Decision-Making Committee in Action

Mary Ellen Labra, R.N., who has been a nurse for 25 years, described examples of two patients whose care she has overseen for whom medical-treatment decisions were made by New York’s Surrogate Decision-Making Committee (SDMC) program.

One patient was an elderly woman diagnosed with PTSD, OCD, an anxiety disorder, and moderate-to-severe mental retardation. A few months after undergoing a bilateral mastectomy in the late 1990s, she received an ultrasound examination, which revealed something suspicious on an ovary.

“This woman, who had limited [mental] ability, made it clear that she didn’t want any more doctors, needles, or hospitals. . . .She had been institutionalized much of her life and found comfort in her routine. Being in the hospital did not allow her to complete her rituals and created greater anxiety,” said Labra, who has worked at Greystone Programs Inc., in Dutchess County, N.Y., since last January. Greystone provides residences for individuals diagnosed with developmental disabilities.

Some medical professionals involved with the case thought the woman should have additional diagnostic procedures; others, including Labra, agreed with the patient.

“The SDMC panel listened to everyone including the woman and decided she should not have any further invasive procedures. For her remaining years, she was able to live with dignity and control over her life,” said Labra.

In another case she described, an ADMC panel ruled that a 45-year-old man diagnosed with moderate mental retardation should have dental surgery, which required general anesthesia. The earliest appointment his caregivers could obtain for him was in a Connecticut hospital, but when the hospital’s administrators found out that consent had been granted via the SDMC program, which they had not heard of previously, they cancelled the appointment.

The commission sped into action. It arranged a teleconference among the panel members, who granted a time extension for the consent. They also explained the program to the hospital’s administrators, who changed their minds about allowing the surgery.

“Without [the commission’s] support, his surgery probably would have been delayed for months,” said Labra.