nutrition will shut her body down.

 

[lovemygoofy]

I am having concerns.

That same scenario happened again when MIL was admitted to the hospital -- my husband told FIL that he wanted to speak with her doctors to get a more first-hand account of her medical issues. FIL blew up and got very agitated -- questioned why my husband wanted to do that. I just don't understand why that would be a problem if everything was above-board.

FIL has always treated MIL in a very infantile way. He's encouraged others to see her as silly. Rolls his eyes at everything she says. He really plays up his role as her "caretaker" - going out of his way to make sure everyone knows how much he's had to do for her.

After she got started on that oxycontin, (which was years ago), MIL would get up, take her oxycontin and go back to bed and that's it. She was always out of it, always sweating profusely, almost always in bed. FIL had a very flexible job -- he would come home, give her the pills and leave again. He was never home. He started taking solo trips to Las Vegas and one time MIL found pics of him with a female co-worker in Vegas. He claimed he'd just "coincidentally" run into her on the plane. He supposedly had no idea she was going to Vegas, as well -- and they'd hung out together. The family found nothing odd about this, but I was flabbergasted. So I would say that, yes, he has a history of being untruthful.

I guess I'm concerned that he's moved on and doesn't have MIL's best interest at heart.

That was Monday. It's Wednesday night now and her heart is beating very well, she's lying there breathing on her own -- it's just a matter of when the dehydration and lack of nutrition will shut her body down.

What the heck??!!? This sounds like a weird Law and Order or something. I am so sorry for your family. More sorry than I can express but if that was my mom I would be raising holy hell about what has been going on.

I don't understand why the doctor can't speak privately with your husband about everything that has happened. I would also go over to the ambulance service and speak with them. Most instances the ambulance service isn't even with the paperwork people so I don't know how they could have gotten the DNR.

Lastly and I am being way ugly, if there was a way I'd start checking out money in the accounts. If the FIL has spent it all away and looking for life insurance or something. I know this is ugly and way jumping the gun but things aren't adding up or just not adding up nicely for me.

I am again so sorry for your family and this situation. I can't imagine your heartbreak.

 

[Luvchefmic]

MIL and FIL were the only ones home.

As to what happened that night -- FIL said that he was giving MIL suppositories because she was feeling nauseated. (He supervised all her medication -- he kept her meds and distributed them to her as she needed it -- she was on Oxycontin for fibromyalgia and a couple of other meds.) She began vomiting and he said that she started to choke on her vomit and passed out. He called 911 -- he said she had only been unconscious a minute or two before they arrived. When they showed up they stuck a hard copy of the advanced directive in his face and said they wouldn't treat her. He argued with them to treat her. This caused a delay and now she is in a vegetative state in the hospital due to the delay in getting oxygen to her brain.

FIL claims that he didn't produce the directive or even mention it -- he insists that the ambulance driver/paramedic had a hard copy and produced it and refused to treat her, thus causing the delay that caused the brain damage.

I just don't see how some random ambulance would have had a hard copy of this woman's directive with them that would have caused this problem in the first place.

I don't know. Somehow this just isn't adding up for me.

Regardless, FIL has now taken MIL off all life-support and they are withholding food and water, so she will pass soon I suppose. It's incredibly sad. MIL was a saint and FIL -- not so much.

I am very sorry for what has happened to your MIL....I was an EMT for over 20 yrs...this story makes no sense at all...I don't want to cause anymore suspicion re-your FIL 's version, however, (depending on where you live) perhaps your DH can request a copy of the records from the ambulance/rescue company...don't know how you would do it as I said not sure how it works in different areas, perhaps make a phone call to her Dr to discuss ?

 

[*Fantasia*]

I'm so sorry about your mil. Hang in there, I hope you find all the answers you're looking for because you're right, something just doesn't add up.

