The latest on Andrea Clarke--as best I know for now.

[knitter4democracy]

Here's what I know for now--the situation is changing constantly, so please keep looking for updates further down in this thread when I have them.

Here's the latest Houston Chronicle article link:
http://www.chron.com/disp/story.mpl/front/3828539.html

Here's what I know from Melanie:
Andrea is quite ill still, but there seem to be signs that she's on a path to getting at least slightly better. Her white cell count is normal for the second day in a row, and that hasn't been true in a long time. Her blood pressure is still too low, a sign that her heart is pretty weak from the infection and all, but her meds have been lowered, which is a good sign. Her lungs are also finally clear for the first time in months. In other words, she's still very ill and in the intensive care unit but doing much better than she was doing even just three days ago.

There's a new doctor in the mix now who is reviewing her case and helping the family know what's going on and how to deal with the hospital. He's of the opinion that Andrea isn't out of the woods yet but doing better than had been reported.

My husband, an internist, looked into getting her up here to Michigan to take her on as a patient, but she's too sick to travel this far. The risk is too great, in his opinion, that she would code on the way, and he doesn't want to put her in any kind of jeopardy. The new doctor apparently agrees with that, so they're looking for new solutions at St. Luke's.

There's going to be a big meeting on Tuesday with the family, the new doctor, another new doctor the hospital has assigned to Andrea's case, and the hospital staff. Lanore, Melanie's sister, is going to be the main one dealing with everyone there, along with the family's lawyer. They're going to ask for the medically futile status to be rescinded and to let their new doctor take over her case. They have a decent chance of that happening, as the hospital is running scared on the bad press and possible liability (many of the current problems stem from her being in the hospital and don't meet the standard of care, i.e. the bedsore, the brain bleed, and the endocarditis).

What we need to do is keep hounding the press. We need to keep e-mailing all of the news people we can think of, calling them if need be, and trying to get the word out there.

You'd think that the press would pick this up, if only because the far left and far right are both on the same side and working for the rights of a very ill patient. Michael Moore's people have been involved since the beginning, as have Right to Life and Terri Schiavo's parents. We need more press, though.

Is Andrea very ill? Yes. Could she die soon? Yes. The issue here is that the hospital and the original physician decided to take her life decision into their own hands and ignore her wishes and the wishes of her family. She is only in her fifties, and she is a widow with a 23 y.o. son. She deserves better than this.


Here's another post from another thread with contact info:
http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=364&topic_id=1050023&mesg_id=1055027

[MadMaddie]

1. Thanks for the update....

[knitter4democracy]

4. I clicked the wrong thing.

The reply below was to your post. Sorry.

[knitter4democracy]

2. It's not over yet.

I was really down last night, but I've had a couple of e-mails from Melanie, and it sounds like my husband was not told the whole truth about Andrea's condition. Grrrr. Anyway, she may not be out of the woods, but they're thinning a bit.

[Cleita]

3. Although I haven't posted until now, I have been following the

situation through DU. I am of course heartened that Andrea seems to be better and has a chance to pull through this now. I am also heartened over the fact that two extreme sides can set aside differences and unite in a common cause when there is no meddling from the sanctimonious and religious right and political right to influence an outcome.

[hiley]

5. Yes she does deserve

better much better.
recommend

[Zookeeper]

7. Kick. n/t

[crispini]

6. K&R

thanks for the update and all of your hard work, k4d!!!

[johnaries]

8. K & R.

[veness]

9. k & r. n/t

[Iowa]

10. K&R

[Janice325]

11. Thanks for keeping us updated.

I'm sending positive, healing vibes ya'll's way.
:grouphug:

[progressivebydesign]

12. Thank you for the updates.. I'll keep checking and kicking n/t

[SeattleGirl]

13. Thank you for the new update, knitter

:grouphug: for Andrea and her family.

[IndyOp]

14. Thank you for the update....

I can barely imagine how exhausted her family is right now... :cry:

:hug:

[knitter4democracy]

16. They really are, too.

I'm hoping Melanie finally got some sleep last night--she's been staying up late. Please keep all of them in your good thoughts and prayers.

