Hospice Patients Alliance: Consumer Advocacy

What to Do Immediately
If Medical Killing Occurs in Hospice

Need to Call Police if Medical Killing Occurs

If you believe that your loved one has been medically killed in a hospice setting there are several things that you can do to make sure justice is achieved and the perpetrators are punished. First of all, you will need to call the police immediately and insist they come out. Normally, you would never call the police in a hospice case, but if this is a killing, then it is appropriate to call the police, and do it immediately, do not wait until the body is removed. Don't be talked out of it by anyone if you are sure of what happened. If there was no foul play, that should be readily determinable from the medical record.

If you find local police or county prosecutors reluctant to investigate the case, you should then contact the state Attorney General 's office. If they are not responsive, you need to contact the United States Federal Bureau of Investigation in your area. Sometimes the FBI will want you to first speak with the US Attorney's Office in your area to see if the federal agencies have jurisdiction in the case, and sometimes you need to first speak with the FBI, ... it varies according to the region of the USA you live in. Just keep reporting what happened up the line until someone takes you seriously and investigates.

Don't Dispose of the Medications

Make sure to keep all the remaining medications left at the bedside. It is standard hospice policy to flush these medications or dispose of them somehow after an expected death. And a nurse or physician who intentionally commits a medical killing will insist that the medications be disposed of, but you have a right to refuse. If this is a medical killing, flushing the medications left over destroys an important source of evidence about exactly what medications were given over a certain period of time. Keep the medications and count every medication there with several witnesses to the count and write it all down, signed by several family members. Stand your ground and refuse to have anything destroyed until the police arrive. Keep a copy of your written notations on how many medications, pills, suppositories, etc. there were left at the time.

Do Not Allow Embalming of Victim Until Autopsy Is Done

If you are going to be able to prove anything in court (either civil or criminal), you will need the coroner's report determining the cause of death. Some nurses are reported to manipulate families to have the patient embalmed immediately, which covers their tracks, so to speak, by destroying some of the evidence...the patient's blood. The blood of a patient can easily be analyzed by a coroner to determine the level of narcotics or any other lethal agents in the patient at the time of death. For example, if the patient is a Parkinson's patient with no instability, and suddenly dies in hospice after being given a massive dose of morphine, a toxic level of morphine will show up in the blood analysis. Some staff insist that the victim's body be taken to a particular funeral home: you should not allow this. Always retain control of where your loved one's body goes and make your own decisions. Hospices are not in the business of telling you which funeral home to use. Some even get kickbacks for referring to a particular funeral home that then charges overly high prices.

Gathering Witnesses and Evidence

If possible, keep detailed records of all family members, friends, acquaintances and others who were witnesses to what happened, even over the weeks and months prior to the medical killing. Record the names and licenses/professional training of all hospice staff that came out to provide care to the patient. These may help bolster your case if they have any knowledge of what happened. Write down a detailed account of your recollection of what happened, and do this as soon as possible after the medical killing. It is important to do, because you may forget a small but very important detail.

Need to Get Legal Counsel Immediately

If you wish to pursue justice in the civil courts, you will need to find a plaintiff's attorney who handles medical malpractice and negligence cases. Getting an attorney who also represents health care corporations could be the worst thing you do, because they may or may not have a conflict of interest and you may not get the best representation. You need to find an attorney who handles only plaintiffs' cases exclusively. An attorney will help you get a copy of the medical records and the runaround most hospices give families is something you want to avoid, if at all possible.

Once you have the medical record, the attorney may arrange for a physician to provide a medical review of the record to see if the standards of care and normal protocols have been violated. If a nurse is involved, you will want to get the opinion of a nurse legal consultant who works with medical malpractice attorneys. Having experts look the case over will help you refine any complaints that you file with government agencies.

Working with the District Attorney

If the District Attorney is evaluating the case, having a plaintiffs' attorney advise you is very helpful. Some district attorneys may tell you that, "proving intent is very difficult to do," or "the nurse was just following doctors' orders," in the hope that they can get you to "forget it." The DA may also say that they are unaware of other cases that have been prosecuted. If that is the case, please make sure they know that there have been prosecutions in the US for nurses who have medically killed terminally ill patients in a palliative care setting.

If they object to pursuing the case by saying that the nurse was "just following orders," first of all, you need to make it clear that nurses have the training and responsibility to administer medications in a safe manner and that there are definite signs of adverse affects which a conscientious nurse would note and be aware of. If they still refuse to act, then get a nurse legal consultant to evaluate the case. District attorneys are not trained in medicine or nursing. However, even then, they simply may have a political "agenda" of not prosecuting such cases. If you do get a consulation from a nurse or physician, you will be able to provide the DA with expert opinion on what is "normal" and within the standards of care. If they refuse to act even then, after being adised by a professional that the actions taken were not within the standards of care, you need to go to your state representatives or Congressmen for assistance.

You should be aware that in most situations, the doctor's orders for medications are ordered to be given on an "as needed" basis and do not allow for sudden increases of dosages of narcotics. Also, there are standard protocols to be followed when increasing a dosage, especially with a narcotic medication. Increasing the dosage of a narcotic by 25% to 50% when there is severe uncontrolled pain is normal and within the standards of care. Increasing the dosage by 100% or more is dangerous and can be lethal, especially if there is no pain.

In the case where there actually is severe pain, increasing by 100% may be done in the beginning when pain control is trying to be achieved and when the patient is begging for relief from pain. If there is no severe pain, then such an increase is far from "normal." If the physician had ordered an increase that was beyond 100% and there was no pain, remember that the physician may have his or her own agenda and be a "believer" in euthanasia. Why increase the morphine (or other narcotic) dosage if there was no pain? If pain is controlled, competent physicians and nurses would not increase the dosage unnecessarily.

Protocol for Increasing Narcotic Dose is Established

The Adult Cancer Pain Guidelines from the Nat'l Comprehensive Cancer Network are available at: www.nccn.org/professionals/physician_gls/pdf/pain.pdf
(must register at NCCN website to access these materials for free)

Also, the Agency for Health Care Research and Quality (AHRQ) has published the standards for managing pain in cancer, which is the case in many hospice patients:

Clinical Practice Guideline Number 9: Management of Cancer Pain; Quick Reference Guide for Clinicians (management of cancer pain); Patient Guide to Managing Cancer Pain;

These books and others are available at their website: www.ahrq.gov as a reference used throughout the 1990s and is very helpful and detailed in its approach.

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