Sara and George and Justice

As an expert witness for the defense, I reviewed the case of a 90-year-old woman with Alzheimer disease who died of complications from a urinary tract infection in a nursing home. The case seemed like a typical clinical situation I had been involved with many times as a geriatrician, but in this case, the doctor was being sued for wrongful death.

Sara had lived in the nursing home for 5 years. George, her devoted husband, couldn't take care of her anymore. He put her in a “good home” and visited her every week, as Sara became a nonverbal, completely dependent person with dementia.

George also picked a good doctor. Dr. H. ran an ethical, caring, competent practice. Dr. H. and George made a point of meeting at the home once a month. During the last year of Sara's life, Dr. H. and George had talked about advance directives. They agreed on a do-not-resuscitate order, which was put in the chart along with documentation of the discussion itself.

After the umpteenth infection, George told Dr. H. that he did not want to hospitalize Sara anymore and would consider withholding antibiotics. George couldn't watch Sara suffer, and he knew Sara wouldn't have wanted this kind of life. George also told Dr. H. he had recently been diagnosed with lung cancer and that he was dying. He didn't want Sara to be alone, with nobody visiting or caring about her after he was gone. But after this long conversation, Dr. H. was in a hurry to get back to the office, and the discussion was not documented in the chart.

The following Friday night, Sara spiked a fever. Dr. H. told the nurse that it was probably another urinary tract infection and asked her to get a urine culture before he started antibiotics …