[Suich]

15. kickity

:kick:

[readmoreoften]

17. K&R

Good luck to you. Let's repeal this terrible law.

[progressivebydesign]

18. Kicking for the dinner crowd. n/t

[liberalla]

19. Thanks for posting this!

I hope they rescind the 'futile care' decision on Tuesday.

[faithnotgreed]

20. thank you - some good news

though i know this is certainly a dynamic situation but good to hear there is positive movement

[nicknameless]

21. Thank you for all you're doing, knitter

O8)

:grouphug:

[northamericancitizen]

22. Kick for Andrea. You are wonderfull knitter eom

[Tigress DEM]

23. When did you get this update? Before or After 4/28 12:43AM

If after, then I assume the transfer to Chicago did NOT take place.

http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=364x1045650

Th1onein (1000+ posts) Fri Apr-28-06 12:43 AM
Original message
KILLING MY SISTER - UPDATE - AND THANK YOU
Edited on Fri Apr-28-06 12:46 AM by Th1onein
Dear Fellow DUers:

Some of you might remember my posting on DU about my sister, Andrea Clark, for whom St. Luke's Episcopal Hospital in Houston was threatening to terminate care. Andrea would have died had St. Luke's been successful. Because of DU and others, Andrea is now being transferred to a facility in Chicago, Illinois. They have no futile care law in Chicago, so Andrea will be okay there.

Andrea is now showing some signs of improvement, although slight. She has endocarditis, which takes about four months, at best, to resolve itself. It's going to be a long road back for her, if she makes it, but I want to thank the mods here and Skinner, for helping us to get the word out.

>>more

[Iowa]

25. Chicago fell through...

The facility wasn't equipped to provide the care she needed.

[knitter4democracy]

28. They called off the transfer just hours before it was to happen.

Some right wing bloggers found out that the facility couldn't handle Andrea's level of care and also had a bad track record, so they contacted the family's lawyer, who then took that to the hospital. The hospital looked into it and confirmed it and then called it off. That's when they agreed to an extension until Tuesday.

[Roland99]

24. Thanks for the update!

[rucky]

26. What is the name of the previous doctor?

I'd like to do some research.

[knitter4democracy]

29. All I've got is his last name, Dr. Giveon.

I can't seem to find him in the St. Luke's system, but I didn't do a major search.

[lostexpectation]

27. Questions

When was this surgery, or how long has she been critical?

Is this a financial issue?

[knitter4democracy]

30. She has been critical for months.

That's not unusual in this kind of case. She had surgery in January and then has developed complications since then, most of which are hospital-caused.

Andrea paid for extra insurance to cover this kind of thing for years, and now the insurance company is saying it won't pay (at least, that's what the social worker told my hubby). That's probably stemming from the medical futility designation, but the Blue Cross/Blue Shield people might have come to that with an independent review of their own. I'm going to start working on them tomorrow.

She's nowhere near her lifetime cap, she's supposed to be fully covered and has scrimped and saved to make sure she'd be covered if this ever happened.

[Name removed]

33. Deleted message

Message removed by moderator. Click here to review the message board rules.

[knitter4democracy]

37. Well, it's both.

The insurance company is saying they're stopping payment tomorrow, and there's the impression that they pressured the hospital in the first place to declare her medically futile.

It's all a mess.

[Name removed]

40. Deleted message

Message removed by moderator. Click here to review the message board rules.

[knitter4democracy]

31. Update on Andrea's condition

Andrea is doing better today. She's not sleeping so much from the pain meds, her white cell count is normal for the second day in a row (as well as no fever), her lungs are clear for the first time in months, and they've been able to lower the pressors she's on to keep her blood pressure up.

They have a good chance at getting a full reassessment on Tuesday, as she's definitely doing better than she was a week ago. She's still not out of the woods, but she's doing better.

[elehhhhna]

32. good good news.

[spooky3]

34. This certainly seems like a case with which John Edwards could help.

[knitter4democracy]

38. I tried to reach him last week.

I'm starting again tomorrow. More press would be a good thing at this point, I think.

