Religion, medicine clash

Orange County Register / July 30, 2000
By Mayrav Saar and William Heisel

The Orange County Register ethics: A woman whose religious beliefs forbid her to receive a blood transfusion is suing UCI over treatment she received at the behest of her two eldest children.

ORANGE -- Their mother lay crumpled on a bed in the intensive care unit a few doors down, hooked up to a ventilator and sedated into unconsciousness. Doctors admitted Marina Ferreira to UCI Medical Center on July 12, 1999 with pneumonia, congestive heart failure, pulmonary hemorrhage and acute renal failure. Her adult children were brought into a small conference room down the hall with three doctors, a social worker and a Jehovah's Witness hospital liaison to hear what they already knew: Their mother was dying.

The two daughters sat side by side crying, but not willing to comfort each other. They were so furious they couldn't even look at each other. Marina Ferreira, 65, had been a Jehovah's Witness for 23 years, a follower of a religion that abstains from blood transfusions. Now as she lay dying her children were fighting -- two for her life, one also for her soul. Her youngest, Carol Quiroz, 27, is also a follower of the faith. The two oldest, Rolando Ferreira and Xinia Turnbull, are Catholic. Now, in the small hospital conference room, Ferreira and Turnbull were saying their mother had told them privately that she wanted a transfusion if it could save her life. Quiroz called them liars. But UCI Medical Center Risk Manager Nance Hove believed they were telling the truth, and so would a court that ordered the transfusion.

"I'm sure you'd understand if that was your parent, and your parent said she was not ready to die," Turnbull said. "What would you do?" Now a fully recovered Marina Ferreira is suing the Univesity of California, Irvine. She says her religion dictates that what her eldest children did was tantamount to rape. She has considered suing them, too, and says she only hugs them because she has to. "It's like they were traitors. The love a mother has for her children lasts forever, but I feel my heart is wounded by what they did," Ferreira said in Spanish. "They knew there were other options, many other options. I know that science has done a lot of things in recent years, and there wasn't any reason for me to have that transfusion." UCI officials will not discuss the suit. But in the balance between medical care and religious convictions, officials say, a hospital takes its cues from patients.

Respecting Rights

UCI's Patients' Rights, posted throughout the hospital, indicate that each patient has a right to "participate actively in decisions regarding medical care. To the extent permitted by law, this includes the right to refuse treatment." The medical center has had a history of handling Jehovah's Witness cases, and doctors there have backed away from treatment that patients have refused, said UCI spokeswoman Kim Pine.

In June, 1999, for instance, SindyBermude, 21, of Fullerton, was rushed to UCI's trauma center after a drunk driver slammed into her car. Sindy's husband, Juan, turned down a blood transfusion for her because he believed his wife, a Jehovah's Witness, would not have wanted it. She died within a few hours. At the time, UCI doctors said her injuries were so bad it's not certain a blood transfusion would have helped.

University of California medical malpractice attorney Peter Schneider said UCI stuck to its policy in the Ferreira case, as well. "I'm confident that all university-affiliated persons followed all legal avenues accurately and appropriately," Schneider said. "All the UC medical centers go to extra lengths to comply with the wishes of patients."

Doctors who have watched patients suffer or die after refusing treatments say it's a difficult lesson, but they have to learn to respect patients' wishes and move on, said Dr. Vinod Malhotra,medical director of bloodless medicine and surgery at Fountain Valley Regional Medical Center. Most of Malhotra's patients are Jehovah's Witnesses, and he says he's become adept at handling bloodless surgeries. But he has watched in agony as superstitions, religious convictions or misinformation cause patientsto deviate from his prescriptions with sometimes fatal results.

The doctor tells a story of a patient whose mammogram detected a tiny lump but whose superstitions kept surgeons at bay. Instead the patient opted for alternative therapy in Mexico. Four years later, the patient came back to his office with an infected breast lesion and tumor that had spread to her brain. She still refused treatment and died two weeks later. "You can get frustrated, but that's only going to give you heartache," Mahorta said. "What can I do?"

A Family Divided

While a patient's decision can be disheartening for a doctor, it can be devastating to family members, said Marina Ferreira's eldest daughter. "I asked my mom, 'Are you ready to die?' " said Xinia Turnbull. "My mom told me that she was not ready to die. But then she would change her story with my sister." In the letter Hove faxed to the court, she stated she was writing "on behalf of Ferreira family members." But Ferreira says Hove listened to the wrong side of the family. Her youngest daughter, Carol Quiroz, was the only one she had designated as legally able to make medical decisions for her. And Quiroz did not approve a blood transfusion decision, according to the lawsuit filed this month in Orange County Superior Court.

A native of Peru, Ferreira became a Jehovah's Witness while living in Costa Rica when Quiroz was just 4 years old. She raised her youngest child in her new faith, but Turnbull and Rolando Ferreira, teenagers at the time, remained in the first religion their mother taught them. "I think the hospital scared them by telling them I was dying," Ferreira said. "They didn't understand my point of view about it. They never really have, and the hospital pressured them into doing it." Quiroz said she knows her brother and sister believed they were doing the best thing for their mom, and she has recently started talking to her sister again. But the wounds have not healed. "It's so hard when it's your brother and sister," Quiroz said. "You love them, but bad things still happened."