Texas appeals court orders continued treatment for gravely ill child

Fort Worth, Texas, Jan 6, 2020 / 15:18 pm

A Texas appeals court ordered Friday that a hospital continue medical treatment for Tinslee Lewis, a terminally ill child in Fort Worth, until it rules in the case.

Lewis was born prematurely Feb. 1, 2019, and has since been in the cardiac intensive care unit at Cook Children's Medical Center.

Physicians at the hospital believe life-sustaining treatment for Lewis is medically inappropriate, a decision affirmed by an ethics committee. Lewis' mother, Trinity, wants treatment to continue, and has gone to court to prevent the life-sustaining treatment from being withdrawn.

A judge acting for the Tarrant County district court ruled Jan. 2 that indefinite medical interventions for Lewis could be stopped, in accord with the Texas Advanced Directives Act.

But the Second Court of Appeals of Texas granted Lewis emergency relief Jan. 3, ordering that Lewis' treatment continue until it can consider the appeal. The court did not set a date for an appeal hearing.

Lewis has Ebstein's anomaly, a congenital heart defect; chronic lung disease; and severe chronic high blood pressure, according to the AP. She has been on a ventilator since July, and also requires cardiac support, painkillers, sedation, and medical paralysis. She currently has severe sepsis.

The hospital said that Lewis' healthcare providers agreed by August that continued care was futile, and had begun discussing with her family the withdrawal of life-sustaining treatment by September. The hospital's ethics committee decided unanimously Oct. 30 that further treatment was medically inappropriate.

The hospital intended to stop Lewis' treatment Nov. 10, after disagreeing with the decision of her mother, Trinity, regarding her treatment.

The Texas Advanced Directives Act includes a '10-day rule' that says when the attending physician has decided and an ethics or medical committee has affirmed that a life-sustaining treatment is medically inappropriate, but the patient or their responsible continues to request the treatment, the attending physician and the health care facility are not obligated to provide life-sustaining treatment after the 10th day after the decision is provided to the patient or their responsible.

The rule says the physician is to make a reasonable effort to transfer the patient in such a case to a physician who is willing to comply with the directive. TADA was adopted in 1999, without a dissenting vote, and was amended in 2003 and 2015. The 2015 amendment was adopted unanimously in the House vote, and by a voice vote in the Senate.

At a December hearing, judge Sandee Bryan Marion said she would allow more time for an alternative facility to be found for Lewis' care. Cook Children's said at that time that it would take no action to withdraw life sustaining treatment from Lewis for seven days from the court's decision, to allow plaintiffs to file a notice of appeal and a motion for emergency relief with an appeals court.

Dr. Jay Duncan, a physician attending Lewis, said at the hearing that until July, there had been hope she might be able to go home, but it became clear that surgical and clinical options had been exhausted and her treatment was no longer beneficial.

Bishop Michael Olson of Fort Worth has offered to assist Lewis' family "in seeking compassionate and appropriate care for her in a Catholic health care facility." He said Jan. 2 that "healthcare decisions involving the vulnerable and severely ill are best made in the patient's interests by family and healthcare providers and not by judges, by politicians, or lobbyists."

A spokesman for the Diocese of Fort Worth told CNA Jan. 3 that the bishop's offer of assistance had been passed to the Lewis family by Cook Children's, and that "a representative of the family has contacted the Diocese."

Cook Children's said it "has been devoted to this precious baby her entire life, providing compassionate, round-the-clock, intensive care and attention since she arrived at our hospital 11months ago. Her body is tired. She is suffering. It's time to end this cycle because, tragically, none of these efforts will ever make her better."

The hospital also noted that it had contacted "more than 20, well-respected healthcare facilities and specialists over the course of several months, but even the highest level of medical expertise cannot correct conditions as severe as Tinslee's."

Trinity Lewis has asked that the '10-day rule' be found unconstitutional by the Texas court system.

She is being supported by Texas Right to Life, which said that "the 10-Day Rule has robbed countless patients of their Right to Life and right to due process."

Not all pro-life groups agree with Texas Right to Life's assessment.

Texas Alliance for Life, another pro-life organization, noted that the case centers on the dispute resolution process in TADA.

"Texas Alliance for Life supports TADA. It is good public policy, it is constitutional, and it provides a balance between the patient's autonomy and the physician's conscience protection rights to do no harm," the group stated.

Texas Alliance for Life, along with the Texas Catholic Conference of Bishops and several other pro-life groups, disability advocates, and medical groups, submitted an amicus curiae brief in the case Dec. 11 stating that TADA "helps achieve their essential objectives" and arguing for its constitutionality.

The brief noted that the Texas bishops' conference "generally supports the framework" of the act "as a balanced dispute resolution process that respects patient dignity and healthcare provider conscience," while also supporting "continued legislative improvements to the act."

The brief concludes by saying that "through the Texas Advanced Directives Act, the Legislature has provided families and physicians with a framework for resolving difficult end-of-life decisions. This design includes a safe harbor encouraging physicians and medical institutions to provide multiple layers of review, culminating in a period of time for families to secure a transfer to another medical facility, during which life-sustaining intervention will continue to be provided. The amici believe that the framework created by TADA is essential and constitutional."

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Disagreement over end-of-life reform is among the three criteria on the basis of which the Texas bishops' conference urged parishes in March 2018 not to participate in the activities of Texas Right to Life.

The bishops said they "have been compelled to publicly correct Texas Right to Life's misstatements on end-of-life care and advance directives, in which Texas Right to Life implied that the legislation the bishops were supporting allowed euthanasia and death panels rather than the reality that the legislation reflected the long-standing Church teaching requiring a balance of patient autonomy and the physician conscience protection."

In its Ethical and Religious Directives for Catholic Health Care Services, the US bishops' conference notes regarding the seriously ill and dying that "we have a duty to preserve our life and to use it for the glory of God, but the duty to preserve life is not absolute, for we may reject life-prolonging procedures that are insufficiently beneficial or excessively burdensome."

The directives state that "a person has a moral obligation to use ordinary or proportionate means of preserving his or her life. Proportionate means are those that in the judgment of the patient offer a reasonable hope of benefit and do not entail an excessive burden or impose excessive expense on the family or the community," and that "a person may forgo extraordinary or disproportionate means of preserving life."

"Disproportionate means are those that in the patient's judgment do not offer a reasonable hope of benefit or entail an excessive burden, or impose excessive expense on the family or the community."

Texas Governor Greg Abbott and Attorney General Ken Paxton released a joint statement Jan. 2 saying that "the state will continue to support Ms. Lewis's exhaustion of all legal options to ensure that Tinslee is given every chance at life."

"The Attorney General's office is involved in the ongoing litigation, fighting to see that due process and the right to life are fully respected by Texas law. The Attorney General's office will be supporting an appeal of this case to the Second Court of Appeals. The State of Texas is fully prepared to continue its support of Ms. Lewis in the Supreme Court if necessary. We are working diligently to do all we can to ensure that Tinslee and her family are provided the care and support that they seek."