[spooky3]

41. I wish you the best. I hope he can help.

[Oversea Visitor]

35. n/t

:kick:

[1monster]

36. Exactly the opposite of what the powers that be and their flunkies, the

"You'd think that the press would pick this up, if only because the far left and far right are both on the same side and working for the rights of a very ill patient. Michael Moore's people have been involved since the beginning, as have Right to Life and Terri Schiavo's parents. We need more press, though."


press want, IMHO.

They don't want the left and the right working together, because then, WE, THE PEOPLE, regain the power they have stolen from us by dividing us.

Remember, the neocons speak Orwellese. Black is white. War is peace. Uniter is Divider.

Unity and consensus of the right and the left is the last thing that is wanted by TPTB.

[knitter4democracy]

39. Good point.

I hadn't thought of that, but it makes sense.

Still, I don't think all reporters and editors go along with that. The Houston Chronicle has been doing a great series on it.

[knitter4democracy]

42. Here's a copy of her attorney's letter--good thing to read

I got this e-mail from June Maxam, the editor of the North Country Gazette who has been a strong force on this case. This is a letter from the family's attorney to the hospital.



Legal Steps Taken In Andrea’s Case To Stop Life Support Removal





The life of Andrea Clark hangs in the balance at St. Luke’s Episcopal Hospital in Houston.

The life support of the 54-year-old woman was to have been removed Sunday after the hospital ethics committee decided under the Texas Futile Care Law that it would be futile to prolong the life of the heart patient and recommended that she be removed from life support despite her family’s wishes and the wishes of Andrea herself.

Under the law, once the decision is made, by law the hospital is authorized to discontinue the disputed treatment after a 10-day delay during which the hospital must try to find a facility that will accept a transfer of the patient.

Plans to transfer Andrea to a facility in Chicago fell apart on Friday and the hospital has reportedly agreed not to remove the ventilator and discontinue dialysis of Andrea until at least Tuesday while the search continues for a facility where she can be transferred.

Jerri Lynn Ward, the Texas attorney who is presenting Andrea and her family, says that efforts are still being made to transfer Andrea’s care to another physician or facility.

She will be serving a cease and desist letter upon the hospital administration Monday to stop the hospital from removing life support from Andrea until she can ask a Houston court for an injunction against the hospital, stopping them from ending Andrea’s life.

The letter follows:



Ms. Ann Thielke, J.D.

In-House Counsel

St. Luke’s Hospital



VIA Email and Fax

Dr. Ron Giveon



Dr. Mark Tran



Dr. Robert Carpenter

Chairman of St. Luke’s Hospital



Case Manager

Blue Cross Blue Shield



Re: Andrea Clark





Dear Sirs and Madam,



As you know, I represent Andrea Clark and her family. On behalf of the family and Andrea, I have been authorized to convey treatment decisions made by the family with regard to her care. Because Andrea is heavily sedated and is limited in her ability to communicate treatment decisions to her physicians and the hospital, the family is empowered under law to make such decisions on her behalf. The family is united in its decision that life-sustaining treatments should NOT be withdrawn or withheld from Andrea Clark pending transfer to another physician or facility.



On behalf of Andrea, the family, acting as a unit, has made the following treatment decisions:

Life-sustaining treatment should continue pending transfer as referenced above.

Dr. Ron Giveon should, in the exercise of reasonable care, prepare an interim summary of his findings and diagnoses to enable other physicians to have sufficient information in order to make a decision as to whether or not to take on the care of Andrea. It is unconscionable to this family that Andrea’s primary attending physician has made himself unavailable to the patient during this trying time—even though he has delegated care to Dr. Tran.

It is the family’s position that Andrea is not a “futile case”. Under the provisions and privacy regulations of HIPAA, the family is entitled to have erroneous information in Andrea’s medical chart corrected. Because, it is at least one physician’s opinion that a diagnosis of futility and decision that life-sustaining treatments are inappropriate, the family requests, pursuant to HIPAA, that the medical chart be corrected and that the discontinuation of life-sustaining treatments on the basis of inappropriateness not be entered into her chart. The decision that Andrea’s case is “futile” has placed seemingly insurmountable obstacles to transferring Andrea’s care to other providers. It is repugnant to notions of justice and fairness that Andrea’s life be threatened because you have unilaterally determined a disputable outcome that impedes her chances of finding another health provider.

