The judge deciding whether the Queen’s Medical Center should be allowed to remove a feeding tube from a debilitated, 95-year-old woman at Queen’s indicated Friday that he might not rule for weeks, which could make the emotional issue moot if Karen Okada dies on her own with her feeding tube still in place.
The issue before Circuit Judge Patrick Border centers on which of Okada’s 1998 wishes should be followed: the power of attorney that she granted to her brother, former Honolulu City Council Chairman George “Scotty” Koga, who does not want Queen’s to remove his sister’s feeding tube; or Okada’s advanced health care directive, which states that she does not want her “‘dying’ be artifically prolonged … and that her instructions ‘shall prevail even if they create a conflict with the desires of my relatives, hospital policies, or the principles of those providing (her) care.’”
Testimony could resume Monday. But Border told lawyers for Queen’s and Okada’s family on Friday that he intends to take his time studying the issues. “I do not take this matter at all lightly,” Border said. “But by the end of the month of October, I think a decision could be made.”
A clearly frustrated William Hunt, representing Queen’s, said a delay in Border’s ruling could give Koga exactly what he wants: to leave his sister’s feeding tube in place even as she may die.
“My concern, your honor, is at that point it’s a fait accompli,” Hunt said. “They’ve gotten whatever they need, whatever they wanted from the beginning.”
Border responded, “This gets about as serious as anything I do.”
He began Friday’s hearing by telling Okada’s family and Queen’s doctors and staff, “This is not something I will do in haste. This is a matter of great public concern.”
Two Queen’s doctors then testified that they believe “beyond a reasonable doubt” that Okada will not recover after a series of medical problems, including a fall that left her with a “devastating brain injury,” followed by a stroke last year and a more recent bout of pneumonia that sent her from the Hale Nani nursing home to Queen’s on Aug. 8.
Okada is “wasting away,” Queen’s Dr. Bradley Willcox testified. “I believe she’s in a persistent vegetative state.”
Queen’s Dr. Kentaro Nishino, who began treating Okada the day after she was admitted, later testified, “I don’t expect that she’ll make any improvement.”
Removing Okada’s feeding tube, Willcox testified, means “she would probably die in two to three weeks, a natural death.”
He added, “It’s not an uncomfortable death. … That’s the way I would want to go.”
Diana Davids, a registered nurse and a member of Queen’s Ethics Committee, which studied the ethical issues pertaining to Okada’s case, said the committee’s belief was that Okada’s advanced health care directive takes precedence over the power of attorney that she granted to her brother.
In response to cross-examination by Koga’s attorney, Scott Makuakane, Davids said that Queen’s policy also gives greater weight to advanced health care directives over powers of attorney.
When pressed by Makuakane about what Okada might have intended when she gave her brother power of attorney, Davids said, “She was trusting her brother to carry out her wishes.”
Makuakane’s case may have to rely on testimony from Okada’s family, who say that her eyes well with tears and she hangs onto their grasp when they try to leave her bedside at Queen’s.
Makuakane said he likely will need more time to find expert witnesses from the mainland because he’s having trouble finding a qualified neurologist who either doesn’t have a relationship with Queen’s or isn’t afraid to testify against the medical center.
