A moral victory has come for same-sex couples, but at a heavy price.  In February of 2007, Lisa Pond arrived in Miami with her partner Janice Langbehn and their children and boarded a cruise ship.  Shortly thereafter, Lisa collapsed and was taken to Jackson Memorial Hospital’s Trauma Center.  Janice and the children came over by taxi and arrived at about 3:30.  Janice was denied access to Lisa, and the social worker told her that “this is an anti-gay state and an anti-gay city” (which of course, he later denied), and advised her that she would require health care proxy status to obtain any information.  Janice called a friend who faxed the requisite paperwork to Jackson, and hospital records show that it arrived at approximately 4:15 pm.  A physician came out around 5:20 to request permission for a “brain monitor”, and again at 6:20 to advise that Lisa had a cerebral aneurysm with no real hope of recovery.  Janice had notified Lisa’s sister who arrived at 11:30, and was told that she was in the ICU.  Somewhere around midnight, Janice and the children were permitted to visit.  Lisa was pronounced dead at 10:45 am, and permission was given to harvest her organs.

Janice Langbehn filed suit in federal court.  Judge Adalberto Jordon agreed with the hospital’s position that there is no legal requirement to allow visitation in a trauma center, as visitors could impede theraputic efforts.  He did, however, state that Jackson Memorial had demonstrated a remarkable lack of compassion unworthy of a renowned trauma center, and apologized that no relief was called for under the law.  I suppose that the apology was better than nothing.

Prior to my retirement, I worked for 20 years in Jackson’s ER, which is right next door to the trauma center.  I have never heard of a documented health care proxy being denied information on a patient’s status.  I asssure you that this is not institutional policy.  There are situations where you are busy with a patient, and cannot have visitors at that time, but you can usually find someone to communicate that to the visitors.  Jackson has social workers, clergy, and patient representatives available to be with the family.  Not all visitors are as reasonable as Janice – on more than one occasion, police intervention has been needed-but she hardly seems threatening.  As for the Trauma Center social worker, he could have sent clergy or patient representatives to be with Janice and the children – he just didn’t.  Further, having known the man for a number of years, I believe every word of Janet’s story.  The Trauma Center had the health care proxy paperwork at 4:30, and there should have been no further question after that.  As for this being an “anti-gay” city – oh, please.  Miami’s LGBT social scene is not as active as South Beach or Ft. Lauderdale, but it’s hardly underground. Jackson Memorial has treated LGBT patients for as long as I can recall, and has done gender reassignment surgery for years,   As far as nursing goes, I’m appalled.  There comes a point in time where all that you have to offer a patient is comfort, and what is more comforting than family?

The President has issued a “Memorandum to the Secretary of Health and Human Services”.  Not quite an Executive Order, but better than nothing.  He wished to make clear to all hospitals participating in Medicare or Medicaid (or both) that designated visitors with durable powers of attorney or health care surrogacy must be accorded  visitation privileges that are “no more restrictive than immediate family”.  He further states that visitors cannot be excluded because of “race, color, national origin, sex, sexual orientation, gender identity, or disibility.”  He affirms the rights of hospitals to restrict visitation when medically appropriate, and supports “clinical decisions that medical professionals make about a patient’s care or treatment.”  That last sentence could be tricky in some circumstances – after all, Jackson swore up and down that the Trauma Center did not have visitation because of the unique circumstances of their care.  I wholeheartedly agree that you should not include visitors in resuscitative efforts or communicable diseases requiring isolation.  That said,  I would hope that nursing staffs would be more discerning and not participate in scenarios like this.  They will never convince me that they could not have overruled a social worker in this matter.  

Janice Langbehn got a call from the President to tell her of this measure, and to apologize to her for what she had been through.  As I retired Jackson Emergency Room nurse, I’d like to apologize to Janice and her family, too.  We’re not all like that, I promise.  I hope that the family accepts these apologies – they are better than nothing, I guess.

Chatblu’s Soapbox will return tomorrow.  In the meantime, this is an open thread.