BAKERSFIELD, Calif. (AP) - A nurse's refusal to give CPR to a dying 87-year-old woman at a California independent living home despite desperate pleas from a 911 dispatcher has prompted outrage and spawned a criminal investigation.
The harrowing 7-minute, 16-second call also raised concerns about the nature of the living arrangements for seniors at a time when their numbers are growing in the U.S. and calls for legislation to prevent a repeat of what happened Feb. 26 at the Glenwood Gardens in Bakersfield.
The woman collapsed in the dining room of the retirement home that offers many levels of care. She lived in the independent living building, which state officials said is like a senior apartment complex and doesn't operate under licensing oversight.
"This is a wakeup call," said Assemblywoman Mariko Yamada, chair of the California Assembly Aging and Long-term Care Committee. "I'm sorry it took a tragedy like this to bring it to our attention."
Yamada cautioned that while it's not yet known whether intervention would have saved the woman's life, "we want to investigate because it has caused a lot of concern and alarm."
Independent living facilities "should not have a policy that says you can stand there and watch somebody die," said Pat McGinnis, founder of California Advocates for Nursing Home Reform, a consumer advocacy group. "How a nurse can do that is beyond comprehension."
In all her years of advocating for the elderly, McGinnis said: "This was so horrifying. I've never seen this happen before."
State officials did not know Monday whether the woman who talked to the 911 dispatcher actually was a nurse, or just identified herself as one during the call. She said one of the home's policies prevented her from doing CPR, according to an audio recording of the call.
"The consensus is if they are a nurse and if they are at work as a nurse, then they should be offering the appropriate medical care," said Russ Heimerich, spokesman for the California Board of Registered Nursing, the agency that licenses health care providers.
The executive director of Glenwood Gardens, Jeffrey Toomer, defended the nurse in a written statement, saying she follow the facility's policy.
"In the event of a health emergency at this independent living community our practice is to immediately call emergency medical personnel for assistance and to wait with the individual needing attention until such personnel arrives," Toomer said. "That is the protocol we followed."
Toomer offered condolences to the woman's family and said a thorough internal review would be conducted. He told media that residents of the facility are informed of the policy and agree to it when they move in. He said the policy does not apply at the adjacent assisted living and skilled nursing facilities.
Multiple calls to the facility and its parent company seeking more information were not returned.
Unlike nursing homes, which provide medical care, independent living facilities generally do not.
"These are like apartments for seniors. You're basically living on your own. They may have some services provided by basic nursing staff, but it's not their responsibility to care for the individual," said Dr. Susan Leonard, a geriatrics expert at the University of California, Los Angeles.
Residents of independent living communities can still take care of themselves, but may need help getting to doctor's appointments. In skilled nursing facilities and nursing homes, many residents require around-the-clock care.
Staff members are "required to perform and provide CPR" unless there's a do-not-resuscitate order, said Greg Crist, a senior vice president at the American Health Care Association.
The dead woman, whose name has been reported but not officially released by authorities, did not have such an order on file at the facility, said Battalion Chief Anthony Galagaza of the Bakersfield Fire Department, which was the first on the scene. That's when firefighters immediately began CPR, continuing until she reached the hospital.
Dr. Patricia Harris, who heads the University of Southern California's geriatrics division, said the survival odds are slim among elderly who receive CPR. Even if they survive, they are never the same. She said she would override the home's policy and risk getting fired "rather than watch somebody die in front of me."
During the call, an unidentified woman called from her cellphone, and asked for paramedics to be sent to help the woman. Later, a woman who identified herself as the nurse got on the phone and told dispatcher Tracey Halvorson she was not permitted to do CPR on the woman.
Halvorson urged the nurse to start CPR, warning the consequences could be dire if no one tried to revive the woman, who had been laid out on the floor on her instructions.
"I understand if your boss is telling you, you can't do it," the dispatcher said. "But ... as a human being ... you know, is there anybody that's willing to help this lady and not let her die?"
"Not at this time," the nurse answered.
Halvorson assured the nurse that Glenwood couldn't be sued if anything went wrong in attempts to resuscitate the resident, saying the local emergency medical system "takes the liability for this call."
Later in the call, Halvorson asked, "Is there a gardener? Any staff, anyone who doesn't work for you? Anywhere? Can we flag someone down in the street and get them to help this lady? Can we flag a stranger down? I bet a stranger would help her."
"I understand if your facility is not willing to do that. Give the phone to a passer-by. This woman is not breathing enough. She is going to die if we don't get this started, do you understand?"
The woman had no pulse and wasn't breathing when fire crews reached her, Galagaza said.
Bakersfield police on Monday were investigating whether there was any criminal wrongdoing. Michaela Beard, a police spokeswoman, said she couldn't provide any further information because the investigation was ongoing.
"It's not uncommon to have someone refuse to provide CPR if they physically can't do it, or they're so upset they just can't function," Kern County Fire Department Deputy Chief Michael Miller said. "What made this one unique was the way the conversation on the phone went. It was just very frustrating to anyone listening to it, like, why wasn't anyone helping this poor woman, since CPR today is much simpler than it was in the past?"