Enough inanity, insanity and missing the point.  I seriously cannot take it anymore.  An 87-year old lady collapses in a California Independent Living Facility's dining room and a nurse determines she is not breathing properly and calls 911.  The dispatcher asks the nurse to administer CPR while awaiting EMTs.  Well now, the paid, talking head pundits pipe in with opinions about what happened on every major talk show-doctors, nurses, lawyers, advertising executives (I don't know what they have to offer either) and God only knows who else. 

Enough inanity, insanity and missing the point.  I seriously cannot take it anymore.  An 87-year old lady collapses in a California Independent Living Facility's dining room and a nurse determines she is not breathing properly and calls 911.  The dispatcher asks the nurse to administer CPR while awaiting EMTs.  Well now, the paid, talking head pundits pipe in with opinions about what happened on every major talk show-doctors, nurses, lawyers, advertising executives (I don't know what they have to offer either) and God only knows who else.  Opinions fly around like unwanted gnats at a picnic.

"She probably had a DNR directive and the nurse knew that no 'extraordinary' steps should be taken," says one apparent clairvoyant. Another "expert"--the ad exec--says "she was 87 and we spend too much on Medicare patients anyway and the nurse did the lady and all of us a favor."  Give me a break--how presumptuous and, forgive me, just plain stupid that is.  "The daughter is not griping and so I would give the nurse the benefit of the medical doubt," says another talking head. This opinion comes from a Doc and it does contain a scintilla of common sense, if not medical insight--although, I must add,  FAR too often in healthcare at all levels a "code of silence" keeps bad acts and bad actors from being exposed  So, this "benefit of the doubt" approach can have its own dangers. In my estimation, all of these opinions and the dozen or so others I heard last week are 100% WRONG in explaining what happened and why and, more importantly, what can or should be done about it.

From someone who has seen and evaluated thousands of these types of mistakes, let me tell you what really happened here.  First, some facts: 1) Yes, this is an independent living/retirement community and by law it does not have to provide any medical care; 2) The Community had a formal policy that its employees are barred from, among other things, administering CPR and she would be fired if she violated that policy-guaranteed; 3) As the dispatcher told the nurse, EMS would take responsibility for anything that went wrong if CPR failed (in addition CA's Good Samaritan law would have protected her, although insulation from liability for the facility would have perhaps been more problematic) and 4) After time for serious reflection, the facility still vigorously defends its policy and has no intention of changing it.

This tragedy happened because of policies and procedures gone wrong.  And, yes, it WAS a tragedy. If not for anyone else, it was a tragedy for the nurse (and derivatively other caregivers in long-term care facilities who live bad policy enforcement every day), who will not soon recover from watching one of her residents die when she did not do what she was trained but not permitted to do--administer CPR.  Don't blame her, but don't celebrate her either.  She should be hugged and told it is not her fault that in a brief moment she made a very human choice-she chose her job over doing what she would have most certainly done if there had been another choice. And, yes, there IS another choice for institutional healthcare providers.

In healthcare everywhere at every level-from the doctor's office to acute care to hospice-there are 4 and only 4 possible scenarios when it comes to policies and procedures: 1) there are NO formal, written policies and procedures in place, which void jeopardizes every patient every day; 2) there are formal, written policies and procedures in place, but they are ignored and hold no real, consistent meaning for the institution or its staff (except, perhaps, when the facility needs an excuse to fire an employee); 3) there are formal, written policies and procedures, which are slavishly followed to a tee upon penalty of severe discipline if and when breached; and 4) there are formal, written policies and procedures, preferably developed in consultation with staff, who use them as guidelines that may be "bent" If and When, in the staff's best judgment,  health, care or safety will be compromised by precisely following the guidelines in a particular situation.

Sadly in American healthcare institutions, scenarios 1, 2 and 3 above dominate the landscape-scenario 4 above is the exception, not the rule.  As a result,  hundreds of thousands of patients in acute care and skilled nursing settings, and residents in Retirement and Assisted Living facilities, die every year because our healthcare system refuses as an industry to do better with policies and procedures drafting, training, and enforcement.  And the other victims?  Hundreds of thousands family members (though not the daughter of the victim at Glenwood apparently) are left to pick up the pieces and wonder why their own personal tragedy happened.  Even sadder, perhaps, are the thousands of concerned, highly conscientious healthcare workers (often the profession's best and brightest, perhaps like our nurse at Glenwood) who suffer medical tragedies in silence and, far too often, burn out and leave the profession altogether.

Hidden in all these costs is the unsettling fact that unless the healthcare industry does better soon, any and all of us of  are potentially only one event away from experiencing the same tragic loss experienced in a healthcare setting by so many who came before us.  Healthcare workers everywhere unite for all our sakes and recapture sanity from the insanity of policies and procedures "gone bad."