By Julie Grimstad
When a healthcare provider recommends
palliative care or hospice, patients and their families need guidance so they
can make the best life-affirming decisions possible in their
circumstances. The Healthcare Advocacy and Leadership Organization (HALO)
advises people to do their homework before electing a palliative care or
hospice program. One place to start is HALO’s website, www.halovoice.org, which has many valuable resources, including
fact/information sheets such as “Questions to Ask a Hospice BEFORE Admission”
and “Drugs Commonly Used in Hospice and Palliative Care.”
The goal of palliative care is to relieve
symptoms—including pain and stress—at any stage in a serious illness and can be
provided in conjunction with curative or life-prolonging treatment. Hospice
care is a subset of palliative care. It is focused on providing comfort care
when a patient no longer has curative options or has chosen to forgo treatment
because the burdens of treatment outweigh the benefits.
When palliative care is provided by healthcare
professionals who have genuine respect for the life of every person committed
to their care, it can be a blessing for patients and their families. Palliative
care should never be used to cause or hasten death.
Unfortunately, there is a growing trend to
misapply palliative medications to make people die, particularly in the hospice
care setting.
Because people who are receiving hospice care
have a limited life-expectancy, it is the “ideal” setting for stealth
euthanasia – intentionally causing patients’ deaths while pretending to provide
appropriate end-of-life care. Patients and families must be vigilant.
“Numerous reports from families of hospice and
palliative care patients indicate that a one-size-fits-all pattern of
administering a combination of opioids and anti-anxiety drugs has emerged.
Whether or not patients have pain and/or agitation, they may begin to receive
these drugs upon admission.” – “Drugs Commonly Used in Hospice and Palliative
Care,” Making a Difference, A Guide for Defending the Medically
Vulnerable, www.halovoice.org
A typical report that HALO receives from
grieving family members is that their loved one, who had been alert and was not
complaining of pain, was administered increasingly frequent and larger doses of
pain medications and sedatives to the point where they were sleeping all the
time and could not eat or drink. Some reported that patients were also denied
usual medications to control blood pressure, diabetes, heart disease,
infections, etc. Other groups receive similar reports. For instance, Murdered
by Hospice, a Facebook group with over 700 members, exists to inform the public
that hospice performs “euthanasia with or WITHOUT CONSENT” and states, “We are
witnesses to medical murder of our loved ones.”
Is palliative care the antidote to assisted
suicide?
There is merit in the argument that we should
ensure patients do not choose assisted suicide because they are not receiving
the best treatment available for management of pain and other symptoms of
disease. However, Oregon’s experience suggests that palliative care is not the
alternative or antidote to assisted suicide. An overwhelming majority of patients who have died by assisted
suicide using Oregon's so-called “death with dignity” law (in effect since
1997) have been enrolled in hospice care programs. The 2019 Oregon Death with
Dignity Annual Report revealed that 90% of patients who killed themselves with
a doctor-prescribed deadly dose of drugs were on hospice at the time of death.
(https://www.deathwithdignity.org/oregon-death-with-dignity-act-annual-reports/)
The American Academy of Hospice and Palliative
Medicine (AAHPM) “takes a position of studied neutrality on the subject of
whether PAD [physician-assisted death] should be legally permitted or
prohibited.” (http://aahpm.org/positions/pad) Neutrality gives the green light to assisted
suicide as surely as support does.
Also, there is more than one way to assist a
suicide. For instance, Voluntary Stopping Eating and Drinking (VSED) is
facilitated by some hospices, particularly in states that do not permit
assisted suicide by physician-prescribed drugs. VSED means that a patient, who
is capable of eating and drinking, chooses to refuse food and fluids with the
intention to cause death. This is suicide. When a hospice supports this
decision by providing “comfort care” as the patient starves and dehydrates to
death, the suicide is assisted – not prevented – by palliative care!
Fraud and abuse are widespread in the
palliative care and hospice industries.
The U.S. Department of Health and Human
Services Office of Inspector General (HHS-OIG), released the results of its
work which identified thousands of Medicare claims that indicate abuse and
neglect of beneficiaries (i.e., patients receiving Medicare benefits).
(See https://oig.hhs.gov/newsroom/media-materials/2019/hospice/ for more information.)
For information about hospice fraud, simply
Google “hospice fraud cases.” Prepare to be astounded at the extent and the
dollar amount involved, and, even worse, the patient abuse.
Here is just one example. The FBI made arrests in February 2018
for healthcare fraud. Brad Harris, the owner of a Frisco-based (near Dallas,
Texas) hospice company, his wife and 14 others were indicted in a $60 million
Medicare fraud scheme that put financial interests over the needs of patients.
Five of the defendants were doctors. Five were nurses. The FBI investigation, which began in
2014, initially focused on allegations that Novus Health Services sought
federal reimbursements for patients recruited by Novus who did not qualify for hospice services and charged
for services that were not medically necessary. Harris also had ordered nurses
to increase drug dosages to speed patients’ deaths and maximize profits,
according to an FBI affidavit. (Harris is an accountant, not a doctor.) Harris
sent text messages to employees such as, “You need to make this patient go
bye-bye.” https://www.runnelscountyregister.com/news/20190325/fbi-hosts-presentation-on-public-information-releases-and-procedures; https://apnews.com/14564cb7d90c44518ec08f4e13b0bfad/Ex-hospice-supervisor-pleads-guilty-in-$60M-fraud-scheme;
and https://www.nbcdfw.com/news/local/fbi-frisco-hospice-owner-directed-nurses-to-overdose-patients/99824/
Advice
If you are considering palliative care or
hospice for yourself or a loved one, do your homework. Providers who are doing
things right and following the rules will be happy to let you know this and to
compare themselves to other palliative care and hospice providers. Ask them for
references – especially the contact information for families who have used/are
using their services. Google the name of the hospice to check for fraud cases
against it. Check out the records of the doctors and nurses providing care. To
report neglect, abuse, or suspected fraud, call 1-800-MEDICARE.
