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"You have a patient who comes out of surgery and is doing fine," says Painter. "But as time quickly moves on, she becomes combative, her speech changes, her motor skills go weird, her sodium levels are diving, she's in pain, pulling her turban and her central line, and they have her tied down and just keep giving her morphine to mask the symptoms and just ignore the real problem until she goes into arrest. It's absolutely incredible."

In Texas, if doctors follow the Advance Directives Act, successfully withdrawing treatment, and the patient dies, they are immune to being sued for the death, says Painter. If medical error caused the condition leading to the withdrawal of treatment, the doctors and hospital can still be liable, but the amount of money potentially owed is substantially less because the patient is dead and will not require large sums to pay for extended medical care.

"There's a conflict of interest here because there's an economic incentive to misuse the law," says Painter. "In my opinion, what they were trying to do was literally bury the malpractice."

Sabrina Martin's case illustrates a growing debate over whether doctors accused of medical error should still be able to unilaterally enter orders not to resuscitate patients or to invoke the Advance Directives Act.

"The assumption, I think, has always been that you have to assume doctors are acting in good faith," says Burke Balch, director of the National Right to Life's Robert Powell Center for Medical Ethics in Washington, D.C. "Yet, human nature is such that people do engage in cover-ups and people do make mistakes. There can be simple bad actors and flat-out malpractice that this (law) provides an opportunity to cover up. And human nature being what it is, that's what tends to happen."

Dr. Robert Fine points out that hospitals cannot initiate the Advance Directive law, only doctors can. And the physician who does invoke the law cannot sit on the ethics committee. In addition, Fine does not believe doctors and hospitals are in cahoots, because in most facilities throughout Texas, hospitals do not employ doctors, rather physicians work as independent agents.

"In my judgment," Fine says, "there's no way for a doctor to use this, to, let's say, hide a mistake. As a matter of fact, if a doctor wants to 'hide a mistake,' the last thing they're going to do is call in an independent committee."

State Representative Garnet Coleman, (D-Houston), who helped author the 1999 act, tends to agree with Fine. When asked if he thinks the law is sometimes used to bury malpractice, he says, "I would hope not, and that's why we have autopsies. I don't think that the law either encourages it and I don't think that it discourages it. As long as you've had an autopsy, then you would find out what was the cause of death and whether there was a medical error."

Texas ethicist William Winslade has a slightly more humanistic take.

"I'm sympathetic to doctors who don't want to provide life-support or treatment to people with incurable diseases," he says. But "in a case where the person's condition was the result of alleged medical error, I think that the hospital would be prudent and it would be morally appropriate for the hospital to prolong the process and not simply invoke the process because they can."
_____________________

Imagine being conscious and aware, fully able to understand what people are saying, yet virtually unable to walk, talk, eat or go to the bathroom on the toilet.

This is the world of Sabrina Martin.

Her short-term memory is not what it used to be, say her parents, but Sabrina can remember practically everything up until her second surgery two years ago. For a while she was able to speak, but recently she has regressed and has difficulty finding her voice.

"Because she is in this locked-in syndrome," Sabrina's physician, Dr. Sharon Kawai, says during a taped interview with Painter, "she knows what she was able to do before and that she's not able to do now."

Lopez and Murray say they must be careful around their daughter not to talk about the hospital and their efforts to save Sabrina because she gets visibly upset and it can take an entire day to calm her down. And then there's the nightmares.

"She would wake up screaming, 'I don't want to die,'" says Lopez. "And we would sit up with her and rock her back to sleep. It was like she was stuck in that traumatic moment when all that craziness was happening at the hospital."

Shortly after transferring to Texas Children's Hospital, Sabrina began to improve so dramatically that doctors recommended she not go home but rather be moved to a rehabilitation facility in San Antonio. There, at Kindred Hospital, Sabrina emerged from her coma. Doctors were able to remove her breathing tube and Sabrina began getting better, even advancing to the point where she was able to help her younger sister do math homework by counting on her fingers. Doctors now say Sabrina should have a full life expectancy.

