A Fast Way To Create A Physician Shortage In The U.S.A. Is To Have Politicians Issue Blanket Orders Not To Recisitate Patients With COVD-19

Comment by Jim Campbell

March 26th, 2020

Hospitals across the U.S. consider universal do-not-resuscitate orders for coronavirus patients.

Many physicians will refuse to abide by DNR designations.

It would seem most hospitals would not do this knowing it would lead to more law suits in the end.

On day one of medical school, students learn a phrase that’s been taught for thousands of years:

In Latin it’s Primum non-nocere first written in Greek, later translated into Latin.

Socrates is considered the founder of modern medicine.

Every year, a new record is set for medical school enrollment.

But despite this influx of new doctors, the U.S. physician work-force continues to trend older.

There were 985,000 licensed physicians in the U.S. in 2018, according to the Federation of State Medical Boards’ (FSMB) biennial census, which notes that their average age has risen to 51.5 years from 50.7 in 2010.

But that number seems to understate the trend.

The census also reports that the number of licensed physicians between 60 and 69 years old grew to almost 192,000 (19.5%) in 2018, up 38% from the 139,000 doctors in their 60s in 2010. Also, the number of licensed physicians 70 and older grew to more than 106,000 (10.8%) in 2018.

That’s nearly a 40% jump from the 2010 figure of 76,000.

A scene played out in intensive care units all over the country every day.

I personally dealt with this as both my parents died the same way.

In the end it was sitting the physician sitting on the bed and telling each of them there was nothing more medically that could be done for them and would they like him to assist in the transition and end the pain and suffering.

Both said yes, the next day their spirits left the body.

The patient’s desire is outweighed by that of the family, the patient suffers, his wishes for DNR fall to the wishes of the member of the family who can’t let go.

The Washington Post

Author: Ariana Eunjung Cha,

March 25, 2020

A nurse holds swabs and test tube to test people for COVID-19 at a drive through station set up in the parking lot of the Beaumont Hospital in Royal Oak, Mich., Monday, March 16, 2020. (AP Photo/Paul Sancya)

A nurse holds swabs and test tube to test people for COVID-19 at a drive through station set up in the parking lot of the Beaumont Hospital in Royal Oak, Mich., Monday, March 16, 2020. (AP Photo/Paul Sancya)

Hospitals on the front lines of the pandemic are engaged in a heated private debate over a calculation few have encountered in their lifetimes – how to weigh the “save at all costs” approach to resuscitating a dying patient against the real danger of exposing doctors and nurses to the contagion of coronavirus.

The conversations are driven by the realization that the risk to staff amid dwindling stores of protective equipment – such as masks, gowns and gloves – may be too great to justify the conventional response when a patient “codes,” and their heart or breathing stops.

Northwestern Memorial Hospital in Chicago has been discussing a universal do-not-resuscitate policy for infected patients, regardless of the wishes of the patient or their family members – a wrenching decision to prioritize the lives of the many over the one.

Richard Wunderink, one of Northwestern’s intensive-care medical directors, said hospital administrators have asked Illinois Gov. J.B. Pritzker for help in clarifying state law and whether it permits the policy shift.

“It’s a major concern for everyone,” he said. “This is something about which we have had lots of communication with families, and I think they are very aware of the grave circumstances.”

Officials at George Washington University Hospital in Washington say they have had similar conversations, but for now will continue to resuscitate covid-19 patients using modified procedures, such as putting plastic sheeting over the patient to create a barrier.

The University of Washington Medical Center in Seattle, one of the country’s major hot spots for infections, is dealing with the problem by severely limiting the number of responders to a contagious patient in cardiac or respiratory arrest.

Several large hospital systems – Atrium Health in the Carolinas, Geisinger in Pennsylvania and regional Kaiser Permanente networks – are looking at guidelines that would allow doctors to override the wishes of the coronavirus patient or family members on a case-by-case basis due to the risk to doctors and nurses, or a shortage of protective equipment, say ethicists and doctors involved in those conversations.

But they would stop short of imposing a do-not-resuscitate order on every coronavirus patient. The companies declined to comment.

Lewis Kaplan, president of the Society of Critical Care Medicine and a University of Pennsylvania surgeon, described how colleagues at different institutions are sharing draft policies to address their changed reality.