 

[themilesfamily]

I am very sorry for what has happened to your MIL....I was an EMT for over 20 yrs...this story makes no sense at all...I don't want to cause anymore suspicion re-your FIL 's version, however, (depending on where you live) perhaps your DH can request a copy of the records from the ambulance/rescue company...don't know how you would do it as I said not sure how it works in different areas, perhaps make a phone call to her Dr to discuss ?

That's a good idea. MIL and FIL live in a large metropolitan area and it appears there are many different ambulance services. Perhaps the hospital would know which brought her in and we can contact them to get an idea of what exactly happened that night.

 

[Longsx3]

I am suspicous too. If you start investigating you may run into HIPPA and find the involved parties are reluctant to share info, I guess I would start with the Ambulance company and also the local court to see if the DNR was registered. Also when was this DNR/Advance directive signed? If your MIL was that out of it due to OXY, did she know what she was signing? You may be able to petition to have a stay on the Advance Directive.

 

[amyjo920]

I didn't completely read all the other posts so I do apologize if I'm repeating something or contradicting someone else as that is definitely not my intention. I've been a paramedic for awhile and definitely have issues about how she was treated, but first of all, protocols are different everywhere. What is the norm here may not be where you live.

My biggest pet peeve is medics, drs, nurses, etc who view the DNR as a "do not treat". That is absolutely not what a DNR is. Up until the point of intubation, defibrillation and CPR, I personally believe everything should be done. DNRs still allow "comfort measures". What a comfort measure consists of means different things to each person and is generally not spelled out anywhere. I have argued this time and time again. I personally believe that suctioning and providing ventilations (without intubation) are comfort measures. How comfortable can a person be while choking/struggling to breath? Others unfortunately do not feel this way. I think they absolutely should have suctioned, and I think you should definitely attempt to contact a supervisor at the ambulance service.

Another possibility is that they did suction but by that point it was too late. Possibly on the way to the hospital? I am a big fan of doing most of the treatment on the way to the hospital. And I have found that it's often faster/easier to grab the patient and go rather than spend the time bringing half the ambulance to the patient and then having to carry it back outside along with the stretcher.

As far as having the DNR with them, I do find that odd, but it also may be the norm there. They possibly keep copies with them, but that doesn't generally happen. Were they at the residence often and familiar with her? Had she provided them with the DNR? I know that we did use to keep a binder in each rig with information for alarm company patients that we could pull out on the way to the call.

Either way, I'm sorry for your situation and wish her much peace! My thoughts are with your family!

 

[barkley]

just as a heads up-with hiipa laws it will be almost impossible to get any kind of medical information. even with a medical power of attorney it's difficult (dh had one on his mom who recently passed away and we were still limited to some extent).

one thing that occurs to me re. the ambulance company-do you know if mil had used an attorney to draw up her legal documents? when mil got her paperwork updated (specificaly her will) the attorney (who also drafted the p.o.a. and the a.m.d.) was given some kind of permission to do certain things on her behalf-including some limited issues having to do with notifying about her medical status. the attorney could have noticed the ambulance company and provided the dnr for them to have on file.

the other thing with an ambulance company-if it's perhaps linked to the hospital (not a private entity) it might have access to certain information (like the dnr). my mil was a "frequent flyer" with her local ambulance company such that they had her information (including dnr).

i'm VERY surprised that IF the emt's had the dnr they would have gone against it as your fil says. an appropriatly executed amd and dnr do not provide wiggle room for even the medical poa to go against it.

if your dh wants information i would suggest that while his mom is alive he immediatly call the adult protective services bureau in the area his mom is hospitalized. he can request an investigation NOW which may provide him with the answers he wants and needs (once a person passes, even the person named executor of their estate can be very limited in what kind of information/records can be accessed-we have learned this in administering mil's estate).

 

[Nancyg56]

Afer reading your last post I am so sad for your family . If you and your DH are really concerned and i certainly can understand where those concerns are coming from, I would contact the social services department in the hospital where your MIl is being treated. Perhaps someone there would know how to best proceed. My heart breaks for your family.

