Lawyers called in matters of life and death

The Record (Hackensack N.J.) (MCT) - It would seem an easy enough decision, on the surface: whether to allow a Bergen County, N.J., infant in desperate need of a blood transfusion to get one. But the parents were Jehovah's Witnesses, and it was against their beliefs.

Enter attorney Jo Ann Pietro _ appointed by a judge at the instigation of the hospital _ to take over as the child's temporary special medical guardian.

"My feeling was that they were relieved," Pietro says of the parents. "I just said, 'Look, if you don't consent to this, your child will die. She will never get to choose whether or not she even wanted to be a Jehovah's Witness.'"

Private attorneys in states including New Jersey are put into such situations routinely, sometimes for relatively little or no pay. They are part of a legion of lawyers who, for whatever their personal motivations, have made themselves available to judges to serve as court-appointed attorneys.

Their job is to act as the court's eyes and ears, evaluating situations on a patient's behalf and recommending to the court what is in his best interests.

In some cases it means being appointed legal guardian of elderly, incapacitated people. That may occur because they have no known relatives, or their children are in litigation to determine who should ultimately take the reins.

In other cases it means being called to a hospital because a patient needs crucial medical treatment, is unable to give consent and has no other known family to decide on his behalf.

The guardian evaluates the situation and makes a recommendation to the court, which then executes an order based on that recommendation.

Whatever the scenario, and there are many others, it often means dealing with desperately ill patients who have no one, relatives fighting over who should be in charge or getting phone calls from doctors in the middle of the night. Nonetheless, those who do it say it has its rewards.

Riverdale, N.J., attorney Jessica Ragno Sprague said: "You learn a lot about these people. They can be absolutely fascinating. Sometimes they have Alzheimer's disease. But I've never found it hard to speak with them. I've actually gotten some amazing stories. Holocaust survivors. Or singing at Carnegie Hall."

As a relatively young lawyer specializing in family law and divorce cases, Sprague says, "It's a good way to get experience. And I thoroughly do enjoy the work. I obviously have student loans to pay, and other bills. But I think as members of the court, we have an obligation to give back to the community and this is one of the ways I try to do it."

Pietro, who is based in Springfield, N.J., points to her years as a registered nurse before becoming an attorney to explain why she gravitates to the work.

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She recalls a case in which a hospital was seeking consent to perform electroshock therapy on a patient with no known relatives.

"There was a reaction to a medication and this was the only treatment, or the patient would die," Pietro explains. "Being a nurse sometimes doesn't help you, because I know the overwhelming number of complications that can come with ECT. It can have very lasting effects, and I had to balance that. But I did recommend that the ECT be done. It worked well. It was like a miracle."

Less miraculous was a Passaic County, N.J., case in which she was court-appointed guardian to an elderly, incapacitated person whose family members were embroiled in bitter litigation over guardianship.

"They had screaming matches in the hallways of the nursing home. Eventually the nursing home wanted to ban the children from coming to see the demented mother," Pietro said. Nonetheless, Pietro fought that, feeling it was important the mother got to see her children, for better or worse.

North Haledon, N.J., lawyer Mike De Marco, who says he has been paid at "reduced fees" but never served for free, recalled a particularly disturbing case out of the City of Passaic in recent years.

"I was appointed guardian for an elderly person, where the allegations were that she was living in a bed of her own feces and that she had a grandson in the home with her who was abusive. On an emergent basis, I had to get access to the house so I could report to the court on her well-being," he said. "The grandson was home. He allowed me into the house. You've never seen anything like this in your life."

Living conditions were as bad as suspected, he said, but physical abuse could not be proven. Ultimately, another court-appointed guardian was assigned to rectify and monitor the woman's living situation, he says.

Judy Wahrenberger, who is law partners with Pietro and was also a nurse, recalls the difficult but moving trip to the University of Medicine and Dentistry of New Jersey she made on short notice Sept. 8. She was appointed special medical guardian to determine whether a 41-year-old AIDS patient with no known relatives could undergo a procedure.

Doctors at the school, where the patient developed brain lesions, wanted to perform an MRI using dyes that could possibly cause allergic reactions. The task was last-minute, and sad, she says.

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"In part it's because I'm a nurse, by training. It always gets the adrenaline running in me, when I go into a hospital," Wahrenberger says. "The heartbreaking part for me was, you looked at this 41-year-old man, and when you just looked at his body, he looked strong and healthy," she says, noting he could barely speak.

"But you knew his body was ravaged by this disease that was close to killing him. It was hard, when you looked at him, and you just knew."

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© 2008, North Jersey Media Group Inc.