Hospice Patients Alliance: Consumer Advocacy

Poor, Elderly, Disabled Veteran Euthanized Against His Will

Case One

Note: the following is the account given by two daughters in the involuntary euthanasia of their father. Names have been withheld to maintain confidentiality.

December, 2000

Letter to authorities:

My sisters and I believe that the circumstances surrounding the death of our father are suspicious and unusual, and therefore fall within the criteria of deaths designated by the (name of state) Death Investigation Act which warrant investigation. We also believe an investigation into the facts and circumstances surrounding our father’s death is wararranted by those agencies responsible for enforcing state and federal regulation compliance and investigating criminal activity, medical malpractice, and Medicare fraud. Because of the complexities and broad scope of this matter, we are addressing this letter to U.S Attorney and the District Attorney for the ____th Judicial Circuit, State of __________.

Our own investigation thus far has produced evidence supporting the allegations asserted herein, and we are concerned that the hospice, doctor, nurses and others involved may alter, desroy or otherwise dispose of any medical and-or other records in their possession and/or under their control before their records can be subpoenaed, if not already altered or destroyed. However, we have copies of medical records which prove most aspects of the fraud and other criminal allegations we will be describing in this letter. The various allegations we are asserting include criminal homicide, conspiracy to commit homicide, Medicare fraud, Title II Conrolled Substance Act violations, medical malpractice and many other violations of the Code of Federal Regulations (“CFR”) and the Official Code of (name of state).

I will address the medicare fraud, i.e., our father’s Hospice certification, first, not because it is the most blatant violation committed, but because it was while under Hospice care that he suffered the damages and , ultimately, his death, which are the subject of this letter. In Dr. (name of doctor)’s capacity as our father’s private physician, he certified to Medicare that our father was terminally ill with lung cancer in order to qualify him for Hospice benefits through Medicare. (name of doctor), it turns out, is also the Medical Director of this Hospice, that he recommended our father to sign up with (name of corporation/hospice) Hospice. There is no medical evidence whatsoever confirming such a diagnosis - no pathology reports, no x-rays, no lab reports. Nor is there any medical evidence of any other type of cancer. (name of doctor) was well aware at the time of Medicare certification, and at all times subsequent thereto, that all tests conducted on our father for any type of malignancy returned negative or inconclusive results.

During the course of our father’s care under (name of corporation/hospice) Hospice, the following violations were committed by (name of doctor) and (name of corporation/hospice).

  1. He was given a drug for which his medical records reveal he was allergic to, although at least four alternative drugs were available on the market, resulting in his death.

  2. He was given a drug which he was told was specifically for his COPD, but actually was medically contraindicated for his primary illness of COPD, resulting in his death:

    Note: Of concern : All of our father’s medications were obtained through through the VA hospital, both those prescribed by his VA physician and (name of doctor). However, (name of doctor) obtained the morphine from a private, local pharmacy, altogether bypassing the VA. This is because my father’s VA hospital records are replete with notations with regard to his morphine allergy and his diagnosis of COPD. (name of doctor) knew he would not be able to get the morphine from the VA, because it would have been red flagged by VA pharmacy.

  3. His regular medications were withheld from him, against his will. This included Lasix for his COPD and his medications for blood pressure (which is evidence that the morphine could not have been administred with the intent to aid and assist his breathing). Morphine in low dosages in combination with a diuretic such as Lasix may be used to decrease pulmonary edema (usually in very end-stage heart failure).

  4. He was denied his right to change his course of treatment when he both wrote and verbally requested that the drug be stopped. He was allergic to this drug and he stated the morphine was making him sicker. His instructions were ignored and the administering of the drug was continued by both Hospice and (name of doctor):

  5. Food and water was denied him via abuse, neglect and later on, due to the comatose state caused by the above described drug (terminal sedation).