“We are now on crisis footing,” he said. “What you take as first-come, first-served, no-holds-barred, everything-that-is-available-should-be-applied medicine is not where we are. We are now facing some difficult choices in how we apply medical resources – including staff.”

The new protocols are part of a larger rationing of lifesaving procedures and equipment – including ventilators – that is quickly become a reality here as in other parts of the world battling the virus. The concerns are not just about health-care workers getting sick but also about them potentially carrying the virus to other patients in the hospital.

Alta Charo, a University of Wisconsin-Madison bioethicist, said that while the idea of withholding treatments may be unsettling, especially in a country as wealthy as ours, it is pragmatic. “It doesn’t help anybody if our doctors and nurses are felled by this virus and not able to care for us,” she said. “The code process is one that puts them at an enhanced risk.”

Wunderink said all of the most critically ill patients in the 12 days since they had their first coronavirus case have experienced steady declines rather than a sudden crash. That allowed medical staff to talk with families about the risk to workers and how having to put on protective gear delays a response and decreases the chance of saving someone’s life.

A consequence of those conversations, he said, is that many family members are making the difficult choice to sign do-not-resuscitate orders.

Health-care providers are bound by oath – and in some states, by law – to do everything they can within the bounds of modern technology to save a patient’s life, absent an order, such as a DNR, to do otherwise. But as cases mount amid a national shortage of personal protective equipment, or PPE, hospitals are beginning to implement emergency measures that will either minimize, modify or completely stop the use of certain procedures on patients with covid-19.

Some of the most anxiety-provoking minutes in a health-care worker’s day involve participating in procedures that send virus-laced droplets from a patient’s airways all over the room.

These include endoscopies, bronchoscopes and other procedures in which tubes or cameras are sent down the throat and are routine in ICUs to look for bleeds or examine the inside of the lungs.

Changing or eliminating those protocols is likely to decrease some patients’ chances for survival. But hospital administrators and doctors say the measures are necessary to save the most lives.

The most extreme of these situations is when a patient, in hospital lingo, “codes.”

When a code blue alarm is activated, it signals that a patient has gone into cardiopulmonary arrest and typically all available personnel – usually somewhere around eight but sometimes as many as 30 people – rush into the room to begin live-saving procedures without which the person would almost certainly perish.

“It’s extremely dangerous in terms of infection risk because it involves multiple bodily fluids,” explained one ICU physician in the Midwest, who did not want her name used because she was not authorized to speak by her hospital.

Fred Wyese, an ICU nurse in Muskegon, Michigan, describes it like a storm:

A team of nurses and doctors, trading off every two minutes, begin the chest compressions that are part of cardiopulmonary resuscitation or CPR. Someone punctures the neck and arms to access blood vessels to put in new intravenous lines. Someone else grabs a “crash cart” stocked with a variety of lifesaving medications and equipment ranging from epinephrine injectors to a defibrillator to restart the heart.

As soon as possible, a breathing tube will be placed down the throat and the person will be hooked up to a mechanical ventilator. Even in the best of times, a patient who is coding presents an ethical maze; there’s often no clear cut answer for when there’s still hope and when it’s too late.

In the process, heaps of protective equipment are used – often many dozens of gloves, gowns, masks, and more.

Bruno Petinaux, chief medical officer at George Washington University Hospital, said the hospital has had a lot of discussion about how – and whether – to resuscitate covid-19 patients who are coding.

“From a safety perspective you can make the argument that the safest thing is to do nothing,” he said. “I don’t believe that is necessarily the right approach. So we have decided not to go in that direction. What we are doing is what can be done safely.”

However, he said, the decision comes down to a hospital’s resources and “every hospital has to assess and evaluate for themselves.” It’s still early in the outbreak in the Washington, D.C. area, and GW still has sufficient equipment and manpower. Petinaux said he cannot rule out a change in protocol if things get worse.

GW’s procedure for responding to coronavirus patients who are coding includes using a machine called a Lucas device, which looks like a bumper, to deliver chest compressions.

But the hospital has only two.

