JPS doctor pulled plug on comatose patient despite family’s protests, father says

On the Christian holiday celebrating the resurrection of Jesus, Berman de Paz Gonzalez watched his son die.

In March 2018, the 54-year-old father sat at his comatose son’s bedside at John Peter Smith Hospital in Fort Worth for three days. As the sun rose on April 1 — Easter Sunday — he prayed to God for his son’s healing.

Instead, a doctor entered the room with a folder and told the father she had orders to disconnect his 21-year-old son, Berman Daniel de Paz-Martinez, from the ventilator. De Paz Gonzalez told the Star-Telegram his confused protests were ignored as another staff member walked to his son’s bedside and disconnected him from the machines keeping him alive. Minutes later, his son died.

De Paz Gonzalez found out later the doctor who disconnected his son was the director of surgery at JPS. He also learned he was not the first family member to accuse her of killing a loved one.

Dr. Therese Duane has been blamed for the deaths of at least four patients at JPS, including de Paz-Martinez, according to a letter anonymously sent by JPS staff to the hospital’s then-CEO. The letter, which was included in documents filed in court as part of a lawsuit by the family, also accuses Duane of harming five other patients with neglectful care.

“Collectively, the staff feel like we are losing our identity at JPS and sacrificing our commitment to patient care,” the letter says, “for the hubris of one physician.”

In 2020, de Paz-Martinez’s family filed a lawsuit against Duane, JPS and Acclaim Physician Group, which was Duane’s direct employer when she worked in JPS’ trauma care center. The medical malpractice suit alleges Duane violated Texas law by removing de Paz-Martinez from life support without permission. JPS was dismissed from the suit in November 2021. The family is appealing the hospital’s dismissal.

Judge John McBryde of U.S. District Court for the Northern District of Texas dismissed the case entirely in September, writing in a summary judgment that the family’s suit failed to show that Duane “deliberately deprived (de Paz-Martinez) of life.”

The family appealed the dismissal in October, and the appeal is ongoing. A hearing that had been set for Wednesday in the Fifth Circuit Court of Appeals was postponed after the court consolidated two appeals and the family asked for an extension until Jan. 12 to file a brief, according to court records.

As of December 2022, Duane has left JPS and her primary practice is with Envision Surgical Services, which is affiliated with Texas Health Resources, according to her staff page on Texas Health Resources’ website. Duane has hospital privileges with Del Sol Medical Center in El Paso, Medical City in Plano, Medical City in Arlington, Medical City in Denton, Bay Area Corpus in Corpus Christi and Texas Health Resources in Fort Worth.

In response to questions about Duane’s employment, Texas Health Resources spokeswoman Kimberly Walton said the hospital does not comment on pending litigation. Texas Health Resources is not involved in the litigation against Duane. Walton said it is Texas Health Resources’ policy to not comment on any subject that is undergoing litigation, even if it is not involved.

Duane could not be reached for comment and did not respond to a message left at her primary office. Jordan Parker, the attorney representing Duane and Acclaim Physician Group, said he could not comment on pending litigation and referred the Star-Telegram’s questions to JPS. A JPS communications spokeswoman referred questions to the hospital’s attorney, who did not respond to the Star-Telegram.

In an email sent to nonprofit organization Direct Action Texas, which wrote about some of the allegations against Duane in January 2021, an unidentified JPS surgical resident said the patients Duane withdrew care from were uninsured and at least one was an undocumented immigrant. The email was obtained by de Paz Gonzalez’s attorney, Jackson Davis, and is included in the court documents.

“As a poor person, who is an immigrant, it is as if you are pushed aside,” de Paz Gonzalez, who is from Guatemala, said in Spanish. “As if there are no laws to protect you.”

The accident

De Paz Gonzalez immigrated to the U.S. from Guatemala in 1994, where he met Emerita Martinez-Torres. In 1997, she gave birth to de Paz-Martinez. The parents were never married, and the two separated when their son was 4 years old.

De Paz Gonzalez said he was “both mother and father” to his only son, who he described as sociable and always smiling. In 2002, de Paz Gonzalez reconnected with his former wife from Guatemala, Angelina Alverado, and the two have been married for about nine years.

On a rainy Friday afternoon last month, Alverado and de Paz Gonzalez sat on a gray couch in northeast Fort Worth. The father pulled a stack of photos several inches thick from an envelope and started to lay the photos on the coffee table. In one, a chubby toddler with thick black hair smiled at the camera. In more recent portraits, an older boy posed with cars, friends and family. In one photo, de Paz-Martinez held up his daughter, who was 4 years old when he died.

