Lawnwood Regional Medical Center has 10 days to amend a disturbing petition asking a judge to end life-prolonging measures for one of their nurses stricken with COVID-19 and send her to hospice over her mother’s objections.
St. Lucie County Circuit Judge Laurie Buchanan dismissed Lawnwood’s initial request Wednesday, agreeing with John Anastasio, attorney for Genea Bristol’s mother, Belinda Bristol, that the pleading was legally insufficient.
Bristol, 41, worked at Lawnwood’s physical rehabilitation center when she contracted COVID-19 and recovered without hospitalization in April 2020, and when the Vero Beach mother of three was diagnosed again Jan. 12.
“They are trying to kill the patient,” Stuart-based Anastasio said Wednesday, noting Genea Bristol risked her life going back into the “lion’s den” at Lawnwood after her first recovery. “She is one of their own. How can they do this?”
There is no alternative, said Lawnwood’s attorney Blake Delaney of Tampa-based Buchanan, Ingersoll and Rooney.
His petition included affidavits from Drs. Michael Bakerman, the hospital’s chief medical officer, and Sasha Boris Grek, one of Bristol’s physicians, who said she has an “irreversible COVID-19 lung injury,” is in “grave” condition and dependent on a machine that puts oxygen in her blood and a ventilator.
No lung transplant available
The hospital said it has tried to find a facility where a lung transplant can be done, but they’ve been told she is not a suitable candidate. There are no other treatments.
The physicians have recommended stopping their aggressive treatment because her condition is “unlikely to experience any significant clinical improvement” and think her condition is irreversible.
All that’s irrelevant in Florida, according to Anastasio.
“This whole petition takes the patient right out of the loop,” he said, noting patient wishes, not the alleged inability to treat a patient, is the crux of the matter. “Given the fact she returned to the hospital (to work), she’s a fighter.”
Delaney, who said he has handled similar cases, said a patient’s right to determine his or her own health care is “not absolute.” For example, health care providers would reject patient demands for such things as assisted suicide or unnecessary surgery, including amputation.
Importance of a living will
While Bristol’s case is an example of why it’s important to have advance directives, such as a living will, or a durable power of attorney, her mother said Genea made her wishes clear the night she went to the hospital.
“She said, ‘Mom, I need you to make them (health care workers) responsible and do everything for me.’ I promised her I would,” Belinda Bristol told me in February.
On Tuesday, Belinda Bristol posted a Facebook message saying her daughter, while on a Facetime call with her father, smiled at him.
Lawnwood, however, said she is incapacitated — an issue the judge, seemingly troubled, raised with Delaney.
Patient is not brain dead
“I’ve been thinking about this case ever since our last hearing,” she said, noting Genea is not brain dead, just under sedation. “Could she be brought out enough to express her feelings?
“If she’s only incapacitated because we are continuing to knock her out then that’s one thing …” the judge continued.
Delaney said the matter is not that simple.
“The patient is attempted to be weaned from sedation constantly … and she can’t tolerate it,” he said, citing stresses on her heart. “Functionally and for all legal purposes she is incapacitated. It’s not possible to bring her out of this state.”
But while Lawnwood might have physicians to support their assertion, could Belinda Bristol or pro-life advocates find others who would argue otherwise?
Are there hospitals anywhere that could save Genea Bristol’s life? How and when could Belinda Bristol ever know her promise to fight for her daughter is futile?
Is treating the patient futile?
Delaney said the futility issue cuts both ways.
“The family also won’t have any evidence to refute the fact the patient’s condition is irreversible and that further care is futile,” he said.
How could it? How difficult would it be for patients’ families unilaterally to bring in medical experts from elsewhere to argue their case?
Delaney said this is an especially complicated case because Genea needs to be hooked up to an extracorporeal membrane oxygenation (ECMO) machine she can’t just take home.
“There are competing interests here,” Delaney said. “Every medical provider has the right to insist on not providing futile care. … You have to see the context … You can’t just look into what the patient wants.”
Florida statutes suggest otherwise, Anastasio said, noting the Florida and U.S. supreme courts have talked about a “presumption of life” when there’s any question.
“When in doubt, you have to presume they want life,” Anastasio said. “I wouldn’t want to have it any other way.”
Texas law irrelevant
Buchanan seemed to agree, noting Delaney’s futility of treatment argument might fly in Texas, which has a different law, but not in Florida.
“We are not Texas,” she said. “It is ultimately going to be what the patient did want … if the patient made that clear.”
If not, the court likely would do what’s in the best interest of the patient.
Based on Lawnwood’s petition, Buchanan suggested hospital officials know what the patient wants.
“Whether I personally or you personally or anybody else agrees with her decision (that’s irrelevant),” Buchanan said. “We follow the law.”
Delaney said he only knows what Belinda Bristol says her daughter’s desires are.
“We don’t have any evidence of what the patient’s desires are,” he said. “We didn’t sit around the Thanksgiving table with her for 41 years like her family did and have these kind of conversations.”
Buchanan expressed to attorneys how unique this case is.
“This is too important of a decision for it not to be done absolutely perfectly,” she said. “I don’t know there’s a perfect solution to it, but I do think we have to make sure the pleadings are framed properly.”
This column reflects the opinion of Laurence Reisman. Contact him via email at lar[email protected], phone at 772-978-2223, Facebook.com/larryreisman or Twitter @LaurenceReisman