Relatives of an 87-year-old woman who died after a nurse at her retirement home refused a 911 dispatcher's pleas to perform CPR expressed satisfaction with the care she received, saying her wishes were to die naturally. Meanwhile, the company that owns the facility now says its worker failed to follow proper procedures. 
 
 A man walks near the main gate of Glenwood Gardens in Bakersfield, Calif., Monday March 4, 2013, where an elderly woman died after a nurse refused to perform CPR on her last week. The central California... (Associated Press) 
 
 Lorraine Bayless' death last week at Glendale Gardens, a Bakersfield independent living facility, prompted outrage after a 7-minute recording of the 911 call was released. Brookdale Senior Living, which owns the facility, initially said its employee acted correctly by waiting until emergency personnel arrived. But late Tuesday, it issued a new statement saying the employee had misinterpreted the company's guidelines and was on voluntary leave while the case is investigated. 
 
 "This incident resulted from a complete misunderstanding of our practice with regards to emergency medical care for our residents," the Tennessee-based company said. 
 
 Shortly before Brookdale's clarification, Bayless' family sent The Associated Press a statement saying she was aware that Glenwood Gardens did not offer trained medical staff, but opted to live there anyway. 
 
 "It was our beloved mother and grandmother's wish to die naturally and without any kind of life prolonging intervention," the family said. "We understand that the 911 tape of this event has caused concern, but our family knows that mom had full knowledge of the limitations of Glenwood Gardens and is at peace." 
 
 The family said it would not sue or try to profit from the death, and called it "a lesson we can all learn from." 
 
 "We regret that this private and most personal time has been escalated by the media," the statement said. 
 
 Bayless collapsed in the Glenwood Gardens dining hall on Feb. 26. Someone called 911 on a cellphone and asked for an ambulance. Later, a woman who identified herself as a nurse got on the line and told dispatcher Tracey Halvorson she was not permitted to do CPR on the woman. 
 
 Halvorson implored the nurse to find someone else and said she would instruct them on how to do the procedure. 
 
 "I understand if your facility is not willing to do that," Halvorson said. "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?" 
 
 By the time paramedics arrived, Bayless had stopped breathing. 
 
 Bakersfield fire officials who responded said Bayless did not have a "do not resuscitate" order on file at the home. The family and the company have not commented. 
 
 Glenwood Gardens is an independent living facility and as such Brookdale has said that by law it is "not licensed to provide medical care to any of its residents." But it added later that it was reviewing company policies "involving emergency medical care across all of our communities." 
 
 The woman who identified herself as a nurse was employed at the facility as a resident services director, the company said. 
 
 Bayless' death has prompted multiple investigations. 
 
 Bakersfield police are trying to determine whether a crime was committed when the nurse refused to help even find someone to perform CPR. The Kern County Aging and Adult Services Department is looking into possible elder abuse and the state Assembly's Aging and Long-term Care Committee is investigating to see whether legislation is needed. 
 
 The nation's largest trade group for senior living facilities has called for its members to review policies. 
 
 "It was a complete tragedy," said Maribeth Bersani, senior vice president of the Assisted Living Federation of America. "Our members are now looking at their policies to make sure they are clear. Whether they have one to initiate (CPR) or not, they should be responsive to what the 911 person tells them to do." 
 
 The California Board of Registered Nursing is concerned that the woman who spoke to the 911 dispatcher did not even respond to requests to find someone who might want to help. 
 
 "If she's not engaged in the practice of nursing, there's no obligation (to help)," agency spokesman Russ Heimerich said. "What complicates this further is the idea that she wouldn't hand the phone over either. So that's why we want to look into it." 
 
 ___ 
 
 AP Science Writer Alicia Chang contributed to this report from Los Angeles. AP researcher Monika Mathur contributed from Washington. ||||| I seem to have misplaced my outrage. 
 
 In Bakersfield, California, an 87-year-old woman collapsed in a senior residence and was allowed to die by a nurse who was following company policy against staff performing cardiopulmonary resuscitation. In a recording of her seven-minute conversation with the 911 dispatcher, the nurse's affect was, to my ear, one of indifference. 
 