On March 28, 2018, de Paz-Martinez went to a birthday party with friends. On the way home, he and his girlfriend got into a fight. The argument became so tense that he asked his girlfriend to stop the car so he could get out. When she refused, he opened the door and either fell or jumped out of the car, where he hit his head on the pavement, according to his father.

An ambulance took de Paz-Martinez to JPS at 1 a.m. Soon after, his father arrived at the trauma center at the hospital, where his son was connected to a ventilator and in a coma.

Medical records from JPS show a gap in how de Paz-Martinez’s family saw his injuries versus the staff’s prognosis. Copies of his medical records were included as exhibits in the civil case.

De Paz Gonzalez told the Star-Telegram in an interview that the doctors told him at the time that his son might pull through because he was young. But medical notes for his son indicate a grim diagnosis, and say the family did not understand the seriousness of the injury.

When a nurse practitioner and translator met with de Paz Gonzalez and his son’s mother on March 30, according to JPS documents, staff noted the purpose of the meeting was to “discuss worsening CT findings” with “unlikely recovery.” Duane was not in the meeting, and was not involved in de Paz-Martinez’s care directly until April 1. Notes from the nurse practitioner say the parents wanted to discuss next steps with the rest of the family and talk to a chaplain before making further decisions.

The next day, on March 31, 2018, de Paz Gonzalez and Martinez-Torres met with the nurse practitioner and translator again to talk about their son’s treatment. According to JPS records, the nurse practitioner noted at the meeting that the family “believes in miracles” and did not want to stop treatment.

De Paz Gonzalez told the Star-Telegram that at the meeting, the family and hospital staff agreed the hospital would keep his son for another seven days, and then the family would take de Paz-Martinez out of the hospital to care for him at home. That plan is not indicated in the physician notes from the meeting, but the meeting notes make it clear the family did not want to end their son’s treatment. According to the nurse practitioner’s notes, the parents asked staff “for more time.”

“No one else could authorize a disconnection, except me, as the father, and Mrs. Emérita Martínez as my son’s mother, because we were present at that meeting.” de Paz Gonzalez said. “No one else could authorize a disconnection.”

The Texas Advance Directives Act outlines what legally is supposed to happen if doctors and family members disagree on life-sustaining treatment. If doctors determine medical care is futile or medically inappropriate, they can seek a judgment from a hospital ethics committee. The committee can choose to end treatment 10 days after a family is notified unless the family can find another hospital to take the patient. According to the lawsuit, those steps were not followed in this case.

According to the nurse practitioner’s notes from a meeting with de Paz-Martinez’s parents, they verbally agreed to a DNR order for their son. A DNR or Do Not Resuscitate order is a medical order written by a doctor that instructs health care providers not to do CPR if a patient’s heart stops beating or they stop breathing.

De Paz Gonzalez says they did not agree to a DNR order. In his court deposition in May 2022, he said he still did not know what a DNR was.

“They never told me he wasn’t going to wake up,” de Paz Gonzalez said in his court deposition. “The plan was we were going to take him out of the hospital, regardless of how he was.”

‘He was going to progress to death’

On July 13, 2022, Duane testified at a hearing in the civil case against her. The following is her account of de Paz-Martinez’s death according to the deposition.

On April 1, 2018, Duane was making her usual rounds as the attending surgeon in JPS’ ICU and went into de Paz-Martinez’s room. As the attending physician in the trauma unit, she was in charge of his care.

During her assessment, Duane said she determined de Paz-Martinez — who she described in the same deposition as having a “non-survivable head injury” — was able to come off the ventilator and breathe on his own. She stepped out of the room, talked to the respiratory therapist and determined he should be removed from the ventilator — a process called extubation. Since she was the physician in charge, she said in her deposition, she did not have to ask permission from anyone to make treatment decisions.

“He was going to progress to death regardless of what I did,” Duane said in the deposition, “and I was trying to give him the opportunity to breathe without the ventilator.”

She said in her deposition that she does not remember de Paz Gonzalez protesting, and she left the room to continue her rounds.

De Paz Gonzalez described the interaction much differently. According to the father, Duane told him, with the assistance of a translator, that she had a disconnection order for his son and that his son was going to be able to breathe without the ventilator. She said, according to de Paz Gonzalez, “for me to continue waiting for my miracle without the machine.”

De Paz Gonzalez said he strongly protested. He was in the room alone since the rest of the family had gone to an Easter service.

“And at that moment I fell into despair, what I did [was] cry,” he said. “And then they took the time to disconnect my son, with me watching, unable to do anything.”

As he protested, another staff member — Duane said she did not know if it was the nurse practitioner or the respiratory therapist — took de Paz-Martinez off the ventilator. In her deposition, Duane said she learned later that he had died. However, the letter sent to the CEO by JPS staff members about Duane alleges that ICU staff tried to get the crash cart to revive de Paz-Martinez but Duane stopped them.