 

[agnes!]

I'm so very sorry your family is going through this, I hope your MIL passes peacefully.

Do you have any concerns about your FIL maybe not being truthful about any of this? The fact that he had control of her meds and only backed off when your DH threatened to check up on him seems very odd behavior.

I am having concerns.

That same scenario happened again when MIL was admitted to the hospital -- my husband told FIL that he wanted to speak with her doctors to get a more first-hand account of her medical issues. FIL blew up and got very agitated -- questioned why my husband wanted to do that. I just don't understand why that would be a problem if everything was above-board.

FIL has always treated MIL in a very infantile way. He's encouraged others to see her as silly. Rolls his eyes at everything she says. He really plays up his role as her "caretaker" - going out of his way to make sure everyone knows how much he's had to do for her.

After she got started on that oxycontin, (which was years ago

), MIL would get up, take her oxycontin and go back to bed and that's it. She was always out of it, always sweating profusely, almost always in bed. FIL had a very flexible job -- he would come home, give her the pills and leave again. He was never home. He started taking solo trips to Las Vegas and one time MIL found pics of him with a female co-worker in Vegas. He claimed he'd just "coincidentally" run into her on the plane. He supposedly had no idea she was going to Vegas, as well -- and they'd hung out together. The family found nothing odd about this, but I was flabbergasted. So I would say that, yes, he has a history of being untruthful.

I guess I'm concerned that he's moved on and doesn't have MIL's best interest at heart.

That was Monday. It's Wednesday night now and her heart is beating very well, she's lying there breathing on her own -- it's just a matter of when the dehydration and lack of nutrition will shut her body down.

I am very sorry for what has happened to your MIL....I was an EMT for over 20 yrs...this story makes no sense at all...I don't want to cause anymore suspicion re-your FIL 's version, however, (depending on where you live) perhaps your DH can request a copy of the records from the ambulance/rescue company...don't know how you would do it as I said not sure how it works in different areas, perhaps make a phone call to her Dr to discuss ?

That's a good idea. MIL and FIL live in a large metropolitan area and it appears there are many different ambulance services. Perhaps the hospital would know which brought her in and we can contact them to get an idea of what exactly happened that night.

Hippaa might be an issue, but get the Hospital Ombudsman or other appropriate entities involved, this whole situation just isn't right. I'd actually hire a PI or a forensic accountant to investigate your FIL. And *yes*, I am *serious*.

I am suspicous too. If you start investigating you may run into HIPPA and find the involved parties are reluctant to share info, I guess I would start with the Ambulance company and also the local court to see if the DNR was registered. Also when was this DNR/Advance directive signed? If your MIL was that out of it due to OXY, did she know what she was signing? You may be able to petition to have a stay on the Advance Directive.

just as a heads up-with hiipa laws it will be almost impossible to get any kind of medical information. even with a medical power of attorney it's difficult (dh had one on his mom who recently passed away and we were still limited to some extent).

one thing that occurs to me re. the ambulance company-do you know if mil had used an attorney to draw up her legal documents? when mil got her paperwork updated (specificaly her will) the attorney (who also drafted the p.o.a. and the a.m.d.) was given some kind of permission to do certain things on her behalf-including some limited issues having to do with notifying about her medical status. the attorney could have noticed the ambulance company and provided the dnr for them to have on file.

the other thing with an ambulance company-if it's perhaps linked to the hospital (not a private entity) it might have access to certain information (like the dnr). my mil was a "frequent flyer" with her local ambulance company such that they had her information (including dnr).

i'm VERY surprised that IF the emt's had the dnr they would have gone against it as your fil says. an appropriatly executed amd and dnr do not provide wiggle room for even the medical poa to go against it.

if your dh wants information i would suggest that while his mom is alive he immediatly call the adult protective services bureau in the area his mom is hospitalized. he can request an investigation NOW which may provide him with the answers he wants and needs (once a person passes, even the person named executor of their estate can be very limited in what kind of information/records can be accessed-we have learned this in administering mil's estate).