 Not so the exasperated dispatcher who perceived, by phone, that a life-saving opportunity was passing and pleaded with the nurse to resuscitate the woman, or to get someone else to do it. But resuscitation was delayed until the ambulance arrived, and a short time later, at the hospital, the woman was declared dead. 
 
 Still, my outrage is missing. 
 
 Oh, here it is. I found it in the story that wasn't covered – but which played out countless times on countless senior citizens that same day. 
 
 In this story, CPR was dutifully performed, without regard for whether it might do more harm than good, followed by urgent races to the ER where holes were cut in throats to accommodate tubes, arteries were probed and accessed to provide antibiotics, fluids and perhaps opiates, and ventilators were cranked up to deliver to elderly humans what they no longer were capable of accessing on their own: the breath of life. 
 
 Except for a lucky few – roughly, one in five – these patients will not resume life as before. They will not eat for themselves, drink for themselves, clean themselves, or possibly ever feel another thing except maybe when their dressing is changed or feeding tube suctioned, when they'll grimace or moan. Maybe the heart will stop and CPR will be performed again. This will go on for days, weeks, maybe months. 
 
 Just another heroic episode of CPR at the end of life. 
 
 We want to die at home but increasingly, we die in hospitals. We want good deaths. We tell pollsters this all the time. But we seem to want only the good part, not the death part. We fear death. We fear everything about it – pain, grief, lawsuits, God's judgment. Our fear is systemic, undermining everything from dialogue between doctor and patient to a family's determination of what is best for a loved one existing in a terminal and interminable state in intensive care. 
 
 I'm not sure what the Bakersfield nurse was thinking, though it must be a strange thing to be a nurse working for a company that restricts how you assist residents. And I'm not sure what truly was in the best interest of Lorraine Bayless, may she rest in peace. The news reports give no indication of the woman's medical state, whether she had completed an advance directive, or if she had stated her wishes for care in such a scenario. 
 
 I want to assume that the nurse knew Bayless, and had a sense of those wishes. And yet, the call for an ambulance would indicate that a life-saving intervention was not against Bayless' wishes. 
 
 But isn't something wrong with the assumption that performing CPR and rushing a dying elder to the ER is always the good and compassionate act? 
 
 In the Journal of the American Medical Association in March 2012, physicians Craig Blinderman of Columbia University Medical Center and Eric Krakauer of Massachusetts General Hospital, with social scientist/bioethicist Mildred Solomon of the Hastings Center, suggested that CPR should no longer be the default option for dying patients: 
 
 "Whenever there is a reasonable chance that the benefits of CPR might outweigh its harms, CPR should be the default option. However, in imminently dying patients, a default status of full resuscitation is not justifiable. Not only is CPR in this situation likely to harm patients without compensatory benefit, the default framework likely influences patients and surrogates to request that full resuscitation is attempted even when the physician believes doing so may be inappropriate." 
 
 Investigation may find that CPR would have been appropriate for Lorraine Bayless, and that the nurse was as unfeeling as her recorded voice and the corporation (not to say, the person) that employed her. And yet, with CPR on an 87-year-old, if you don't crack a rib, you're not really trying. A nurse knows this. 
 
 A colleague of mine in Community Voices in Medical Ethics recently told an EMT, as she was being loaded into an ambulance, that she did not want to be resuscitated should her heart stop. But the emergency medical technician, for personal or professional reasons, said he could not honor the request. 
 
 My friend's heart never stopped, and we had a laugh when she told me the story. Badly injured in a head-on collision, her recovery is ongoing. But she's healthy enough to find humor in having avoided unwanted resuscitation. 
 
 EMTs did not abide my mom's DNR, and attempted heroic measures. But Mom was already gone. I'd like to think she didn't feel a thing and was enjoying the afterlife she so faithfully believed in. 
 
 I know this much: the Bakersfield dispatcher demanding CPR was not there. The nurse was alone with her judgment, her employer's fear-based policy, and a dying woman. 
 
