Family Seeks to End Nightmare of ‘Living Death’

Family members will always remember her as “the little banty hen,” a tiny, fiercely protective bundle of energy who, even in her late 60s, could match her young grandchildren blow for blow in fun and frolic.

When Grandma showed up, say her two daughters, the kids knew they were in for a treat, whether it was a junket to the beach or a trip to Knott’s Berry Farm, where the Rowland Heights woman would climb aboard the parachute jump with all the girlish excitement exhibited by her 6-year-old granddaughter.

“It was always full-blast and feisty with Mother,” says Florence DuBois of her mother, Avis Flott.

But all of that came to a sudden, gruesome halt in December, 1978.

Struck by Automobile

On her way to a Christmas show at a granddaughter’s school, Flott was struck down by a car. She had stopped at a curbside mailbox to mail Christmas cards, according to family members.

“She was rushing across the street to make a call at a pay telephone, when she was struck by this vehicle,” said Vivian McMahon, Flott’s oldest daughter.

Characteristically, Flott was in a hurry because she was supposed to take pictures of her granddaughter in the show.

Flott, now 77, has been in a coma ever since, a small, limp figure in a ground-floor room at the El Monte Golden Age Convalescent Hospital. Stricken with irreversible brain damage, she is kept alive with the use of a nasogastric tube running through her nose and into her stomach, through which medical staff pump a daily diet of 1,200 calories of nutrition.

In August, Flott’s daughters--asserting that their mother had expressly stated on various occasions before the accident that she “never wanted to be kept alive on machines”--filed suit to have the tube removed in an effort to terminate her life. The procedure, in effect, would starve the woman to death.

McMahon and DuBois touched off a lengthy court battle--one that still has not been resolved--which eventually may have implications for other comatose patients in the state’s nursing homes.

‘Will Not Have Been in Vain’

“Maybe our mother’s death will not have been in vain if her case can help others in her condition,” said McMahon, a soft-spoken woman who sometimes struggles for words when she talks about the case.

So far, Los Angeles Superior Court Judge Warren Deering has ruled that the tube can be removed from the comatose woman, a committee of lawyers representing all parties in the case has met to hash out the procedures for having the tube removed and the family has watched the once-energetic woman vegetate for another month.

According to lawyers involved with the case, it demonstrates a troublesome lack of guidance coming from the courts in cases of patients who cannot express their own desires, particularly those who are comatose but not brain dead and are being cared for in nursing homes.

If the Flott case were to go to the state Court of Appeal, the result could be issuance of guidelines for state-licensed nursing homes in dealing with brain-impaired patients, lawyers said.

“There hasn’t been a civil appellate court decision in California regarding the withdrawal of feeding of a comatose patient,” said Brian Birnie, an attorney representing Flott’s physician, Dr. Kurt Gunther. “The courts haven’t established what standards of proof there should be to determine a patient’s wishes.”

An apparent agreement to resolve the meandering case hit a snag this week, delaying the resolution of the case. State law-enforcement officials object to what they see as a precedent-setting proposal for a blanket injunction against criminal prosecution in the case, and medical authorities will not proceed in removing the tube without it.

“It’s a display of inertia,” said a frustrated Richard Scott, attorney for Flott’s family. “The medical people won’t go out on a limb without some assurance of safety, but the government won’t tell them the diameter or the strength of the limb.”

Flott will have been in a coma for eight years on Dec. 12.

Unfavorable Prognosis

The medical prognosis is not good for Flott. The two daughters say that doctors have told them that their mother may linger on in a coma for 10 years or more, before she succumbs from the effects of lung congestion or heart failure.

According to Birnie, speaking for Dr. Gunther, Flott’s recovery from the coma would be “borderline miraculous,” though she is not legally “brain dead.”

“The thing that’s so heartbreaking about the situation is that it’s never over,” said McMahon the other day in the living room of her West Covina home. “It’s just a living death. You can’t in any sense say she’s alive.”

“We want to see Mother die with a little dignity,” added DuBois, who is from Norwalk.

Suit Filed

The legal issues first were raised last spring, when Flott’s family, which includes a son, Ralph Charles Flott, of El Cajon, decided to try to have the comatose woman’s life terminated. That was shortly after the death of Flott’s husband, Ralph Mark Flott, in April.

After a series of meetings with the woman’s doctor and the management of the convalescent hospital, the family filed suit on Aug. 27 in Superior Court, seeking a court order removing the tube and $10,000 in damages for every day the tube remained in place.

Among the hurdles they had to overcome were the strenuous objections of Dr. Gunther, who said that Ralph Flott had never expressed a desire to have his wife’s life terminated.

“But the doctor admitted that he had not seen my father for two years before he died,” said DuBois, the credit manager for a construction equipment leasing firm.

Sympathy for Doctor

“I feel very sympathetic to the doctor,” DuBois added. “He’s devoted his life to preserving life. He told us that he’s from Germany, where he saw people starve to death during the war. But this is different.”

Gunther referred all inquiries regarding his role in the case to his lawyer.

The family maintains that Ralph Flott’s daily visits to his wife in the hospital had given structure to his life, which had been “devastated” by his wife’s accident. But by the end of his life, Ralph Flott had decided that efforts to keep his wife alive were pointless, the daughters said.