I ... Lastly and I am being way ugly, if there was a way I'd start checking out money in the accounts. If the FIL has spent it all away and looking for life insurance or something. I know this is ugly and way jumping the gun but things aren't adding up or just not adding up nicely for me.

I am again so sorry for your family and this situation. I can't imagine your heartbreak.

All of the bolded above.

agnes!

 

[PaulaSB12]

What the heck??!!? This sounds like a weird Law and Order or something. I am so sorry for your family. More sorry than I can express but if that was my mom I would be raising holy hell about what has been going on.

I don't understand why the doctor can't speak privately with your husband about everything that has happened. I would also go over to the ambulance service and speak with them. Most instances the ambulance service isn't even with the paperwork people so I don't know how they could have gotten the DNR.

Lastly and I am being way ugly, if there was a way I'd start checking out money in the accounts. If the FIL has spent it all away and looking for life insurance or something. I know this is ugly and way jumping the gun but things aren't adding up or just not adding up nicely for me.

I am again so sorry for your family and this situation. I can't imagine your heartbreak.

How can you check on the accounts of your parents? I am sure the banks will not be allowed to hand over personal financial details of their customers to family members.

 

[mickeymedic]

Another paramedic weighing in here: I agree with those who say the FIL's story makes no sense. I am hard-pressed to figure out a way that the EMTs walked through the door with a DNR in hand. That just doesn't happen. In my experience, if a patient has a DNR, it is the family or the care givers who are waving that paper in our face - not the other way around. And like others have said, the EMTs are not going to dig through a filing cabinet worth of paperwork to find a DNR before responding to a scene. They were dispatched to a choking call - not a cardiac arrest. Even if (and it's a really huge stretch) the ambulance complany somehow did have paperwork on file for someone at that address, I don't see why they would have thought they would need the DNR. One last point regarding DNR - another reason I highly doubt that an ambulance company would keep a DNR on file for future use is that patients and families have the right to change their mind about DNR status. If the family/care-giver hands me the DNR, I will honor it. If the family withholds the DNR, I have no way of knowing it exists. (In fact, I must rescusitate unless I have a hard-copy of the DNR in hand.) If I somehow magically walk through the door with a DNR that the family, for whatever reason, doesn't want to have honored, I have now opened a whole can of worms that I don't believe any ambulance agency would actually want to deal with.

Anyway, I wish peace for you and your family. I am sorry you are going through this.

 

[need2cruise]

Another EMT weighing in here.

First of all, IF the EMT's had a DNR--then it is next to impossible that they would've had time to have the call come in, go in the office and obtain it (and it has to be locked up due to HIPAA laws) and then jump in the ambulance and drive to the scene--alert dispatch and get inside in under 1-2 minutes as your FIL is claiming on the time length. Not to mention, why would they have the DNR to begin with? I don't know of any situation for that kind of paperwork to be kept unless it is a situation with an elderly adult (or someone with a terminal illness) who is living alone and wants their wishes to be met and they have noone living with them or nearby to give that information to responding agencies.

Also-this is a female in her 60's with no serious health issues other than the fib/my.........why is she aspirating? Was there a possible OD on the oxy by the FIL (intentional or unintentional) that made her unable to try to clear her own airway? Things just don't add up to me on his story of the "events".

 

[Eeyore'sthebest]

She was on oxycontin for fibromyalgia? That's a very potent narcotic - not to mention extremely addictive.. Are you sure she didn't have some other serious illness that was being kept from the rest of the family?

It's a shame that you all have to go through this.. Hopefully she will pass peacefully and quickly..

C. Ann just wanted to say that my DH has fibro and severe arthritis. He is on Oxycontin for it. Has been for years. So yes, it is prescribed in some cases.