The family has decided that the regimen of pain medication be reassessed and the dosage appropriately decreased so that a proper assessment of Andrea’s condition can be made by physicians other than the ones to whom this letter is directed.

The family withdraws consent and authorization from the attending physicians and the hospital to discuss with, disclose to or elicit opinions from Dr. Robert Carpenter regarding protected health information concerning Andrea Clark. It is the family’s opinion that Dr. Carpenter’s actions and opinions in this matter are informed solely by his personal philosophies regarding “futile care theories” and that he has not taken an objective approach in this matter. Furthermore, it is the family understands that Dr. Carpenter is an ob-gyn, and not a cardiologist. Thus, the family questions Dr. Carpenter’s seemingly active role in affirming treatment decisions of Andrea’s treating physicians.

Moreover, it is the family’s opinion that Lanore Dixon and Charles Clark were treated with rudeness, insensitivity and disdain during an ethics committee meeting which focused on pain management for Andrea. The family felt that its positions were ignored and ridiculed by Dr. Carpenter. Moreover, the report Dr. Carpenter wrote as a result of that particular ethics committee meeting was rife with misstatements of the facts. For instance, Dr. Carpenter wrote: "…The specific question asked concerning that belief is when, if ever, her sister told her that she wanted to exist in a state of pain and suffering to achieve that goal. That question was never answered."

Lanore Dixon strongly disputes this and asserts that she did; indeed, state “that Andrea did tell me that she wanted all measures to be taken to save her life unless she was brain dead.”





It is the family’s decision and desire that Dr. Carpenter recuse himself from consideration of this case and any decision regarding Andrea’s care. The family will be exploring its recourse under the law and under the enforcement mechanisms of HIPAA to this end.

The family requests that the ethics committee be convened on a day and time convenient for the family, their attorney and their medical experts to discuss Andrea’s care.

The family insists that Dr. Carpenter, or any other hospital staff member desist from any attempts to unduly or unreasonably persuade, intimidate or bully any potential treating physician into accepting Dr. Carpenter’s opinion that life-sustaining treatments should be withdrawn. The family, again, withdraws any consent or authorization from the parties in this matter for Dr. Carpenter to receive or discuss protected health information regarding Andrea Clark

The family insists that it be made privy to any conversations between representatives or case managers and attending physicians or hospital staff and Andrea Clark’s insurer regarding matters of coverage. The family is entitled to know if the insurer is placing pressure on the hospital based on its assessments regarding length of stay or any other measure impacting the insurer’s willingness to pay.

Furthermore, Andrea Clark has apparently developed a pressure-ulcer while under your care. The family has been informed that the pain that Andrea is experiencing, and which in part is being used to justify withdrawing life-sustaining treatment, is resulting from the pressure ulcer. The family is entitled to evaluate whether or not proper and timely interventions were implemented to prevent Andrea from developing the pressure ulcer. Further, it is the expectation of the family that all necessary and proper treatment be continued to promote healing of the ulcer. It is the position of the family that the attending physicians and hospital have developed a conflict of interest as a result of Andrea’s development of a pressure ulcer that should preclude you from making a treatment decision that will inevitably result in her death. Therefore, any action or decision that you make to withdraw life-sustaining treatment is ethically tainted by questions of fact regarding the level of care received by Andrea Clark.

On behalf of the family, I am putting you on notice that the family intends to file pleadings with the appropriate court in order to restrain you from withdrawing life-sustaining treatments. There are numerous questions of fact that should not be solely determined by you with regard to Andrea’s treatment. There are fact issues with regard to whether or not the physicians and the hospital have acted with reasonable care in deciding that life-sustaining treatment should be withdrawn. Should you act to withdraw life-sustaining treatment prior to review by an appropriate Court, the family intends file complaints with the appropriate regulatory and licensure entities and to take any available legal action permitted under the law and in equity.