“During the last six months of his life he used to say, ‘Maybe I got it wrong. Maybe I’m supposed to go first and make a place for her,’ ” DuBois said.

Judge Deering ruled on Sept. 18 that Flott’s life could be terminated, but he refused to issue an order until all the parties in the case, including doctors, the family and state agencies which license health facilities, submitted a plan for carrying out the order.

No Endorsement

Lawyers representing Flott’s family, Gunther and the health facility, as well as representatives of the attorney general and county counsel, met several times during the past two weeks. But the procedures they agreed to were submitted to Deering on Tuesday without the endorsement of either medical authorities or state agencies.

The problem is, all parties agree, a technicality. The medical people wanted clear-cut assurances from the court that there would be no criminal action taken against them, and the state objected.

“It’s really more a policy declaration than anything to do with the case,” explained Deputy County Counsel Stephen Carnevale. “The chances of any criminal prosecution against anyone are almost non-existent.”

“What we have here is a regrettable incidence of a carefully crafted plan suddenly coming unraveled,” said Scott, the attorney for the two daughters.

Lack of Authority

Both the Los Angeles County district attorney and the criminal wing of the state attorney general’s contend that the courts lack the jurisdiction to enjoin criminal prosecution.

Meanwhile, family members continue their regular visits to the El Monte Golden Age Convalescent Hospital--”I can’t stand to stay for more than about 10 minutes,” said DuBois--and to remember the spunky woman who was the real Avis Flott.

“She was so energetic she could never just sit and watch television without working on a crossword puzzle or knitting or something,” said McMahon, a secretary in the Hacienda La Puente Unified School District.

Flott, a 5-foot-2 former production-line worker, came to California from Kansas 40 years ago, with her husband and three children. The daughters remember her as a strict disciplinarian, fun-loving and scrupulously attentive to the details of being a parent.

Ironed Comic Books

“When we were children back in Kansas, Mother wouldn’t let us out of the house during polio season,” recalled DuBois. “She’d iron our comic books to kill the germs. Once when my brother ran outside, she washed his feet with Lysol water.”

When Ralph Flott, a car inspector for the Atchison, Topeka & Santa Fe Railway, was transferred to Los Angeles, Avis Flott took a job at the Continental Can Co., where she worked for the next 25 years.

Both of the Flotts, who were married more than 50 years, retired in the early 1970s. Until Ralph Flott’s first heart attack in 1973, it was a very active retirement. They sold their home in Anaheim and moved into a mobile home in Rowland Heights, which became the staging ground for countless trips to Las Vegas and Northern California.

“Mother was very, very lucky,” said DuBois. “She won many jackpots in Las Vegas. She could go into a grocery store and sign up for one of those promotional things and she’d always win something.”

Protective of Husband

Even after her husband’s heart attack, there were trips and activities. But Flott, protective of her husband’s health, became even more of a guiding presence.

“She’d put him in a lawn chair in the back yard and not even let him lift a hoe,” said DuBois.

Much of her energy was then being devoted to her granddaughter Emilee, the 6-year-old to whose Christmas show Flott was rushing when she was struck down.

“Mother used to call her up and read stories to her over the phone,” says McMahon.

The two daughters insist that their mother was clear on the subject of extraordinary life-sustaining medical efforts.

Paralyzed Sister

“She had a sister who was paralyzed from a stroke,” said McMahon. “When mother went to visit her, she was lying in bed; she couldn’t move or speak. Her sister had a hearing aid in her ear, and the family kept turning it this way and that way, not knowing if they were turning it up or down and shouting into her ear. Mother was hysterical.”

DuBois said that, about a month before Flott’s accident, her mother had said expressly that she was against the use of life-sustaining machinery.

“She said that she and Dad had talked about it, and they didn’t want any machines on them,” said DuBois. “But she was such a go-go-go person, I didn’t pay too much attention. Of course, by the time I got to the hospital, they had already hooked her up.”

With his wife in a coma, Ralph Flott seemed lost.

Shut-In Existence

“He went home and pulled the drapes and he never opened them again,” said McMahon. “At the same time, though, he seemed to get stronger. He started driving the car again. He said he had to be there for her. But his life was over from that day, except for getting up to go visit mother.”

His death in April at last made Avis Flott’s continued comatose existence pointless, the daughters contend.

A cloud of depression continues to hang over the life of the family.

“Nothing can be shared in a pleasant way any more,” said McMahon. “Mother was always the one who got everyone together. She did all the planning.”

Several of the attorneys involved in the case suggested that this week’s impasse represented little more than a snag in the case’s resolution.

“It’s not a major falling apart,” said Jay Hartz, the attorney who represents the El Monte Golden Age Convalescent Hospital. “There are just a couple of wrinkles to be worked out.”

Scott said that the family is prepared to go to the Court of Appeal, if the wrinkles can’t be smoothed out.

“The old lady continues to lie there in the condition she expressly said she didn’t want to be in,” he said. “If she could talk, I think she’d say the equivalent of, ‘Get this damned tube out of me and let me go to heaven.’ ”