Morphine Dispute : Bouvia Will Be Moved to County-USC

A Los Angeles Superior Court judge on Thursday ordered the county Department of Health Services to transfer quadriplegic Elizabeth Bouvia out of a county hospital in Lancaster, where doctors planned to discontinue injections of morphine, the painkiller that Bouvia claims is vital to her comfort.

Judge Jack M. Newman ordered Bouvia transferred within five days to the County-USC Medical Center, where morphine injections were begun last year and are expected to continue.

The ruling brought to an end an acrimonious five-month relationship between Bouvia, who wants to find a hospital or convalescent home that will provide her with painkillers while she starves herself, and the staff of the county’s High Desert Hospital in Lancaster. The hospital first force-fed Bouvia, believing she was not eating enough to live. Then, days before a court overruled it on that issue, the hospital began weaning Bouvia from morphine, believing she had overstated her complaints of pain.

A victim of cerebral palsy and arthritis, Bouvia, 29, declared in 1983 that she no longer wished to live. In past months, she has been ingesting a minimal liquid diet until she can find a facility that will support her wish to die by starvation.

Newman avoided dealing with a thornier patients’ rights issue that was raised when Bouvia sued the county last month to block High Desert from cutting off her morphine: Can a court order a physician to continue to provide treatment that he feels is improper?

The squabble began taking shape last December when Bouvia, who is under the county’s care as an indigent, was transferred from the USC facility to High Desert on the grounds that she no longer required acute care.

Objection to Morphine

Doctors at High Desert soon took exception to the morphine injections. County-USC physicians had begun them in an effort to ease Bouvia’s chronic pain after she contended that orally administered analgesics made her nauseous.

Last month, when High Desert began gradually reducing Bouvia’s morphine injections, her attorneys sued and won a temporary restraining order from Newman.

The attorneys claimed High Desert was violating a landmark state appellate court ruling that had been made in Bouvia’s earlier lawsuit against forced feeding. The appellate court ruled that Bouvia had the absolute right to refuse force-feeding or any other unwanted medical treatment even if it created a life-threatening condition.

This week, Bouvia’s attorneys argued that the decision on refusal of treatment also gave her the right to block High Desert doctors from discontinuing the morphine.

The county counsel’s office warned Newman that if he followed such reasoning, the judge would force High Desert doctors to violate the state Medical Practice Act by administering a controlled substance against their better judgment.

“It is up to the physician whether to continue,” Principal Deputy County Counsel Steven J. Carnevale said of the morphine therapy in arguments Wednesday. “Otherwise the patient is prescribing her own medicine.”

On Thursday, Newman said he would not require continuation of morphine but said Bouvia “does have the right to refuse the course of medical treatment offered to her at High Desert Hospital.”

Richard Scott, one of six volunteer American Civil Liberties Union attorneys representing Bouvia, said he believes that doctors at County-USC will keep Bouvia on morphine.

Carnevale said the county had opposed the transfer because it still does not believe Bouvia needs an acute-care facility. However, he said he was relieved that Newman “didn’t tell doctors how to practice medicine at County-USC.” He said no decision had yet been made on whether to appeal the transfer.

A report by two court-appointed consultants, Dr. Donald Catlin and Dr. David Gorelick, said that a hostile relationship between Bouvia and the High Desert staff had made pain control difficult. Psychological and social assistance have been lacking, the physicians said. They recommended Bouvia be transferred to a hospital where she would be evaluated daily by experts in chronic pain.

Scott said that while the USC facility does not have those services under a formal program, its staff has been compassionate toward Bouvia and will be helpful.

Referring to the persistent tension between Bouvia and the High Desert staff, Scott said his client will be delighted to leave and said he assumed “there’s going to be champagne” opened by the hospital staff in celebration as well.