If the Lucas devices are not readily accessible, doctors and nurses have been told to drape plastic sheeting – the 7-millimeter kind available at Home Depot or Lowe’s – over the patient’s body to minimize the spread of droplets and then proceed with chest compressions. Because the patient would presumably be on a ventilator, there is no risk of suffocation.

In Washington state which had the nation’s first covid-19 cases, UW Medicine’s chief medical officer, Tim Dellit, said the decision to send in fewer doctors and nurses to help a coding patient is about “minimizing use of PPE as we go into the surge.”

He said the hospital is monitoring health-care workers’ health closely.

So far, the percentage of infections among those tested is less than in the general population, which, he hopes, means their precautions are working.

A woman exits a COVID-19 testing site while hundreds wait in line at Elmhurst Hospital Center, Wednesday, March 25, 2020, in New York. Gov. Andrew Cuomo sounded his most dire warning yet about the coronavirus pandemic Tuesday, saying the infection rate in New York is accelerating and the state could be as close as two weeks away from a crisis that sees 40,000 people in intensive care. Such a surge would overwhelm hospitals, which now have just 3,000 intensive care unit beds statewide. (AP Photo/John Minchillo)

A woman exits a COVID-19 testing site while hundreds wait in line at Elmhurst Hospital Center, Wednesday, March 25, 2020, in New York. Gov. Andrew Cuomo sounded his most dire warning yet about the coronavirus pandemic Tuesday, saying the infection rate in New York is accelerating and the state could be as close as two weeks away from a crisis that sees 40,000 people in intensive care.

Such a surge would overwhelm hospitals, which now have just 3,000 intensive care unit beds statewide. (AP Photo/John Minchillo)

Bioethicist Scott Halpern at the University of Pennsylvania is the author of one widely circulated model guideline being considered by many hospitals.

In an interview, he said a blanket stop to resuscitations for infected patients is too “draconian” and may end up sacrificing a young person who is otherwise in good health. However, health-care workers and limited protective equipment cannot be ignored.

“If we risk their well-being in service of one patient, we detract from the care of future patients, which is unfair,” he said.

Halpern’s document calls for two physicians, the one directly taking care of a patient and one who is not, to sign off on do-not-resuscitate orders. They must document the reason for the decision, and the family must be informed but does not have to agree.

Wyese, the Michigan ICU nurse, said his own hospital has been thinking about these issues for years but still is unprepared.

“They made us do all kinds of mandatory education and fittings and made it sound like they are prepared,” he said. “But when it hits the fan, they don’t have the supplies so the plans they had in place aren’t working.”

Over the weekend, Wyese said, a suspected covid-19 patient was rushed in and put into a negative pressure room to prevent the virus spread. In normal times, a nurse in full hazmat-type gear would sit with the patient to care for him, but there was little equipment to spare.

So Wyese had to monitor him from the outside. Before he walked inside, he said, he would have to put on a face shield, N95 mask, and other equipment and slather antibacterial foam on his bald head as the hospital did not have any more head coverings.

Only one powered air-purifying respirator or PAPR was available for the room and others nearby that could be used when performing an invasive procedure – but it was 150 feet away.

While he said his hospital’s policy still called for a full response to patients whose heart or breathing stopped, he worried any efforts would be challenging, if not futile.

“By the time you get all gowned up and double-gloved the patient is going to be dead,” he said. “We are going to be coding dead people.

It is a nightmare.”

THE END

– – –

About JCscuba

I am firmly devoted to bringing you the truth and the stories that the mainstream media ignores. Together we can restore our constitutional republic to what the founding fathers envisioned and fight back against the progressive movement. Obama nearly destroyed our country economically, militarily coupled with his racism he set us further on the march to becoming a Socialist State. Now it's up to President Trump to restore America to prominence. Republicans who refuse to go along with most of his agenda RINOs must be forced to walk the plank, they are RINOs and little else.
This entry was posted in Uncategorized. Bookmark the permalink.

8 Responses to A Fast Way To Create A Physician Shortage In The U.S.A. Is To Have Politicians Issue Blanket Orders Not To Recisitate Patients With COVD-19

  1. Stealth General says:

    These are tough times for doctors and medical workers and it’s likely to be a very changed world when this is all over with. It is extremely difficult for doctors and families to make DNR decisions together, but one thing is for sure, politicians, lawyers and insurance companies must NOT be in the decision process!

