Man Living Last Days Hears Grim News From Doctor Via Video

Marcia Frellick

March 12, 2019

News reports that a doctor used a live video feed to tell a patient that his death was imminent have set off a flurry of reaction and questions of ethics and appropriateness.

According to several news reports, Ernest Quintana, 78, who had chronic obstructive pulmonary disease, was at Kaiser Permanente Fremont Medical Center in California on March 3 when a machine was rolled into his room and a physician said via a screen on a video robot that test results indicated that Quintana would likely die within a few days.

Quintana's granddaughter, Annalisia Wilharm, who was with him at the time, told the BBC, "I look up and there's this robot at the door. The next thing I know he's telling him, 'I got these [magnetic resonance imaging] results back and there's no lungs left, there's nothing to work with.' "

"I'm freaking out inside, I'm trying not to cry — I'm trying not to scream because it's just me and him," she said.

Wilharm added that Quintana's wife was not in the room. Wilharm told CNN that she had to call her mother and grandmother to come back to the hospital.

"He just got the worst news of his life without his wife of 58 years," she told the BBC. She shared on Facebook a picture of the doctor speaking via video and wrote, "This was horrible for me and him."

When Quintana's wife arrived, she complained to staff about how the news was delivered to her husband, according to news reports.

Quintana died 2 days after the video conversation.

Family friend Julianne Spangler posted the video photo on Facebook on March 9 and wrote, "As a society we cannot accept this as a 'new norm' or 'standard operating procedure.' "

"There is still a need for human touch especially in the last hours of your life. Every struggle, every happy moment, every tear being reduced to a video screen telling you you have no longer to live is not acceptable. Demand better," she wrote.

Kaiser Responds

The hospital did not respond to Medscape Medical New's request for comment. However, Michelle Gaskill-Hames, RN, senior vice president and area manager, Kaiser Permanente Greater Southern Alameda County, responded on Sunday to news coverage:

"We are deeply sorry for falling short of the Quintana family's expectations. We offer our sincere condolences for the loss of their beloved family member and friend. We also take their concerns very seriously and have reached out to the Quintana family to address them.

"It is important to understand that we do not have robots that have medical discussions with patients or deliver terminal diagnoses. The evening video conversation was a follow-up to earlier in-person physician visits and was not used in the delivery of the initial diagnosis.

"That said, we will use this as an opportunity to review how to improve patient experiences with video capabilities.

"We discussed the diagnosis and prognosis of the case in person with the Quintana family and their loved one since he entered our hospital and our physicians and nurses were in regular, in-person communication with the patient and family about his condition. In order to provide an urgent evening consultation with a specialist physician, a live conversation was conducted using a video connection. A nurse was in the room to accompany the video conversation, as is our standard practice.

"When we provide these video conversations, they are always with a nurse or other physician in the room with the patient and family. Use of secure video conversations allows a small hospital to make additional specialists available ‪24/7 for patient consultation, enhancing the care provided and bringing additional consultative expertise to the bedside."

Communication Gaps in Medicine

David Magnus, PhD, professor of medicine and director of the Stanford Center for Biomedical Ethics at Stanford University in California, told Medscape Medical News that, based on the family's reaction and the circumstances reported, the video element was probably not singly responsible for the family's outrage. It likely is indicative of a problem in medicine with communicating grim news in general, especially at end of life, he said.

Though he acknowledged he didn't know the specifics surrounding Quintana's care, he said that a provider should make sure the family is kept informed at each step as a patient declines and when the time comes, ask the patient if he or she is ready to hear difficult news, and whether the closest relatives are present. If video delivery is necessary, that should be explained so the family is not taken by surprise and knows what to expect, Magnus said.

"It might not have been interpreted the same way if it had not been so sudden and stark and in contrast to communications that had come earlier," he said.

Wilharm told the New York Times about the introduction of the live video feed into the room: "I just figured it was routine. I didn't think he'd get his death sentence here."

Magnus, who researches physician communication to patients, said it's not wrong to deliver grim news via telemedicine, though he added, "it's hard to see why they would be using it for a patient in a large suburban setting."

He added that video delivery of news can be done well or poorly just as it can in person, though telemedicine makes it more challenging to compassionately deliver the news.

"What happened at Kaiser and what was really upsetting at least at first, was the communication and the impersonal nature of that communication, but there are a lot of other things that are important in communication that may not have gone very well," Magnus said.

Magnus has disclosed no relevant financial relationships.

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