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AUSTIN, TEX---Another life and death situation is being played out in a Texas hospital and once again, a hospital's ethics committee has imposed the state's Futile Care Law and decreed that a patient's life support will be terminated despite the wishes of the patient and her family.
The life of Venlang Vo hangs in the balance at St. David's North Austin Medical Center in Austin, Texas.
The hospital has told Mrs. Vo's family that they will end her medical treatment and therefore her life on June 5 under the Texas Futile Care law.
The circumstances are very similar to the Andrea Clark case. Although intense media coverage resulted in St. Luke's Episcopal Hospital in Houston reversing its futile care decision in Andrea's case, Andrea lost her battle for life.
http://www.northcountrygazette.org/articles/050306InternetPower.html
http://www.northcountrygazette.org/articles/050706LosesFight.html
Ms. Vo is in her 60's and a patient at St. David's North Austin Medical Center in Austin, Texas. She has been diagnosed as being in a persistent vegetative state but that is disputed by the family. Ms. Vo's daughter, Loann Trihn, an emergency room doctor, says that such a diagnosis is very subjective and involves clinical assessments. Dr. Trihn and her father say they have both witnessed her mother being responsive.
Mrs. Vo was born in Vietnam. She was a young mother when Saigon fell. Her husband was an officer in the South Vietnamese Navy. After the Communists took over, they put her husband in a re-education camp. Mrs. Vo worked hard to earn enough money to bribe guards so that her husband could escape the camp. After his escape, the couple fled from Vietnam on a rickety boat with other "boat people" in 1979. They came to America, where Yolang continued to work hard so that she could bring her young daughter out of Vietnam to America. She achieved that in 1981. She also helped her sisters and the rest of her family escape the Communists to come to America. Yolang's family reveres her.
The hospital in her case, has, with grace and compassion, agreed to work with the family to explore alternatives. Yolang still has a chance to be with her family to whom she is so beloved.
Under Chapter 166 of the Texas Health and Safety Code, if an attending physician disagrees with a surrogate over a life-and-death treatment decision, there must be an ethics committee consultation with notice to the surrogate and an opportunity to participate. In a futility case such as Andrea's and Mrs. Vo's in which the treatment team was seeking to stop treatment, if the ethics committee agrees with the team, the hospital will be authorized to discontinue the disputed treatment, after a 10-day delay, during which the hospital must help try to find a facility that will accept a transfer of the patient.
"The attending physician wishes to withdraw dialysis, That is not acceptable to the family--and it against the express wishes of the patient expressed before she became unable to communicate. Ms. Vo needs a new shunt surgically implanted for her dialysis. She is receiving it by a different means at the present. The physician, apparently, does not believe that her state of life justifies the surgery", Austin attorney Jerri Ward says, the attorney representing the Vo family.
"Withdrawal of dialysis with no further attempt at creating a surgical access port not only condemns Ms. Vo to a rapid and untimely death, but prevents any initiation of dialysis on an outpatient basis should her sepsis be successfully treated and maximum medical improvement be obtained. The family has observed signs that the mother retains certain cognitive abilities which may well improve with continued treatment. Removing dialysis is a preemptive and premature act which deprives her of a more natural path toward a peaceful end of life and is contrary to her expressed wishes to fight with all her strength until her time has come. Dialysis is no longer an extreme procedure and is performed for many patients on a routine outpatient basis and can in some case be self administered. To deny such a service in a critically ill patient without family consent and access to judicial due process is ethically, morally and very possibly legally wrong. The care for this lady should continue according to the highest current medical standard".
Ward says that a physician she retained to look at this opines regarding the surgical implantation of the shunt as follows:
"Whether to perform surgery is always based on the risks of surgery versus its benefits in individual cases. When the risk of not performing surgery exceeds the risk of the surgical procedure, then surgery is indicated. In this case, as pointed out in the Continuation of Affidavit, the risk of death without the shunt surgery appears to be 100%, whereas the risk from surgery, while perhaps high, is unlikely to be 100%, based on the information provided. Therefore, using the risk-benefit analysis, this patient can only benefit from surgery. The fact that she is cognitively impaired should not be used as a reason to deny her surgery.
Mrs. Vo's daughter, Dr. Trihn, says because of the futile care decision made by the hospital ethic's committee, the family is having great difficulty locating a facility to treat her. Although the hospital gave the family more time to find a facility to which they could transfer Mrs. Vo, as of now they have no prospects.
