Hi, it’s Patrik Hutzel from INTENSIVECAREHOTLINE.COM where we instantly improve the lives for Families of critically ill Patients in Intensive Care, so that you can make informed decisions, have PEACE OF MIND, real power, real control and so that you can influence decision making fast, even if you’re not a doctor or a nurse in Intensive Care!

This is another episode of “YOUR QUESTIONS ANSWERED“ and in last week’s episode I answered another question from one of my clients and the question in the last episode was

How Do I Make a Decision If the Medical Team Is Telling Me to Withdraw the Treatment for My Sister but, I Still Want to Fight for Her?

You can check out last week’s question by clicking on the link here.

In this week’s episode of “YOUR QUESTIONS ANSWERED“, I want to answer the next questions from one my clients Andrea who has her 34 year old sister in Intensive Care with non-Hodgkin’s Lymphoma and is currently experiencing decrease in blood count as well as having second thoughts about the treatment her sister is getting.

How could I know if the hospital staff is withdrawing treatment without my permission?

“You can also check out previous 1:1 consulting and advocacy  sessions with me and Andrea here.”

PART 1

PART 2

PART 3

PART 4

PART 5

PART 6

PART 7

PART 8

PART 9

PART 10

Patrik: Right. Do you remember who the previous one was?

Andrea: His name is was… Doct.. Associate Professor Grobatchov, he’s got his name on the board, I could actually …

Patrik: No, right now, Right, no, I wouldn’t, no, I don’t recall that name either.

That’s okay.

Andrea: Some eastern European guy.

Patrik: Right.

Andrea: Professor Grobatchov, or whatever.

Patrik: Right. And, do you know whether … do you know whether that’s the director of the ICU?

Andrea: I’m not sure … no, I don’t believe he’s the director. I think he’s just an associate professor.

Patrik:  Yeah, yeah, yeah, yeah, yeah, yeah. Okay. Alright.

Andrea: I don’t know who the director is.

Patrik: Okay, I’ll find … I’ll have a Google search a bit later.

Patrik: Okay. The other thing that’s really important to know, if they want to go down that track, of withdrawal of treatment… now, if you ever feel under pressure there, just don’t engage in that conversation at all, that’s number one. If, for whatever reason, they keep hounding you with that, they have a hospital, or even an ICU policy, around withdrawal of treatment, and they got to stick with that policy.

Now, that policy is most likely saying that they need family consent. It doesn’t have to say that, but there is a very high chance, that if it doesn’t say they need family consent, that they at least need to consult you.

Patrik: Now, there’s these huge debates going on, in any first world country around who is making that final decision. And, there’s lots of … who is making a final decision when to withdraw treatment. And, there’s lots of gray areas, there’s laws in different states, in different countries, and that’s what I … and I haven’t researched, I think you used that website … the law is slightly in favour of the hospital. Slightly. Okay.

Patrik: In Queensland, it’s not. In Queensland, it’s in favour of a patient and the family. In Victoria, it’s in favour of a patient and the family. I’m not 100 percent sure what the New South Wales law says. But, at the end of the day, if you feel they are putting you under too much pressure, don’t engage in that conversation at all. Just … just tell them, “Look, we’re not engaging in that conversation.”

Andrea: And … and they have to continually treat her, right?

Patrik: Absolutely. Absolutely. They need your consent. And, sometimes, their policy might say that, they only have to consult you, and not consent you.

Andrea:  Right.

Patrik: But, I see it as a positive sign that they didn’t issue as an NFR, when you asked them not to. I see that as a positive sign.

Andrea:  What’s that, what’s an NFR?

Patrik:  So…. This is the … the not for resuscitation.

Andrea:  What they did, they issued that initially, but I asked them to reverse that.

Patrik:  And, are you 100 percent certain that they reversed that?

Andrea:  I don’t … no, I’m not.