"The people at Memorial Hermann said this would never happen," says Lopez.

Today, Sabrina must wear a diaper and primarily eats through her feeding tube, but she can swallow some soft foods like mashed potatoes and drinks from a bottle. She is wheelchair-bound, but can partially stand when lifted out of her seat. Occasionally she'll whisper, but mostly she nods her head and makes noises to express herself.

Still, it's a long way from being a "vegetable," say Lopez and Murray. And to them it's a blessing.

"It's all small improvements," says Lopez, "but to us they're major."

Starting this summer, Sabrina will begin attending Special Education classes at Klein Intermediate in hopes of doing well and continuing on with school in the fall.

While Lopez continues to work full-time, Murray quit his job as a salesman two years ago and takes care of Sabrina at home. But he has help.

Davida Veal was a former classmate and basketball teammate of Sabrina's before the surgeries, but now she calls Martin her best friend in the world. Two years ago, Veal decided to help care for Martin. She moved out of her own home and is living with Lopez and Murray, sharing a bedroom with ­Martin.

Write Your Comment show comments (11)

  1. As a practicing physician I can assure you that convening an ethics board (containing physicians, nurses and laypeople)to review every aspect of a case in great detail is the last thing a physician who had made a mistake would want to do.
    The laws in Texas are a blessing and exist so that physicians and nurses have the right to NOT continue painful and unnessesary treatments even if the family wants to continue. This is to protect the patient from unrealistic family members and the staff from doing things they find morally and profesionally wrong. They must continue full treatment until an independent group makes a decision.
    A DNR order is usually approved by the family, but is a decision made by a physician that advanced recusitation on a patient would not be benificial and would cause suffering for no reason.

    Comment by Robert — April 30, 2008 @ 12:31PM

  2. A physician is making my decisions or the decisions of my family? No way!

    Any person who calls themselves a physician and is in the business of killing should have their license revoked forever.

    This poor girl would have been dead if the doctors who promise to do no harm had their way. Now, she's in a loving home and has a loving friend and laughs at her jokes. The decision to kill her is not anyone's decision.

    These "independent" boards that help doctors cover up their mistakes is a joke.

    Comment by Astralis — April 30, 2008 @ 02:00PM

  3. I hate sue happy people, but in this case....SUE, SUE, SUE.

    Blessings to the family, I'm so sorry this happened to your little girl.

    I know there are two sides of this story and only one side was presented, but from what is being reported this never should have happened.

    Comment by Barb — May 1, 2008 @ 06:17AM

  4. hey, im one of sabrina's ex boyfriends....i have been close to this family for a long time, even before all this started....to get straight to the point...those doctors DID NOT treat sabrina with care...what so ever..they can deny it all they want, but if they would have just did their job, we would not be in the situation right now. Those doctors CRUSHED Sabrina's dreams and future...i would be at the hospital EVERY DAY to check on sabrina...and everytime i would go, it seems like she got worse and worse...sitting in her room, and her monitors would start beeping, and doctors would not come in and check on here...they seriously NEGLECTED her.she's had seisures, strokes, HER HEART STOPPED!! 2 years later and she's making a little progress, slowly but surely...don't take your child to memorial herman children's hospital!!!!!!

    Comment by joey thomas — May 2, 2008 @ 03:15PM

  5. hey, im one of sabrina's ex boyfriends....i have been close to this family for a long time, even before all this started....to get straight to the point...those doctors DID NOT treat sabrina with care...what so ever..they can deny it all they want, but if they would have just did their job, we would not be in the situation right now. Those doctors CRUSHED Sabrina's dreams and future...i would be at the hospital EVERY DAY to check on sabrina...and everytime i would go, it seems like she got worse and worse...sitting in her room, and her monitors would start beeping, and doctors would not come in and check on here...they seriously NEGLECTED her.she's had seisures, strokes, HER HEART STOPPED!! 2 years later and she's making a little progress, slowly but surely...don't take your child to memorial herman children's hospital!!!!!!

