A nurse's refusal to perform cardiopulmonary resuscitation on a dying 87-year-old woman in California despite desperate pleas on the telephone from an emergency dispatcher has prompted outrage and spawned a criminal investigation.
Lorraine Bayless collapsed in the dining room of a retirement home in Bakersfield which state officials said was an independent living complex and did not need a licence.
The harrowing seven-minute, 16-second telephone call also raised concerns that policies at living facilities for elderly people could prevent staff from intervening in medical emergencies and prompted calls on Monday for legislation to prevent a repeat of what happened on 26 February.
During the call, an unidentified woman asked for paramedics to be sent to help Bayless. 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 Bayless.
Halvorson urged the nurse to start CPR, warning the consequences could be dire if no one tried to revive Bayless, 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 the home, Glenwood Gardens, could not 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 passerby. This woman is not breathing enough. She is going to die if we don't get this started, do you understand?"
The woman reportedly had no pulse and had stopped breathing by the time fire crews arrived.
Sergeant Jason Matson of the Bakersfield police department said its investigation had not revealed criminal wrongdoing, but inquiries were continuing.
State officials did not know on Monday whether the woman who talked to the emergency dispatcher 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, which licenses healthcare providers.
The executive director of Glenwood Gardens, Jeffrey Toomer, defended the nurse in a written statement, saying she had followed 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."
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. "How a nurse can do that is beyond comprehension."
McGinnis added: "This was so horrifying. I've never seen this happen before."