A Cautionary Tale of MedicineCredit: Real Waba
In one of the most important and potentially far-reaching cases ever assigned to the European Supreme Court, lawyers for the Spanish government will soon argue that the death penalty is a just punishment for four American healthcare professionals accused of murder. The case, which has been winding its way through the Spanish courts for over a decade, is particularly unusual in that the victim is not technically dead.
Another peculiarity is that the four, while subject to Spanish law in the case of murder, are not protected by the blanket immunity given to Spanish doctors for deaths due to malpractice. The final wrinkle is that the death penalty is illegal in Spain but the four could be extradited to Texas where the sentence could be carried out.
The U.S. State Department, finally involved, has refused any comment although its recent actions suggest that it will abide by any decision of the European court as long as it does not coincide with the wishes of the American people.
In March, 2001, Yralih Dyoll, an expat living in the city of Barcelona, was discovered dying in his bed by some neighbors who had broken in to Mr. Dyoll’s house when they thought he was away. Realizing that they could be charged as accessories to murder if they did nothing, they argued for 30 minutes but eventually decided to call an ambulance since their car had been parked outside for the entire time.
Subsequently, Mr. Dyoll was transported, despite his repeated protests, to Montefiore Hospital in New York City. He neither complained of severe chest pains, nor shortness of breath, nor extreme fatigue. To the contrary, Mr. Dyoll was heard to mutter on numerous occasions, “Please, just let me be” In any event, the ambulance crew transferred Mr. Dyoll into the care of the hospital staff.
The heretofore, stalwart staff at the hospital, which included two doctors, one nurse and an orderly who was cleaning the bathrooms, immediately sprang into action. Despite his repeated protestations, Mr. Dyoll was given a single room where he continued to refuse treatment and the doctors ignored his wishes. He was eventually placed in physical restraints to stop him from leaving his bed.
While these events transpired, a hospital administrator was apprised of the situation and immediately grasped its gravity; Mr. Dyoll had not been properly admitted and the hospital was in danger of not being paid. In a grand gesture, she reached out to Mr. Dyoll’s daughter, Heather, and informed her of the situation but not the costs and indicated that a signature and credit card were required. The unwitting daughter immediately rushed to the hospital.
His daughter arrived at the hospital as they were wheeling Mr. Dyoll into surgery. It would be the last time she would see her father in a conscious state. Though medically unnecessary and of no benefit to the patient, the operation was intended to confirm which of Mr. Dyoll’s organs could be harvested in the event of his death. At no time were any efforts exerted to determine Mr. Dyoll’s actual problems.
The operation proceeded normally until the surgeon was about to close the incisions and disaster struck; Mr. Dyoll was having a massive heart attack brought on by the procedure and an improper dose of the anesthetic, sevoflurane. While the surgeon could deal with the heart attack, there was no one in the operating room to rectify the problem with the anesthesia.
Why? The nurse overseeing the anesthesia had gone to find the actual anesthesiologist who had left the room in mid-operation for lunch almost an hour earlier. The nurse’s intuition had been right and she found doctor cozily ensconced in a conversation with his wife. A later investigation would reveal that the nurse was the doctor’s mistress and her jealously had prompted her departure from the operating room. She later told investigators that she visibly upset and it took several minutes for her to regain her composure. She and the doctor then returned to the operating room.
.and the End
As the pair entered the operating room, they were greeted by much commotion from all involved except for Mr. Dyoll who maintained a remarkably calm demeanor. The pair had little to do as the anesthesia apparatus had already been removed and a “crash” cart ordered. With nothing else to do, the anesthesiologist reached over and turned off the EKG which was making a very disturbing, high-pitched squeal. Nothing much happened over the next few minutes as they waited for the cart to materialize.
Unfortunately, one event did occur; Mr. Dyoll died as they all waited for the union orderly to retrieve the “crash” cart. The retrieval did not take unusually long but it was longer than Mr. Dyoll had. It seems that union rules dictate that retrieving said cart normally requires eight minutes. Since the cart was in the next room, the orderly decided to have a quick smoke to kill seven minutes and then returned with the equipment.
In the interim, Mr. Dyoll had expired. In fact, his brain had been deprived of oxygen for thirteen minutes before the emergency staff was able to restart his heart. As such, Mr. Dyoll joined a long list of nutritious foods as he sat staring blankly at the wall.
The situation is now at an impasse. Mr. Dyoll’s daughter wants the life support machines removed so that her father - who was officially admitted as a failed suicide attempt – can finally die. The doctor, nurse and orderly who are all Americans, refuse to perform this euthanasia on the grounds that they will be charged with negligent homicide and be subject to the death penalty. It should be further noted that the actual charges would be for their earlier actions and not for the removal of the life support system – a process which is completely legal in Spain.
The hospital administration is of two minds about the matter. On the one hand, they would like to shut down the life support because the resources being spent on Mr. Dyoll’s current care would be better used on the new doctor’s lounge. On the other, the hospital’s lawyers feel that their interests are better served if the legal fees go to them instead of to the litigants in any wrongful death settlement.
In the meantime, Mr. Dyoll sits and stares. Sometimes, they turn on the TV, to drown out his incessant wheezing. One can only hope that he likes Jerry Lewis reruns. In any event, he has had very little to say on the matter and is not expected to testify at the trial.
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The High Court is expected to start the proceedings in early January just after their holiday break.
Unfortunately, for the defendants, in a blow to their cases, careers and vacation plans, their visas have been revoked pending the outcome of the trial. The hospital guarantees that Mr. Dyoll will last for as long as necessary no matter how much paperwork is involved. Then, when the trial is over, and they are free from any further liability, they will finally do with Mr. Dyoll as they see fit. On the final analysis, one can only surmise that there is a fine line between fact and fiction.