First, do no harm.
Trascription of Annotations
Notes on front endpapers: How many cases did you follow that you didn't write about? Taylor/Poarch 3 months. Jake. Armondo Dimas age 25. Patrick Dismuke. Landon--spina bifida. Dexter Advain. Underlinings/notes: Patrick born with Hirschsprung's disease. Telling measure of bureaucracy/economics at Hermann, half its beds empty/conference rooms double-booked. Should Michigan doctor be allowed to hook desperate patients to suicide machine? Institutional Ethics Committee--fewer than 4% of US hospitals have them. 60% had them by 1987. Least common committee topic--money--if hospital can afford a certain type of treatment. Unspoken subject always there. 1945 older building adequate for charity patients/black patients. 130 children depend on Javier. CHOSEN--Chronic Health Oriented Services for Ninos. DNR--Do Not Resuscitate. DNR orders at Hermann, Supportive Care Protocols. As a young child, Patrick Dismuke, when asked to talk about dying, refused, his mother never again raised the subject. Armando Dimas--gunshot victim. Head in a bed. Hermann=regional trauma center. Bullet fragments from spine, lodged in medulla, multiple complications--pulmonary/cardiac. Prognosis for recovery poor. Teresa Knepper wanted to join ethics committee. Committee response to new realities of health care: legal fears, moral uncertainty, need to codify policy. Daily questions of medicine harder. Respirators 1950s. Heart transplants--1982. 1983 Reverend Julian Byrd--formed ethics committee. Green men--If someone says no to amputation because the little green men advised against it, patient incompetent. If 73 year-old does not want the debilitated condition, not incompetent. Byrd left Hermann in 1987 to form ethics committee at Methodist Hospital--Lin Weeks became chair of the Hermann committee. 23 members of committee. Consultants. Quorum of 6. Committee only consultation/advice. Matthew Knepper not diagnosed with cerebral palsy until 1 year old. When Matthew 2, Teresa joined ethics committee at Shands Teaching Hospital in Gainesville, FL. First nonmedical, nonclinical member of Hermann Ethics Committee. Houston--65 hospitals in/around the city, densest concentration in Texas Medical Center. Med Center= 50 buildings, 14 hospitals. 55,000 people paid to work. 2 million patients. Turner nursing ratio 1 to 1. Nurse Virginia Lennox--strong attachment to Taylor's parents, Fran and Carey. Every year more babies in isolettes/warmers born to prostitutes/IV drug users/teens without prenatal care. Neonatal intensive care units product of the '60s/'70s. Between '61-'75 only 6% of babies weighing less than 1,000 grams, 2 lbs., 2 oz., able to survive. 1st half of '80s 50% survived. $2.6 billion spent on US neonatal intensive care--$160,000 per baby. More than 30% of babies weighing less than 1,000 grams at birth would have some handicap. Survival of babies Taylor's age/size 30%. Fran/Carey do not like Dr. Sharon Crandell; Dr. Crandell likes Fran/Carey. Snow Queen. Malpractice. Even if felt parents were doing wrong, not willing to put career on the line, with legal system, could not go around parents. Dr. Eugene Adcock rotated into rounds. Medical charts. Beg. of modern medicine, abbreviations, run-on words conspiracy of doctors against patients. D.W. Cathell--"Physician Himself". Bad idea to do anything to detract from doctor's dignity, lessen you in public esteem to make everyone aware that you are an ordinary person. Idiopathic means don't know the cause. Patrick, b. 21 July 1972--healthy newborn, near 10 lbs. At 2 months old clenched fists to belly and screamed--diagnosed with Hirschsprunger's disease. Hirschsprunger's occurs when the cells that cause the intestines to contract are missing. At 3 months spent 1st night at Hermann. Medical ethics became chic in the '80s--Nancy Cruzan. Patrick addicted to hospital, contaminated own lines to be brought back. George Henry Hermann, b. 6 Aug.1834, died 21 Oct. 1914--parents Swiss immigrants. After Civil War, bought/sold cattle. In 60s stomach pains from cancer--Johns Hopkins. Stethoscope 1816. Microscope 1870s. X ray 1895. 1877 Nitro. Aspirin, Bayer 1899. 1840s ether/chloroform first used medically. 1865 Joseph Lister discovered how to kill germs. 1872 178 hospitals in US, by 1910 more than 4,000. Willed huge plots of land to the city, $2,619,419 in cash. 1925 Hospital opened. 35,000 came to wander the hospital halls. 1st patient, Mrs. Sarah Brecheen. Did not admit patients with incurable diseases. Penicillin 1941. Streptomycin 1944. Chloretracycline--tetracycline, 1948. Monroe D. Anderson--$19 million--used to found cancer research hospital. Only 100/300 Hermann beds dedicated to poor. Robertson Pavilion added to Hermann in 1949--$3.5 million addition. $200,000 X-ray section, largest in US. Death rate in 1950, 841 per 100,000. 556 per 100,000 in 1982. Life expectancy in 1950 was 68; by 1982 74.5. By 1954 14 buildings. Anderson largest cancer hospital in country. Methodist Hospital became Mecca for heart patients. 1969 1st to use artificial heart on patient. 1968 Univ. of Texas agreed to open medical school in Houston. Hermann became teaching hospital. By '70s $2.5 million each year for charity care. 1976 LifeFighter helicopter-ambulance program. 1981 Hermann turned a profit. 10% of Hermann's gross revenues allocated to charity care. Armando not told of prognosis. Family expressed disapproval over care at Hermann. Mother convinced he would recover wanted to take him elsewhere, no other Houston hospital would admit him given injuries/lack of funds. When told of condition, Armando refused DNR. First 3 weeks $57,020.86 in medical expenses. Helo, room, bed. Blood test, IV, food. Prices did not reflect actual costs. Patients who do not pay bills, insurance companies. Actual costs v. billed. Billed $57,020.86 v. actual $29, 837. Medical care $500 million that year, 11.2% of the Gross National Product. Diagnostic Related Groups (DRGs). Patrick exhausted 30 day limit, Medicaid paid $55,835.20--March-June bill $139,773.96 Hermann absorbed the cost. Take from insured to give to uninsured. Many hospitals cannot handle strain, have gone out of business. 1988 102 hospitals closed. 75 Texas hospitals closed between '84-'88. Ben Taub v. Methodist. Methodist--largest private hospital on earth. Unlike Methodist, Hermann governed by will requiring part of revenues be used for charity. Baylor v. Texas. Baylor students dress better. Hermann more than $4 million in debt. 1st Ethics committee meeting about money. Dexter Advani. Parents too involved, insurance cancelled. Dexter enrolled in Medicare. When unpaid bill reached over $150,000 sent to Ben Taub. Patrick, Aug. outpatient Ampho--8 hour treatment. Taylor--Texas Natural Death Act. Living Will. Big questions of medical ethics. Are parents basing decision on fact that baby might die, or the way her life will be if she lives. Teresa thinking of Matthew. 1975 Karen Ann Quinlan. Sharon Crandell needed support of committee to remove ventilator. 40 uninsured patients ran up bill of $2,356,232 in a week. Ethics board 12 cases in 5 months. Another trustee scandal hit Hermann. Book result of 3 years with ethics committee. May 1988 to Oct. 1988 is book's span.