Dr. Trihn doesn't have admission privileges at the hospital where she is employed but is currently trying to work with administration to see if they will help. Ward says that Dr. Trihn would like to take her mother home if she can obtain outpatient dialysis but there are also obstacles with that.
Lanore Dixon, Andrea Clark's sister, said she was in Austin this past weekend and asked Jerri Ward, both Clark's and Vo's attorney, if she could visit Mrs. Vo. Dixon says she and the attorney were escorted to Mrs. Vo's hospital room by her husband.
"Before I was allowed in the room, a nurse stopped us at the door and
demanded to know who I was", Dixon says. "I told her I was a friend of the family. She wanted to know what "kind" of friend I was. I told her I was an "important" friend of the family. She said if I was media she couldn't let me in. This didn't seem right to me, but I didn't argue the point since I wasn't media. I assured her I was not media. We washed and gowned and went in to see Mrs. Vo. The nurse hovered in the room and about the door for most of the visit.
"We weren't there five minutes and another hospital official along with a
security guard came into the room and handed me a business card", Dixon said. "She told me I'd have to call the administrator on the card and identify myself. Is it just me or is this sounding Gestapo to you too? I asked her if she was telling me
I couldn't visit the patient if unless I called this person. She started hedging a bit..."I'm just saying you are to call..." I demanded to know if she was telling me I couldn't visit the patient. Then the security guard interrupted and said he thought there was some kind of misunderstanding and he drew the woman back out into the hall to talk in low tones--after a few minutes they disappeared down the hall.
"By this time I was fairly livid. I wanted to visit with Mrs. Vo and they kept interrupting. After another five minutes, here comes another hospital official to verify that I was not media. I don't know what's wrong with those people. How many times do they have to be told I am not media? And even if I were, it's none of their business if the family wants me there! I mean, is Mrs. Vo a patient or a prisoner?
"Mr. Tran loves his wife so much. The entire time we were there he rubbed her skin with oil, did range of motion exercises on her, cleaned her mouth, suctioned her mouth and vent. The nurse was mad about that...she was so rude.
"Mrs. Vo is much healthier than Andrea. She's nice and fat and her skin is beautiful--not all broken down like Andrea's. She watches you with her eyes--despite the nurse telling us that "she can't track." Nonsense. She probably is uncooperative with the hospital because she knows they don't care about her. She was "tracking" her husband, me, and Jerri just fine. The nurse got mad when Mr. Tran swabbed out his wife's mouth. The nurse said, "I just did that." He ignored her and continued to care for his wife, so the nurse started complaining to us about it. Jerri asked the nurse if it would hurt if he cleaned out his wife's mouth. She hesitated, then she said, "Well, she doesn't like it." Sure enough, Mrs. Vo was making an ugly face as her husband swabbed her mouth. Well, apparently, the patient has preferences about having her mouth cleaned. To me, this says she is
responding to her environment. And even the nurse admitted that.
"No one can convince me that Mr. Tran isn't experiencing a feeling of love as
he cares for his wife or that Mrs. Vo isn't experiencing the feeling of being loved as he takes care of her. Those are the most exquisite of all human experiences--if Mrs. Vo still has access to the best of all human experiences, how can it be anything other than pure murder for them to remove her life support?
"This is all becoming very surreal to me...how is it that hospitals seem to feel a sense of entitlement when it comes to killing off patients? How is it that they have so much resentment towards those who believe in a patient's right to life? Are they so comfortable with the God-like power attributed to them by the law and families that they become apoplectic at the very notion that someone might question their authority?
"That kind of power is very dangerous to anyone who could possibly become a patient. Texas isn't the only state with medical futility laws. We all need to be fighting this battle", Dixon says.
Emails to the hospital may be sent through the contact form at http://www.stdavidsmedweb.com/namc/content.asp?id=57. Telephone numbers for St. David's and North Austin Medical Center are 512-901-2500 for administration and 512-397-4215. St. David's main phone number is 512-901-1000.
Mrs. Vo's daughter and husband are frantically searching for another licensed care facility and a nephrologist who will meet Mrs. Vo's medical needs before the June 5 deadline. As it stands, there are very few prospects and your prayers would be appreciated. If you have information about possible treatment options or know a physician in Texas, the family may be contacted at lthetrinh@yahoo.com 5-16-06
© 2006 North
Country Gazette
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