Related article:

• THE 5 THINGS YOU NEED TO KNOW IF THE MEDICAL TEAM IN INTENSIVE CARE WANTS TO “LIMIT TREATMENT”, WANTS TO “WITHDRAW TREATMENT”, “WITHDRAW LIFE SUPPORT” OR WANTS TO ISSUE A “DNR” (DO NOT RESUSCITATE) OR “NFR” (NOT FOR RESUSCITATION) ORDER FOR YOUR CRITICALLY ILL LOVED ONE!

Patrik:  Okay….

Andrea:  I mean; I’ve lost … what they said they had. They’re honouring what we say they should…. But how do I know it …

Patrik:  Yup! Yes, I can tell you how you can find out.

Andrea:  Yep.

Patrik:  Number one, if you think … when you are at the bedside and you think there’s a nurse that you have good rapport with …

Andrea:  Yes.

Patrik:  Ask the nurse. And, if you feel like they’re not willing to share that with you, or you feel like they may not tell you the truth, ask for the notes, ask for the medical records. Because, if they had issued an NFR (Not for resuscitation), it would be … if it’s an electronic system, it would be documented somewhere in the electronic system. If they still have a paper system, there would be a form in the medical notes, an NFR form.

Patrik:  Now, again, an NFR, they have a policy around that and, that policy, will most likely say that they have to get consent from you. If, for whatever reason, they’ve issued this NFR, and the boxes are ticked, and they’ve signed it, without your consent, that’s illegal. And, they are breaching, either, the law, or their own hospital policy. Right?

Patrik: I’ll tell you what that means in technical terms. If, they’ve issued an NFR, without your consent, what it means is, number one, if your sister’s heart stops, God forbid, they will not resuscitate her. Now, if that happens, and they let your sister go, they could be in big, big, trouble, because they’ve done that against your will.

Andrea:  How come … how come the ICU …head ICU, the guy looking after the team, issue the NCR …

Patrik: NFR (Not for resuscitation)? Yeah… yeah…

Andrea:  Without … Not … not … NFR, so NFR. How could he issue the NFR, without…?

Patrik:  Without your consent? Yeah.

Andrea:  Without consent?

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Patrik:  Yeah, I could tell you. Well, number one, it happens all the time. It’s one of the reasons I’m doing what I’m doing. I have seen this so often, I have challenged it many times. When I was working fulltime at the ICU. I refused to look after patients that … I’d seen it so often. I was getting so angry over these, I said … I said to people, “How can you do that, without informing the family?” It’s what happens across the board.

Patrik: And, if people … there’s probably hundreds of patients in ICU, every day, that have an NFR, without families or patients being informed, if patients are awake. It’s highly unethical, but it happens – happens every day. That’s why I think … well, that’s why I know it’s so important for families to ask the right questions.

Andrea:  Yep, for sure.

Patrik:  Right? And, that’s why I’m asking you. They telling you they’ve taken the NFR off, but I wouldn’t be sure.

Andrea:  Well, I … well, listen, Patrik, to be honest with you …

Patrik:  Yeah.

Andrea:  I shouldn’t completely trust them. I don’t completely trust them with my sister, and looking after her …

Patrik:   Yeah.

Andrea: And, whether they could actually kill her intentionally, with all the medication. That’s my … I mean, I know it’s like a conspiracy theory type thing, but I’m just very paranoid.

Patrik:  Yeah, yeah.

Andrea: What’s their best interest? Their best interest is to actually vacate that bed.

Patrik: Absolutely.

Andrea:  Because, they think she’s dying anyway and won’t wake up.

Patrik:  That’s right. That’s exactly right. That’s in their best interest. And, their worst nightmare is that your sister will occupy that bed for the next four weeks.

That’s their worst nightmare.

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Andrea:  For sure. Yeah.

Patrik: And, you got to be aware of, what they may frame as, in her best interests, is probably in the ICU’s best interest.

Andrea: I completely … I can see them … I read between the lines. I … that it’s all that money, I understand.