    Like

    • JCscuba says:

      That’s a major 10-4 General. I believe they will come at us with continued crises in the hope of Derailing the Trump Machine. Thanks not likely to happen. Thanks General, I appreciate your comment.

      Like

  2. Pamela Kelly says:

    In wake of the coronavirus, I believe it is highly likely that there will be a sharp increase in the practice of euthanasia in America. Nearly 40 years ago, when I was a student in a Catholic high school, the priest who taught my psychology class one day told his students that the greatest moral issues facing our generation would be abortion-on-demand and euthanasia. He was absolutely right. However, he should have added one more condition to the list which I believe is the root cause of the both of these issues: secular humanism.

    Several years ago, when former President Barack Obama, one of the greatest perpetrators for the cause of secular humanism, declared, at the beginning of Holy Week, that America was no longer a Christian nation I remember I was angry at his flippant remark. But, I have come to realize now, that despite my personal dislike for this man, he was telling the truth.

    America has willingly forsaken her Judeo-Christian heritage, which has given her citizens more freedom and independence than any other people or nation on the face of the earth, to embrace the inferior, self-centered and greedy wisdom of sinful man. The carnal thoughts of the fallen sons and daughters of Adam stand in enmity to the thoughts and purposes of righteous Almighty God.

    Euthanasia is not an act of mercy. It has no compassion for its victims. God calls the willful and deliberate act of taking human life, made in His own likeness and image, murder.

    “Quick, easy, and painless” not to mention “convenient” is the excuse used by those who advocate assisted suicide and euthanasia.

    One of the most sad and tragic examples of this lie was that of Theresa Schindler-Schiavo, whose fragile life was condemned by the courts and through the will of her estranged husband and his lawyer to die in a Florida hospice in 2005. It took fifteen agonizing days for Teri’s life to end using the “quick, easy, and painless” method of being starved and dehydrated to death, while her immediate family was forced to watch in grief and horror from the sidelines, barred from being at Teri’s bedside by state troopers assigned to guard her room. All her mother and father and family wanted was to be able to take her home and care for her. Many health professionals whom examined Teri’s case believed, along with her parents, that she could have been rehabilitated.

    Meanwhile, her estranged husband Michael Schiavo claimed that Teri once told him that she would never want to live as a “vegetable”. The only problem with this statement is that it was based on his own hearsay. There was never any solid proof that she ever made such a statement.
    And although he never legally divorced Teri while she was still alive, her so-called, “devoted” husband who claimed that he “only wanted to honor her wishes” took up with another woman and had children with her. Whatever happened to his devotion in the keeping of the vow, “For better or worse, for richer or poorer, in sickness and in health, until death do us part?” Why is it that his bigamy went unnoticed by the courts while they continued to allow him to

    I believe the real argument in Teri’s case was centered over who would have control of the substantial amount of money awarded by the courts for her care after her husband sued the hospital where she was eventually taken on the night she collapsed in 1990. However, a more pertinent question remains unanswered to this day regarding this most universally infamous and tragic case of euthanasia. According to Teri’s parents, Robert and Mary Schindler, on the night their daughter collapsed in her home and her husband claims he could not revive her, why did he end up waiting over an hour before calling for help?

    Like

    • JCscuba says:

      I’m of the belief that this will burn out and “THEY,” Will think of another way to distract as they continue to use this as a way to prevent a Trump victory in November.

      Like

  3. Pamela Kelly says:

    PS:… “Why is it that his bigamy went unnoticed by the courts while they continued to allow him to have control over the decisions regarding his wife’s condition?” Does not a person’s character count anymore? Apparently not. I was trying to write this before being interrupted by unforeseen events!

    Like

    • JCscuba says:

      Wait till I show you the book and Images from a Dean Koontz who predicted this over 20 years ago?
      I’ll put them on the blog now. Enjoy.

      Like

  4. GG says:

    All comments above reflect my own thoughts on this topic. It’s a double edged sword either way, as well as possible outcomes for patient. It’s a tough call , but certainly a moral one. That ought to auto-omit faceless bureaucrats from making decisions to ration care, and blanket decide outcomes when every human is different.
    Good article. Hard subject to think about.

    Like

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.