    Comment by joey thomas — May 2, 2008 @ 03:15PM

  6. Many people are patients at Hermann hospital and never pay their bills. It is a huge place that handles most of the local trauma . Many lives are saved at Hermann. For the ones that will not make it, the DNR is a kind way to let nature take its place. The story of that child is a sad one but things happen that are out of the control of all parties concerned. A reality check is needed here. The child appears to be in a vegetative state and no doubt, if she were able to communicate she would prefer to be set free. Often times parents suffer from guilt, selfishness in terms of wanting to hold on to their children even though they should let go. In this case, these people are determined to get money to satisfy their point of view and greed. They are wrong for doing so. They will not win. Hospitals try their best and not all will end up satisfied. We have to face reality that all things do not end up the way we expect.

    Comment by alumette — May 3, 2008 @ 07:35AM

  7. Frankly, no one gives a shit if they need to save their own asses. Since when do doctors really care if you're in pain or if treatment is unnecessary. BULLSHIT. She has a right to life. THere are many stories of people who defy the odds, so whose to say that one day she will be at least 50% better. As you can see towards the end of the article, she isn't a 'vegetable'...the way i see it, the parents can afford the supposed "unnecessary treatment" then is it really HURTING the doctors to treat the patient?? Last I checked, the doctors didn't give birth to her, they're not her parents, they don't know the emotional devastation of what losing a kid does to you; so they should get off their biggity high horse and treat the patients..that's what they get paid for. I'm currently in med-school and I would NEVER see myself playing God with someone's life. I hope they get sued up the ass.

    Comment by becky — May 3, 2008 @ 08:54AM

  8. The first time I found this article I was mortified. I read it out loud to my wife and a friend of ours. At the time I was only able to read the first half of the article. I just finished it and though I'm very saddened by it, I am also very happy that Sabrina recovered even if not fully. I don't know what I would do if a member of my family was suddenly in this condition. I do know though that there would be some medical staff that would be suffering as much if not more than my family for that negligence. Good wishes and prayers to Sabrina and her Family and Friends.

    Comment by Shane — May 6, 2008 @ 03:57PM

  9. Though I'm sure that this unfortunate girl's money hungry family and obviously highly educated ex-boyfriend are providing a completely unbiased veiw of the situation, I wish that the Press would have included some of the physician's side or at least 'A' physicians side of the story. The reporting is a little sensationalistic and one sided.

    Comment by Micheal — May 7, 2008 @ 09:42AM

  10. Yeah, what's up with doctors on their "biggity high horse". Becky, who is obviously in medical school ;), seems to of stated a very non-emotional, well thought out point. (you can tell from all the exclamation points and profanity) It needs to be stated that doctors are the caretakers of the PATIENT, not the family. Many times, especially in pediatric cases, the family/random boyfriends etc fail or refuse to understand and exept the situation. In that case many helpless people are subjected to painful and unneccesary procedures (intubation, feeding tubes placed through the abdominal wall, etc) that only prolong the inevitable. My sister and I wanted everything done for my father, even though, in retrospect, he had no chance of survival. A very patient and caring physician at Hermann helped us understand the process and my father died naturally in peace with us at his side. The doctors at Hermann did us a great service and saved my father a lot of needless pain.

    Comment by Dakwan — May 7, 2008 @ 09:44AM

  11. Oh. This was an "article" in a "news" publication. I thought it was a pamphlet from the Right to Life folks. Were any medical ethicists consulted? Did the "reporter" review the medical records himself or just talk to the family and their attorney? Did the "reporter" research locked-in syndrome enough to understand that this poor child doesn't have that? Did the "reporter" talk about the cases in which families insist that their all-but-dead relatives keep received life-sustaining treatment even when it is excruciating to the patient?

    Right. It was a pamphlet.

    Comment by Elizabeth — May 15, 2008 @ 11:39AM

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