It is the family’s opinion that the attending physician and ethics committee have overreached in this case. It should not be your decision as to whether or not Andrea’s life is worth living. The family demands that life-sustaining treatments be continued in light of the fact that the family intends to take this matter up with the Court.

Should you have any questions, please contact me. Thank you for your immediate attention to this matter.





Very truly yours,







Jerri Lynn Ward, J.D.

Garlo Ward, P.C.



Cc: MFCU, OAG

HHSC (Texas)

Texas Board of Medical Examiners

Texas Department of Health

Episcopal Diocese of Houston 4-30-06

[PublicWrath]

44. Do I understand correctly that an ob-gyn's opinion

was influential in the hospital's decision to terminate life support for Andrea, -a heart patient? I'm just stunned. It gets worse and worse.

[knitter4democracy]

45. He's the head of the ethics committee.

Apparently, he was also quite a jerk to them, never a good thing in this kind of situation.

[SeattleGirl]

46. Oh, lovely. I think he needs a refresher course in ethics.

Anyone can debate and discuss the ethics of a situation. But one thing that goes into many ethics codes and statements is that a person making a decision be informed as to what they are deciding. In this case, even though this Dr. Carpenter is the head of the Ethics Committee, he is not a heart specialist, and thus should defer to and listen to those who ARE specialists in that area. If Andrea had ovarian or uterine cancer, then yes, his knowledge would be pertinent to the decision (that is, if his medical knowledge is better than his "bedside manner"). But for someone who is not an expert is a particular medical field to make a decision to end treatment on a patient who's problem is best treated by someone from another medical field, is just wrong. And, it is not ethical.

When considering the ethics of a situation, one cannot just look at "ethics" as something detatched from the person or persons involved in the situation; one must look at it from the standpoint of the specific situation (and persons) involved. Otherwise, one is not acting in an ethical manner.

My prayers continue to be with Andrea and her family, that her/their wishes be honored, and that the right thing is done for her and the family.

[knitter4democracy]

50. I do too.

Everything he's doing goes entirely against everything my husband was taught in med school and residency on medical ethics.

He's also just plain arrogant--it's a well-known fact in the medical community that patients don't sue doctors they like, no matter how bad the malpractice is (many studies on that one, all saying the same thing). Arrogant doctors get sued. He's a liability for the hospital.

[PublicWrath]

48. It sure isn't very ethical to demean and humiliate a family in crisis.

If he's been the head of the committee for very long, he's probably treated other families in the same manner. It's very disturbing.

[knitter4democracy]

49. He has a bad reputation.

Apparently, Andrea's not the first he's done this to. Her family is just the first to fight it so hard and so well.

[NancyG]

43. kick nt

[faithnotgreed]

47. kick for andrea

im watching "the hospital" right now

i dont know why but i havent seen it before but i know its a good satire on the state of health care which is (semi) appropriate right now
not to mention racial tension/protesting/status insular quo and a few who are trying to do the right thing in the midst of this madness

kick for andrea and everyone working so hard on her behalf
i believe much good will come from it

[knitter4democracy]

51. A couple of new things for us to know and use:

First of all, there's a local Dem who's getting involved (yay!!). His name is Gary Denton, and he's going to do what he can to get the story out, at least on DailyKos but also on other sites.

Secondly, they've started up a website that shows support for Andrea. It requires a one-time registration, but it seems good. It's a way to let the family know that you are supporting them and trying to help as well as get updates.

The website is: http://www.carepages.com/ServeCarePage?cpn=AndreaClarkLives&extrefid=tlcinvite

According to the e-mail I got, the other way to access the page is:

1. Go to www.carepages.com

2. Click "Visit a CarePage"

3. Register (first-time users only)

4. After you've registered, enter the exact CarePage Name below:

AndreaClarkLives

Today is insurance day for me. I'm going to see if I can find out what's going on there so that the lawyer can address that, too. Please keep e-mailing everyone about this and contacting the media--our best weapon is our united voice!

[NancyG]

52. kick nt