Doctor’s Diary October 15, 2022: Pulling the Plug

Pulling the Plug

How many older adults and disabled have had their “plug pulled”?

Here is a recent story how a group of senior advocates fought back and rectified state law to protect vulnerable citizens from profiteering hospital and HMO administrators taking over medical decision-making.

“There Oughta Be a Law!”

Four years ago as Chairman of a hospital Ethics Committee, I was asked to convene an emergency meeting brought by a distraught family as medical decisions had to be made for their ill loved one. At the meeting were hospital and HMO lawyers, and the family including three adult children and their mother. 

The father had arrived at the hospital unconscious, and was admitted to the Intensive Care Unit where medical care was rendered over the next several weeks.

The lawyers contended under California law since the unconscious patient did not have an Advanced Directive for Healthcare or designated Power of Attorney, then medical decision-making should be made by the hospital and HMO administrators.

The family felt as “next of kin”, they had the right to make medical decisions. They were wrong.

Under existing California law, “next of kin” was not in the decision-making hierarchy and the hospital and HMO administrators would be allowed to “pull the plug.” The family tearfully objected, and a son cried out “There oughta be a law!”

The Ethics Committee could do nothing further. My final statement was to warn the hospital and HMO as a local writer, I would let the community know how they treat their patients and families.

A year later, my wife Robin and I were elected to a state supported organization called the California Senior Legislature (CSL). In existence over 40 years, it brought laws forward especially related to improving the quality of life for older adults.

In our research, we found 46 of 51 States including the District of Columbia have “Next of Kin” laws should a patient be admitted unconscious without an Advanced Directive or Power of Attorney. Not in California. 

From CSL efforts, enough legal information was found to enhance existing law and lessen the threat, protecting Californians from unscrupulous business people.

We wrote a proposal adding “next of kin” to state statute. It was formatted to Legislative specifications by the California Legal Counsel, then “pitched” to lawmakers through CSL. 

Assembly Member Mike Gipson from the California 64th District “authored” the proposed bill introducing it into the State Assembly on February 16, 2022 as AB 2338.

Working closely through his Legislative Aide, Richardson Davis, Assembly Member Gipson allowed my wife and I to provide committee testimony as it went through the Legislature.

Clearing the Assembly and moving into the Senate, voting was almost unanimous as Committee Chairs reminded members there was no “stakeholder” opposition to our proposal. Ultimately, AB 2338 passed both Legislative bodies with a total 206 “yes” votes and only 1 “no” vote! It was signed into law by Governor Newsom on September 29, 2022.

Now in the State of California if you are admitted to a hospital unconscious and not have an Advanced Healthcare Directive designating Power of Attorney, “next of kin” will be given authority to make medical decisions on behalf of their loved ones and not hospital or HMO administrators.

We are fearful many ill patients in the past have had the “plug pulled” on loved ones as family members were not aware of California law.

Still, only 1/3 of adults have a signed Advanced Directive for Healthcare and designated Power of Attorney in place. Much of this can be completed online, and will mitigate medical and legal decision-making complications should you become ill.

The Ethics Committee was unable to intervene in the care of the unconscious father, yet the hospital and HMO did not “pull the plug.” 

Eventually their father regained consciousness, improved, and walked out of the hospital.

Gene Uzawa Dorio, M.D.