“The last thing I remember [is] that my son, after the disconnection, gave a very loud sigh and that was the last thing I saw of him,” de Paz Gonzalez said. “And after two, three minutes he changed color. I knew what was happening.”

De Paz Gonzalez said he demanded to speak to Duane to “ask her why she deceived me.” Another doctor came to talk to him and said Duane was not at the hospital anymore. According to the letter from staff, Duane called the other doctor to pronounce de Paz-Martinez dead so she could make it to Easter Mass.

De Paz Gonzalez called the rest of his family to tell them what happened. Two hours later, as he sat at home alone and tried to process what had happened, the hospital called him. They asked if they could harvest his son’s organs.

Aside from that phone call, he said no one else from the hospital has ever contacted him about his son’s death.

‘Questionable’ care

In her deposition, Duane said she was not trying to cause de Paz-Martinez’s death.

“Was it your intent for him to die?” Davis, de Paz Gonzalez’s attorney, asked her in court.

“No,” she said.

Duane said she ordered de Paz-Martinez be taken off the ventilator because her assessment was that he would be able to breathe on his own.

”He was going to die from his head injury whether or not he stayed on the ventilator,” she said in her deposition. “... But that is a separate entity from what I was trying to do with extubating him because I thought he would breathe.”

A JPS peer review committee investigated de Paz-Martinez’s death and determined that Duane’s decision to remove him from the ventilator was “inappropriate.” According to the committee’s findings, which are included in court exhibits, Duane relied on only one of many factors typically used to determine if a patient can survive without a ventilator. De Paz-Martinez failed all but one of those tests, but Duane ordered he be taken off the ventilator, anyway. The committee called her assessment “questionable,” especially since de Paz-Martinez was in a severe coma.

The Texas Medical Board investigated his death, but the investigation was dismissed, according to court records.

While Duane said in her deposition that she thought de Paz-Martinez might survive without the ventilator, she wrote in her own notes on the day of his death that she was trying to give him “a natural death.”

In the deposition, Davis asked Duane whether she believes it is reasonable for families to hold out hope for “miracles” for their loved ones. Duane said as a physician, she has “watched people’s worlds fall apart over and over and over again.”

“Is it OK to support them in having unrealistic hopes? No,” she said.

Near the end of the deposition, Davis asked Duane if she would do anything differently if she had to do the case over.

“I think I did the best I could for that patient at the time with what I had,” she said. “And I am very sorry that this poor family has suffered, but I did the best I could with what I had.”

She goes on to say she faced four years of “soul-crushing attacks” and had to build her own residency program to provide care to sick and dying patients and “watch their loved ones die and pray·with them.”

“When was the last time you made an end-of-life care decision for a patient?” Davis asked.

“This past weekend,” Duane answered.

Other allegations

Duane left JPS in the spring of 2018. According to Duane in her deposition, she was fired without cause. According to JPS documents included in the civil suit, JPS placed Duane on “precautionary suspension” in April, about three weeks after de Paz-Martinez died. When asked why she was let go, Duane said she believes there were people at JPS who did not like that a woman was in charge of the Department of Surgery.

Before Duane left JPS, a group of JPS staff anonymously sent a letter detailing other concerns about her to Robert Earley, the CEO of JPS at the time. JPS did not respond to the Star-Telegram’s questions about the letter and its allegations. The allegations in the letter, which was filed in court as part of the lawsuit, include:

• A woman was admitted for strangulation and was taken off a ventilator without the family being notified. Duane told staff not to perform CPR or put the patient back on the ventilator “despite the patient being a full code at the time of rounds per family’s wishes.” She told a chaplain in the room that she needed his help explaining to the family that the woman should be “allowed to pass peacefully.”

• A 23-year-old woman was admitted after having an abortion and was septic. Duane arrived at the ICU and a nurse said, “I am glad you are here, this girl is very sick,” to which Duane responded, “You know why she is sick? She did this to herself.” The woman coded and staff started to try and resuscitate her. Duane walked into the room and said, “What are you doing? Stop compressions.” She walked over to the patient, kissed her on the forehead, said a Hail Mary and walked out.

• A man who was being treated for a gunshot wound started to deteriorate. Duane told staff not to revive the patient because “JPS was organ hungry and that we were just trying to beat out Vanderbilt.”

De Paz Gonzalez did not know until he spoke with the Star-Telegram that Duane was still working with patients.

“My demand is that she not continue working as a doctor,” he said.

Star-Telegram staff writer Harriet Ramos contributed to this report.