Reasonable treatment or extreme measures?

If it's Rosemary Frost's time to go, her relatives want to let her. But doctors are going to court to continue care.

By DONG-PHUONG NGUYEN

© St. Petersburg Times,
published August 3, 2001

TAMPA -- Rosemary Frost has been in the intensive care unit at Tampa General Hospital for two weeks. She has third-degree burns over 54 percent of her body, cannot communicate and is teetering on death, relatives said.

Her family has asked doctors to stop treating her so that she can slip away peacefully.

But doctors think they can save the 72-year-old Kenneth City woman and have refused to go along with the family's wishes.

In a move experts consider unusual, the hospital's lawyers filed a petition in Hillsborough court this week seeking permission to administer emergency medical treatment.

As a result, representatives from both sides will appear before a hearing officer this morning to argue her fate. A hearing is scheduled for 10 a.m. before Nick Ficarrotta, general master of the 13th Judicial Court.

At that time, members of Frost's family will reiterate what they have told her doctors: that she has a living will stating that she wished no exceptional attempts be taken in the event of a tragedy.

"(Her living will says) no ventilators, no extraordinary measures. The standard "forget about it,' " Frost's youngest son, Mark Frost, said. "She's always made it known to us."

But a hospital spokesman said Thursday that the decision to seek guardianship was based on a review of the medical facts and the patient's inability to speak.

"The doctor believes it is in the best interest of the patient to continue treatment," said spokesman John Dunn. "In most cases, the paramount issue is, "what are the patient's wishes?' Unfortunately, in this particular case, we cannot determine that. We cannot communicate with the patient."

Dunn would not comment on the living will or give any detail on Frost's medical condition, citing patient confidentiality. He referred a reporter to the court petition the hospital filed, but Chief Judge Manuel Menendez ordered it sealed Thursday.

Dunn said the hospital has a duty to consider the welfare of its patients.

"This is a tragic case," Dunn said. "We certainly feel for the family. This is a very rare and very unfortunate circumstance. We're appearing in a non-adversarial manner."

Rosemary Frost, a former receptionist for a Catholic church, was admitted to the hospital July 19 for burns over most of her body. She was attempting to light a cigarette when her nightgown caught fire, said Kenneth City police Cpl. John Butler.

Despite a severe case of rheumatoid arthritis, she was able to make it to the shower to put out the fire, he said. She called a neighbor, who summoned paramedics.

She was flown to the hospital and underwent surgery. Mark Frost lives with his mother, who is divorced, but was not home at the time of the accident.

When doctors approached Mark Frost and his two older siblings about performing a second surgery, they hesitated, knowing their mother's wishes.

After struggling with the decision, they allowed surgeons to proceed. When approached a third time, however, they decided against it. They discussed her quality of life and determined it was not the way she would want to live.

"The hospital doesn't consider her terminal . . . but she's going to be totally and completely bedridden, staring at the ceiling, being fed and changed," he said. "That was the nightmare of her life."

Frost said his mother is in the intensive care unit with burns from her hips to the neck. He added that she is frail, took injections for her arthritis and suffers from depression.

"She just squints and tries to mouth words," he said. "But she is doped up. We've got no beef with the hospital. We just want her to go peacefully."

It is rare for a hospital to file a petition in court for permission to override a family's wishes, experts say. However, while Florida law generally is friendly to the family's or patient's wishes, stopping treatment may not always be appropriate.

"That is the one gray area, if (the doctor) thinks that he can do something to really save her," said Marty Ratliff, executive director of Project GRACE, a local advocacy group for better end-of-life care. "But there's always that benefit versus burden: What are you going to have to put her through, and what will be gained? Will she be in the condition she was in before, or will she have to live on machines, and in great pain?"

Charles Sabatino, president of the National Academy of Elder Law Attorneys and counsel to the American Bar Association's Commission on Legal Problems of the Elderly, said doctors must take care to ensure family members don't impose their views on the patient.

But when it comes time to consider whether to withhold treatment, they must weigh more than whether the patient can simply be kept alive.

"The whole evaluation should be, "Is the quality of life consistent with what the patient would accept?' " Sabatino said. "That requires not just the living will, but really trying to figure out what mom, or whoever the patient is, would really want."

- Dong-Phuong Nguyen can be reached at (813) 226-3403 or Nguyen@sptimes.com. Times staff writer Wes Allison contributed to this report.

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