Patient trapped in middle of nasty dispute

Valentin Medvedev speaks with his eyes: open for yes, closed for no.

Until 15 months ago, he was a research scientist at the University of Washington Department of Chemical Engineering. Then in February 2006, he had a stroke that paralyzed almost his entire body but seems to have left his mind mostly intact.

He gets few visitors, despite a devoted circle of family and friends. That's because a court found that his family was so disruptive, it caused him harm. Visits from family and friends must include a supervisor, whom they must pay. Even then, the family members can have no say about his care.

"He is completely alone," said his wife, Maria.

Meanwhile, his unpaid bills are approaching $300,000. A court fight over who should care for him — and how — continues.

Calling the case extraordinary during a hearing this week, King County Court Commissioner Carlos Velategui placed blame squarely on the family.

Meanwhile, as the battle rages around him, Medvedev can do little but wait.

Medvedev's stroke was unusual: It occurred in the brain stem, which controls voluntary movement. Other than his eyes and some slight control of his head and right hand, the 69-year-old Medvedev (pronounced med-VED-ev) is immobile. Doctors call it "incomplete locked-in syndrome."

For months, someone visited him just about every day, bringing movies, shaving him, taking him on wheelchair strolls. The Medvedevs and their two children, Anna and Andrei, had arrived in the United States in 1996 from Ukraine, where Medvedev had a distinguished career, court documents state.

Since the stroke, he has spent time in Virginia Mason Medical Center and three other local hospitals, undergoing treatments related to his stroke, colon cancer and other problems. Now he is in a nursing home.

Everyone involved in the case agrees: Medvedev wants very much to live. With that in mind, family members have learned everything they could about his medical condition.

Anna, 34, and Andrei, 28, weren't shy about pushing for what they felt their father needed, regardless of whether doctors agreed. When their requests were denied, they pressed harder, sometimes phoning repeatedly, other times arguing with staff members in hospital hallways, court records state. Several times, staff members called security.

The way the family saw it, the staff was rude and dismissed legitimate concerns. The attitude, Andrei wrote in court papers, was "those damn foreigners — they think they are so smart."

They fought for their father, Anna said, because "he couldn't do it himself."

In any case, they were warned repeatedly, but their behavior continued.

Finally, Virginia Mason Medical Center had enough. In August, the hospital filed an anti-harassment petition, saying Anna and Andrei were abusive and threatening toward the staff and disrupted hospital operations.

The family denied acting inappropriately. Nonetheless, Velategui barred Anna and Andrei from the hospital temporarily, later describing their tactics as "guerilla warfare." (Two other hospitals that had treated him told one or more family members they couldn't return for a year.)

Two weeks later, a judge lifted the order but required the family to abide by certain rules.

Hospital dispute

Virginia Mason, however, still had a problem.

Last summer, the hospital was pushing to perform several routine medical procedures that the family opposed. In addition, Medvedev's insurance company declined to pay for continued hospitalization, saying it wasn't medically necessary. But the family wouldn't consent when the hospital wanted to discharge him. Hospital fees were mounting.

Family members maintained they had good reason for their opposition. For example, they said Medvedev had unexplained bleeding, and they didn't want him to leave until it was diagnosed.

"My heart was crying," Anna said. "I'm not a mother yet, but I felt like he was somebody I had to take care of. I really felt like I wanted to protect him and save him and I couldn't."

As it turned out, Medvedev had colon cancer; surgery to remove it was successful.

The family thinks Medicare, Medicaid or health insurance should cover the bills.

Intent on transferring Medvedev out, Virginia Mason petitioned the court last September to assign him a guardian, who could authorize the move. (Later, the University of Washington Medical Center took over as petitioner, when Medvedev was moved there.)

Guardians are appointed to care for people deemed incapacitated. They might manage the person's finances, arrange for medical care, or get the person help around the house. A guardian can be either a paid professional or a volunteer, such as a friend or a relative.

It's rare for hospitals to ask the court to appoint a guardian for a patient, court records show. When they do, it's mostly when the family can't step in. That wasn't the case here. Medvedev's wife, Maria, said she has been a caregiver to elderly and disabled people for nearly a decade.

Family members didn't want Medvedev to have a professional guardian, but they didn't hire a lawyer. Instead, they fought the hospital on their own with voluminous court pleadings — losing virtually every ruling. Then they appealed, losing again and again.

In December, the court ruled Medvedev needed a guardian — a professional one — to manage his money and his life.

Unpaid bills

The family wasn't exactly cooperative, according to the guardian, Partners in Care. For example, the guardian said family members continued to try to direct his medical care by arranging for one procedure and interrupting another, without the guardian's consent. And, the guardian said, they didn't provide Medvedev's financial information, making it impossible for bills to get paid.

Between December and March, bills included about $76,000 in lawyer fees and $23,000 in guardian fees — a figure Lynne Fulp, who runs Partners in Care, calls "staggeringly" high. Medvedev owes $154,000 to hospitals.

Partners in Care decided there was only one way to get control of the situation.

In February, the guardian asked the court to prevent Medvedev's family from "engaging in abuse and unlawful harassment" of him. Already, family members had caused him harm, the guardian said. For example, Anna removed the tape from a feeding tube, "which created a risk of aspiration," legal papers state.

Family members also tried to keep the guardian away from him and arrange a discharge from the hospital. In addition, the family's reputation led numerous care facilities to reject him as a resident, Fulp said. Other facilities said they'd accept him only if there was a protection order in place, she said.

"No one will touch him," Fulp said.

Family members, on the other hand, argued in court filings that their actions were mischaracterized.

The guardian won. By court order, family members can visit only with Partners in Care's consent. They can't discuss health care with doctors or nurses, or even Medvedev himself. Nor can they mention the court battle. To make sure they follow the rules, Anna and Andrei are prohibited from speaking with him in Russian, their native language.

For more than a month, Partners in Care did not authorize a visit. Some of that time, Medvedev was in an "undisclosed location for ongoing health care needs and protection," court files state.

Friends were barred from visiting, because of their ties to the family.

When visits were finally allowed, family members had to hire someone to supervise them. That costs up to $300 each time.

When a reporter asked to visit, Fulp said The Seattle Times would have to pay a supervisor, as well. The newspaper has a policy against paying for interviews.

"It is not the guardian who has created this situation," a Partners in Care attorney wrote in a letter to Medvedev's friends: It was his own family.

"I cannot sleep"

Life for the family has been hard.

"I not know about his condition," Maria said, struggling with her English. "I cannot sleep."

Fulp, as well, is exhausted by problems she believes the family created.

"Our only effort is to make it so Dr. Medvedev can get the care he needs," Fulp said. "We have wrung ourselves out."

As for Medvedev himself, Fulp wrote, "all is finally looking good for him after many, many months of struggle."

But family members said he's lonely, and they can't afford to pay for regular visits. As it is, they fear bankruptcy.

At a hearing Thursday, the court ruled the guardian can use Medvedev's CDs and retirement money and borrow against his home to pay bills. But that won't pay for family visits.

Maria wants to become his guardian and bring him home. Velategui said he has trouble seeing how that would ever be possible, given the complexity of the situation.

Maria is undeterred.

"I don't know how many days or years is left for him," she said. "But I want to be each day with him."

Maureen O'Hagan: 206-464-2562 or mohagan@seattletimes.com