Mirela (left) and Maja (right) were born in the same year and raised like twins, doing everything together. Photo / Supplied
Mirela (left) and Maja (right) were born in the same year and raised like twins, doing everything together. Photo / Supplied
A family have taken legal action in a desperate fight to keep a young mum alive after doctors placed her on Do Not Resuscitate (DNR), allegedly without consultation.
Maja, whose last name is withheld for privacy reasons, lies unconscious at Auckland City Hospital after suffering a "unwitnessed" cardiac arrest while on the Covid-19 isolation ward nearly a month ago.
A U-shaped tube connecting her voice box to her lungs is helping her breathe. She cannot speak or swallow. At most, she moves her eyelids and mouth. Sometimes her right arm twitches.
The hospital's Adverse Event Review Committee is investigating the circumstances of the cardiac arrest and say it will take "some time ... often several weeks" to complete.
Te Whatu Ora (Health NZ) Auckland confirmed it had received a complaint about Maja's care from the family and for ethical and privacy reasons couldn't comment on individual patient care.
The hospital's chief medical officer Dr Margaret Wilsher said it could be distressing to have a very ill loved one, and staff remained committed to working closely with the family.
Meanwhile, intensive care doctors have told the family she has severe brain damage and will likely die. They've advised the family to remove the trachea (windpipe) tube to allow her to die "peacefully".
However, the family members were not ready to let her go and said they felt extremely distressed that doctors were, in their opinion, pressuring them to do so.
Maja's sister Mirela Saban told the Herald her family wanted to wait until the hospital's investigation was complete before they made a decision and was seeking a second opinion from a Melbourne neurosurgeon.
"Maja is a beautiful dancer and model, she is too young to die. She has a 2-year-old who needs her, he needs his mum and we are not ready to let her go," Saban said.
"I will do anything to save my sister."
She said they were born in the same year - about 10 months apart - so were raised as twins.
"We did everything together growing up. We are so close. We slept in the same bed until we were 21," she said.
"I cannot let her go without a last fight."
Maja (left) with her sister Mirela Saban (right) on her wedding day. Photo / Supplied
The family's heartbreak was compounded after learning doctors had put Maja on a DNR list without them being consulted, she said.
A DNR order means that if the patient has a medical event cardiopulmonary resuscitation (CPR), to try and save them, will not be given.
According to the Health and Disability Commission (HDC), doctors could make the DNR call if the patient isn't responsive and views of family are not binding.
"In cases where a consumer is already incompetent but has not made an advance directive refusing future CPR, the decision about resuscitation is a medical issue for the clinician responsible for the consumer's care."
A lawyer representing the family told the hospital - in a letter seen by the Herald - it appeared premature "for clinical staff to make a decision that treatment was futile and implement that decision without seeking input or consent from the family".
"It is axiomatic that decisions to withhold or withdraw medical treatment should take into account ... multiple factors, which include recognition of the importance of family's wishes and needs, values and beliefs, as well as considering fully Maja's best interests," the lawyer said.
In April, Maja was rushed to hospital after experiencing severe headaches. A CT scan revealed she had a brain tumour.
She had surgery to try to remove the tumour but she suffered a major bleed and the family was warned to prepare that she might not survive, Saban said.
Though Maja survived a second surgery, Saban said her sister then got a shingles infection, pneumonia, underwent surgery to drain fluid surrounding her brain and then suffered a blood clot.
"She survived all this and went a long way in the next three months. She was doing so well that there were plans made about moving her to a rehabilitation facility."
"My mother is a nurse with 30 years' experience and it is shocking that she needs to stay in hospital with Maja in case she needs to resuscitate her since the hospital is refusing to do that even though the investigation is still going on," Saban said.
A letter from the hospital's clinical ethics advisory group to a critical care specialist said Maja suffered severe brain damage from the cardiac arrest and it was likely she would die.
"Your teams are concerned that further interventions such as CPR in the event of a further cardiac arrest or readmission to DCCM (Department of Critical Care Medicine) would not change what will happen as there are no further treatments that can be offered to help Ms S."
Wilsher said she appreciated how hard it could be for families when their loved one was not recovering as they hoped.
"We have a legal and ethical obligation to provide medical care that is in our patients' best interests. This includes having open conversations, which take place over time, about our patients' expected health outcomes," Wilsher said.
"If a patient or their family wish to seek a second opinion, we have processes to help facilitate this."
She said patient safety and quality of care was the hospital's top priority and they encouraged patients or whānau who had concerns to contact them directly.
"Alternatively, they can contact the Health and Disability Commissioner for an independent review."