 It's worth noting that, according to a television reporter, Bayless' daughter "was satisfied with the care her mother received". And that Bayless' daughter is a nurse. ||||| Photo by Justin Sullivan/Getty Images 
 
 This week, an emergency dispatcher in Bakersfield, Calif., frantically urged a caller to administer CPR to an 87-year-old female nursing home resident who wasn't breathing. The caller, who identified herself as a nurse at the home, refused, citing the facility's protocol against staff administering CPR. By the time emergency responders arrived, the resident had no pulse, and she died at a nearby hospital. The incident has prompted California law enforcement and the media to examine the legal and ethical implications of the nursing home's policies. It also raises the question: Can you get in trouble for performing life-saving acts? And are you in hot water if you don't help? 
 
 It depends on the state and country you are in. There is no one federal law governing the issue. Under the 2000 Federal Cardiac Arrest Survival Act, Congress gave immunity from civil damages to people administering CPR or an automatic external defibrillator, with exceptions in cases of gross negligence or willful misconduct. All states have Good Samaritan laws that grant some immunity protection for those performing CPR and an AED (again with restrictions) but they vary. Minnesota and Vermont require bystanders at an emergency to provide reasonable assistance, such as calling 911. Not assisting in Minnesota can land you a petty misdemeanor, and in Vermont a fine of up to $100. California, Nevada, and a few other states have contemplated amending their Good Samaritan laws to include a duty to assist. In some European countries and elsewhere, failing to help someone in need is a criminal offense. 
 
 
 
 A bystander providing CPR immediately after sudden cardiac arrest can double or triple a victim’s chance of survival, according to the American Heart Association. Only 32 percent of cardiac arrest victims, however, receive CPR from a bystander. A slew of complex legal, moral, ethical, and behavioral factors prevent more people from performing CPR. A series of surveys and focus groups conducted by the San Francisco Department of Public Health in 1996 found the top reason why bystanders don't perform CPR is concern about their personal safety, according to John Brown, medical director of the San Francisco Emergency Medical Services Agency. "They're worried the person is faking it—maybe they'll get mugged ... or that they're going to hurt themselves bending over," Brown says. The next two reasons are that people are worried they would hurt the injured person through applying CPR techniques such as chest compression, and they're afraid of not being good enough at the technique. Catching an infectious disease is another reason why bystanders usually don't stop to help, Brown says, despite the fact that using a shirt tail or a scarf can create a barrier between lips that provides some protection. Another reason is they’re afraid they’ll be sued. "There is no legal obligation for a bystander to help an injured person," says Brown. "They can just walk by; it's up to that individual." 
 
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 Seattle implemented a Medic One System recently in which citizens are trained to be active participants by recognizing when a fellow citizen needs medical care, calling 911, and assisting until emergency responders arrive. Results of community training and education are paying off. Nationally, only 10 percent of bystanders administer CPR. But such programs have increased the rate of bystander participation using compression-only CPR by 20 percent to 30 percent, according to Brown, citing statistics from the Centers for Disease Control's Cardiac Arrest Registry to Enhance Survival. The rate of survival in the case of cardiac arrest outside a hospital is 8 percent in the United States. "If you've a cardiac arrest in Seattle, your chances of walking out of the hospital are close to 56 percent," says Brown.
– The death of an 87-year-old woman in a California retirement community after a nurse refused to perform CPR is raising all sorts of ethical and legal questions. But Lorraine Bayless' family says the woman was aware that there were no trained medical staffers on hand and "had full knowledge of the limitation" of the facility, reports the AP. "We understand that the 911 tape of this event has caused concern," the family says in a statement, but "it was our beloved mother and grandmother's wish to die naturally and without any kind of life prolonging intervention," and she "is at peace." The company that owns the facility, however, says the nurse did not follow proper procedures and the incident is being investigated. The 2000 Federal Cardiac Arrest Survival Act provides immunity from civil damages to most people who give CPR or use an automatic external defibrillator, and all states have Good Samaritan laws to protect those performing CPR or using an AED, reports Slate. But just 32% of people suffering from cardiac arrest get CPR from a bystander, and surveys show people are frightened of performing CPR incorrectly, catching a disease from the victim, or even being mugged by a faker. However, the Guardian points out that for the elderly, receiving CPR can actually do more harm than good—the chance of CPR working on the elderly can be as low as 5%, but seniors are much more likely to have their ribs cracked and to suffer from a myriad of long-term health problems if they do survive.