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34 HEALTHCARE NEWS CVS Health to Acquire Aetna for $69B: 5 Things to Know By Laura Dyrda I n a groundbreaking deal for the health- care industry, CVS Health acquired Aetna for $69 billion. Here are five things to know: 1. Under terms of the deal, CVS Health would acquire all outstanding shares of Aetna for a combination of cash and stock. Aetna share- holders are slotted to receive $145.00 per share in cash as well as 0.8378 CVS Health shares for each Aetna share. In total, the transaction is valued at around $207 per share. When the transaction closes, Aetna shareholders will own around 22 percent of the combined company. 2. CVS will assume Aetna's debt, which brings to total value of the transaction to $77 billion. 3. e transaction will fill an "unmet need" in the healthcare system, according to CVS, and represents an evolution of both companies as they seek to succeed in consumer-driven healthcare. CVS has taken several steps to be- come an integrated healthcare company over the past few years. While Aetna is expanding efforts from those related to a traditional pay- er to focus on consumer well-being. "With the analytics of Aetna and CVS Health's human touch, we will create a health- care platform built around individuals," said CVS Health President and CEO Larry Merlo. "We look forward to working with the talent- ed people at Aetna to position the combined company as America's front door to quality healthcare, integrating more closely the work of doctors, pharmacists and other healthcare professionals and health benefits companies to create a platform that is easier to use and less expensive for consumers." 4. CVS expects the transaction to close in the second half of 2018 pending approval by shareholders from both companies and reg- ulatory approval. Barclays, Goldman Sachs and Bank of America Merrill Lynch provided $49 billion of financing commitments for the transaction. 5. When the transaction closes, Aetna's CEO Mark Bertolini and two other directors will join the CVS Health Board of Directors. Aet- na's management team will play a significant role in the new combined company, and Aet- na will operate as a standalone business unit within the CVS Health enterprise. n Unconscious Patient's 'Do Not Resuscitate' Tattoo Creates Ethical Dilemma for ER Staff By Megan Knowles E mergency room staff at a Florida hospital found an unconscious patient with "do not resuscitate" tat- tooed on his chest, prompting confusion and ethical concern, according to a case report in The New England Journal of Medicine. Paramedics brought the unconscious 70-year-old man to the ER, where he was found to have an elevated blood al- cohol level. The man had a history of chronic obstructive pulmonary disease, diabetes and an irregular heart rate. The "do not resuscitate" tattoo on his chest underlined "not," and included what staff presumed to be his signa- ture. The man arrived at the ER with no identification or family present, which prompted the social work depart- ment to assist in contacting his next of kin. ER staff failed to help the patient regain a level of con- sciousness where he could adequately discuss his goals for care. The staff initially decided not to honor the patient's tattoo. They reasoned they should not make an irrevers- ible choice due to the situation's uncertainty. However, this decision left staff conflicted and they requested an ethics consultation. The ethics consultants advised staff to honor the patient's DNR tattoo. They reasoned staff could infer the tattoo ex- pressed the patient's authentic preference and added that laws are not always flexible enough to respect a patient's best interest. A DNR order was written and the social work department obtained a copy of the patient's Florida Department of Health "out-of-hospital" DNR order, which was consistent with his tattoo. The patient died after his health continued to deteriorate throughout the night, without receiving CPR. "This patient's tattooed DNR request produced more con- fusion than clarity, given concerns about its legality and likely unfounded beliefs that tattoos might represent per- manent reminders of regretted decisions made while the person was intoxicated," the authors wrote. "We were re- lieved to find his written DNR request, especially because a review of the literature identified a case report of a person whose DNR tattoo did not reflect his current wishes." The case report authors noted this incident does not sup- port or oppose the use of tattoos to express end-of-life wishes for patients who are incapacitated. n The ethics consultants advised staff to honor the patient's "Do Not Resuscitate" tatoo.