You're right. It was aspiration. The dad described her as "choking" on her own vomit -- but she actually aspirated it.

As to the oxycontin for fibromyalgia -- she didn't have any medical condition that I know of that would warrant such a powerful narcotic other than the fibromyalgia -- and that's why the family said she took it. I can only go by what FIL said because he's the one who supervised anything medical for her -- meds, doctor appointments, etc.

My husband talked to his dad numerous times about getting MIL off of oxycontin, but FIL was resistant -- he said that's what the doctors wanted her on. Eventually DH threatened to call her doctor himself and express his concerns, and at that point FIL said they started cutting her oxycontin levels down.

Just as an FYI, as a narcotic, depending on how high the dosage was your MIL would need to be hospitalized to detox her off the Oxy. My DH was warned that when he got to a certain level that this would be required. One night he ran out and had to wait until the pharmacy opened the next morning. I took the morning off of work even though he told me he would be fine. By the time I got home with his meds his only response was "Wow, now I know why drug addicts do what they do to get their next fix." It was truly eye opening for him.
So I just wanted to let you know that there is no way in hell that your FIL should have been weaning your MIL off the Oxy without medical supervision.

I hope your MIL passes peacefully. I'm so sorry this is happening.

 

[Bren's Mom]

OP, so sorry about your MIL.

Both dh and I are in public safety, I've been an EMT for almost 20 years, he's been an EMT/Paramedic for 25 and is in high level management for a large, national ambulance service. Depending on the law in your state, there are very strict regulations regarding DNR orders/advance directives. In CT, a whole procedure must be followed with lots of paperwork. EMTs and Paramedics are trained what to look for, and they definitely don't carry this paperwork with them. Also, don't bother calling the ambulance company who transported her. They are prevented from talking to you by HIPAA. However, if you have concerns about your FIL, have your DH talk to MILs doctor and ask he/she if they'll will obtain a copy and investigate. The doctor can tell your DH if he feels there are any issues with either the ambulance crew (which I doubt) or with your FIL (sorry, this is much more likely) and then your DH can petition to become your MILs guardian if he feels that's necessary.

I hope things work out.

 

[sbell111]

... The doctor can tell your DH if he feels there are any issues with either the ambulance crew (which I doubt) or with your FIL (sorry, this is much more likely) and then your DH can petition to become your MILs guardian if he feels that's necessary.

Given that the MIL had a DNR and that all there is left to do at this point is wait for her to pass, I don't think that it would be useful for the son to make such a petition.

Honestly, whether the husband presented the DNR or the medics brought it with them doesn't matter. The DNR existed because the wife wanted it to. Her requests were followed and it will soon lead to her death. It's sad, but it doesn't mean that the husband is the devil.

 

[agnes!]

OP, so sorry about your MIL.

Both dh and I are in public safety, I've been an EMT for almost 20 years, he's been an EMT/Paramedic for 25 and is in high level management for a large, national ambulance service. Depending on the law in your state, there are very strict regulations regarding DNR orders/advance directives. In CT, a whole procedure must be followed with lots of paperwork. EMTs and Paramedics are trained what to look for, and they definitely don't carry this paperwork with them. Also, don't bother calling the ambulance company who transported her. They are prevented from talking to you by HIPAA. However, if you have concerns about your FIL, have your DH talk to MILs doctor and ask he/she if they'll will obtain a copy and investigate. The doctor can tell your DH if he feels there are any issues with either the ambulance crew (which I doubt) or with your FIL (sorry, this is much more likely) and then your DH can petition to become your MILs guardian if he feels that's necessary.

I hope things work out.

I agree, especially with the bolded above. I think that your DH needs to seriously consider hiring an attorney, especially perhaps a family-law attorney (for the guardianship-issue) and also discuss with them the oddness of your FIL's 'story'.

This whole situation just doesn't pass the smell test to me, something is wrong, it might not be criminal, but it sure doesn't seem right.

agnes!