New York and California are, by now, well-known for having "Right-to-Know" laws. I recall that Arizona (like Maryland, Vermont, and others) had introduced at least one bill to do the same thing. It sure seems like if there were a case to illustrate the problems that motivated such bills, it is the case of Amanda Trujillo. She writes:
I'm a registered nurse of six years , specializing in cardiology, geriatrics, and end of life/palliative care. Back in April of this year I was caring for a dying patient whom I had discovered had no clue about what they were about to participate in when they agreed to get a major invasive surgery. When I properly educated the patient using the allowed materials by my employer they became upset that the physician never explained details of the surgery or what had to be done after the surgery (complex lifetime daily self care). The patient also had no idea that they had a choice about whether they had to get the surgery or not or that there were other options. They asked about hospice and comfort care and I educated the patient within my nursing license and the nursing code of ethics. The patient requested a case management consult to visit with hospice to explore this option further in order to make a better decision for their course of care. I documented extensively for the doctor to read the next day and I also passed the info on to the next nurse taking over, emphasizing the importance of speaking with the doctor about the gross misunderstanding they had about the surgery. The doctor became enraged, threw a well witnessed tantrum in the nursing station, refused to let the patient visit with hospice, and insisted I be fired and my license taken. He was successful on all counts. Instead of initiating the hospital policy of consulting with an ethics committee to sort out the situation the hospital fired me instead. The doctor was angry that the patient had changed their mind about the surgery and my nurse manager was angry that I "messed up all the doctors' hard work and planning for the surgery." . . .
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Sign in nowThe physicians (the AMA) and the Drug Companies and all providers lobbied against being put under the federal mandate of the 1991 Patient Self Determination Act ----and they won, of course!
If physicians were mandated in 1991 to talk about "end of life choices" for OUTPATIENT Care and inpatient care, as were the hospitals for inpatient care, this would have worked to ration treatments that would, of course, ration PROFITS.
How disgusting that this good nurse was punished so severely for trying to educate a "dying" patient as to the realities of the situation so that the patient could make an "informed" choice about the surgery.
Was it arrogance or greed on the part of the Doctor ---or both? ---and, unfortunately, perfectly legal under current law.
http://thenerdynurse.com/2012/01/arizona-nurse-has-license-threatened-by-doctor-after-providing-patient-education.html
The nurses work for the hospital but are agents of the specialist physicians. The hospital and the physician have a natural alliance and protect each others backs!
The patients, for many doctors, but not all, Thank God, are nothing but "product" upon which to earn profit!
Good nurses are interested in their patients and it must hurt them to see "dying" patients who are being "overtreated" and who don't understand the consequences of the treatments or the alternatives that are available.
Much of this could have been avoided if the 1991 Patient Self Determination Act had applied to physicians as well as hospitals.
Amanda Trujillo should become front-page news. It would be interesting to know the outcome of the patient.
Did the patient live with an improved quality of life after the surgery?