Patrik:  It’s all about money. An ICU bed costs $5,000 dollars a day. They’re short staffed. We know all of that.

Andrea: Yeah.

Patrik:  ICUs are chronically short staffed with aged doctors on it. They have five patients knocking at this bed.

Andrea: Yes.

Patrik:  Every day. But that … You got to … you got to … that shouldn’t be on your mind, and you’re doing the right thing. Your … your focus is your sister.

Andrea:  Yes.

Patrik:  Right. That is something you should be asking, either, quietly, if you think there’s a good nurse, and if you don’t trust them, ask for the notes.

Andrea:  Ask for the medical records or the medical notes?

Patrik:  Yeah yeah…. the medical notes. Both terms are referring to the same thing.

Andrea:  Yes, thank you. They … I can get all of those?

Patrik:  Yep, and you should be able to get all of those under the Freedom of Information Act.

Andrea: Yep.

Patrik:  They probably won’t like it, but just ignore it.

Andrea: I’ll just gonna say, how do … not putting my sister in any danger by doing that, am I?

Patrik:  Yep. No. No. No. People, look, I can tell you that if … if I work with clients like we doing now, and we have concerns around documentation, or around NFR, it’s usually what I advise people to do. And, you know I have not seen that of being to detriment to a patient or a family.

Andrea: I mean, once we have the family meeting, and if you’re, hopefully, present, you’d be able to request that.

Find more information about family meetings:

• “FOLLOW THIS ULTIMATE 6 STEP GUIDE FOR FAMILY MEETINGS WITH THE INTENSIVE CARE TEAM, THAT GETS YOU TO HAVE PEACE OF MIND, CONTROL, POWER AND INFLUENCE FAST, IF YOUR LOVED ONE IS CRITICALLY ILL IN INTENSIVE CARE!”

Patrik: Yeah. No, no, absolutely.

Andrea: I can request that, for your review. For your review?

Patrik: Yeah… Yes, absolutely. Yep, absolutely.

Andrea: That’s probably a good way of doing it.

Patrik: Yep, absolutely.

Andrea:  Or … I actually know how to do all that, request a notice today, for the second opinion, for the brain consultant.

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Patrik: Great. And, you know what is so important? When you do that today, ask with a deadline. Always ask with a deadline. So, you say to them, “Look, I want the notes by whatever it is, Monday, 12 p.m.” You make up the time. Whatever you ask for, I would always ask with a deadline.

Andrea: Yep, okay.

Patrik: Because, otherwise, they just … they’re all busy, we know all of that. But, you got to ask with specific deadlines.

Andrea: Yep.

Patrik:  What else? Do you know whether they’ve got an electronic system there, or are they still paper based?

Andrea: I think it’s electronic, because everything is typed up on a computer on the notes.

Patrik:  Okay. Okay.

Andrea:  So, that should be easy.

Patrik: Well, it should be easy. They don’t have to photocopy anything. They just have to press the print button probably or, even email it to you, I don’t know how they can go about it.

Andrea:  Yep.

Patrik:  Okay. You got to ask that NFR stuff, because I wouldn’t trust them at all.

Andrea: No, I don’t trust them. I don’t trust them at all. I’ve seen enough. Like one stage they didn’t scan her brain, after being in hospital for four days. I’ve lost absolute faith, in them.

Patrik:  Absolutely. Absolutely.

Andrea: And, I think it’s just, sort of, incompetence. One thing I didn’t understand, and I said it to my sister, is, her vas cath  she had on her chest, and that was either form of infection, for her … sepsis, or it was getting aggravated and which is like, we’ve relived this, it’s like deja vu, we’ve actually had this experience after she had her skin cell transplant. She was in ICU, on high dependency, not on the … the critical one …

Patrik:  Yeah… not ICU, yeah, yeah, yeah, yeah.

“Look out for next week’s episode of YOUR QUESTIONS ANSWERED where I continue to help Andrea with this challenge of having her 34-year-old sister in ICU!”

Kind Regards

Patrik