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Based on review of the medical record it was determined that the hospital failed to comply with patient #1's advance directives as evidenced by:

Patient #1 was a 77 year-old male admitted on 02/16/2010, to Doctors Community Hospital. Patient #1 presented to the Emergency Department with shortness of breath. He had a history of COPD, lung cancer congestive heart failure, dementia, seizures, anemia, arrhythmias, and bipolar disease.

He was admitted to the intensive care unit with likely sepsis and he was started on BiPAP. The record showed that patient #1 had respiratory failure, with COPD, lung cancer, and pneumonia requiring ventilator support with high FiO2 requirements during this length-of-stay. He became hypotensive. The record revealed that he was noted to have persistent shock state, and he could not be weaned from the ventilator. Treatment included pulmonary care, broad-spectrum antibiotics, vasopressors (medications that increase mean arterial blood pressure), and oxygen. He nonetheless remained critical and his condition continued to deteriorate during the length-of-stay.

Patient #1 had executed an Power of Attorney declaration which included a statement of his wishes and specifically indicated "generally, I do not want my life to be prolonged and I do not want life-sustaining treatment to be provided or continued ... if I am terminally ill and the application of life sustaining procedures would serve only to artificially delay the moment of my death without providing me with any additional significant opportunities to have meaningful interactions with other individuals with whom I have an ongoing and close relationship ... "

Despite patient #1 having executed the Power of Attorney in which he enumerated his wishes, and despite having provided that documentation to the hospital, the hospital continued aggressive management against the stated wishes of the patient and on the basis of stated wishes of family members. On 02/27/2010 patient #1 experienced a nonsustained ventricular tachycardia (a life threatening cardiac arrhythmia) and the hospital called a code blue. The record indicated that the patient's pulse was maintained and the 1st code ended, but then multiple additional codes were called and advance cardiac life support protocols were utilized.