  6. (name of doctor) falsified my father's death certificate by incorrectly stating the cause of death to be lung cancer, by incorrectly stating the time of death to be two hours later than it occurred (right after an IV was given), and as for the other two causes of death listed by (name of doctor), i.e., pleural effusion and COPD, it will be shown that these were causes of death only because of his intentional hastening of these illness (by not providing appropriate care) to the point of his death.

  7. Several months before his death, my father was given a vial of morphine by a nurse at (name of corporation-hospice) and was told to keep it in his bedside stand to “think about”. It is doubtful that this vial of morphine was prescribed and legally dispensed by a pharmacist because there was no pharmacy label on it, just the manufacturer's label. It is not legal to dispense unlabeled morphine (or medications of any kind) and especially not without a specific doctor's order. The implications of this action by (name of corporation/hospice) is in direct violation of Hospice regulations and all basic standards of care.

  8. When advised by family members that our father wanted the morphine stopped, (name of doctor) failed to contact our father to verify his wishes about the morphine.

  9. (name of doctor) and (name of corporation/hospice) prescribed dosages exceeding those necessary for my father’s symptoms, and utilized methods of administering the morphine in contradiction to the standards of care for his condition, used excessive amounts of drug, and had them given to him by injection rather than a standard method of oral, subcutaneous or IV pump.

  10. He was illegally discharged from Hospice care and then reinstated a week later, suffering severe mental distress from such action by (name of doctor) and (name of corporation/hospice), in violation of Hospice guidelines and regulations as oulined in the CFR:

  11. He was denied his final arrangements with regard to his children due to the inadequacy of the “spirtual counselor” assigned to him.

  12. (name of doctor) and (name of corporation/hospice) made only one brief visit to our father during a 6-day stay at the (name of hospital) Hospital ( this was only a few weeks before his death), contrary to Medicare Hospice regulations.

  13. Various other violations of the laws and standards of care were committed, including, but not limited to, violations of basic standards of care and misleading family members about the effects of the morphine, causing them to submit to and assist in the assault and battery on our father, i.e., forcing him to take morphine injections against his wishes and convincing family members to ignore his wishes, as well and administer the morphine injections.

  14. The hospice violated our father's wishes to remain alert and oriented. The hospice's actions placed our father in a medically induced coma, despite the fact that he stringently denied experiencing any pain whatsoever during this time. He had not been comatose until given the morphine directly against his wishes.

  15. (name of doctor) and (name of corporation/hospice) did not provide continuous 24 hour nursing care for our father during the crisis symptoms resulting from the overdosage of morphine, (during the last days of his life) when he needed professional care the most.

  16. (name of doctor) and (name of corporation/hospice) rendered our father helpless through the administration of the morphine, and that is how he died, and he did not die with dignity as Hospice is supposed to provide for.

With regard to the fraudulent diagnosis and fraudulent cause of death, please be advised that we are in possession of our father’s medical records from the VA Hospital (name of hospital), where any and all tests for cancer were performed . (name of doctor) advised certain family members three days before our father’s death that he, himself, possessed no medical evidence of lung cancer, and that he had made his diagnosis based on the medical records of the VA Hospital and on what our father told him.

The VA Hospital could not have provided him with any evidence of lung cancer because no such records exist and secondly, physicians cannot legally or ethically diagnose and certify a terminal illness simply upon a patient's unsubstantiated fears. And the fact that the doctor admitted having our father's VA Hospital records means the doctor was fully aware of our father's allergy to morphine and also, that our father had COPD, for which morphine is generally contraindicated. Morphine depresses and slows down the respiratory rate, and especially in COPD patients can lead to death when the breathing is made to stop.

I should also mention that the doctor had treated him for his COPD during the three years he was his medical doctor, so he was aware of all his different illnesses, including renal insufficiency, which also made morphine contraindicated for him because it prevents adequate elimination of the morphine from the body.

Also not receiving his lasix caused the fluid buildup (pleural effusion) in his lungs to escalate. The morphine induced coma also resulted in his inability to cough, preventing him clearing his airways when in the medically induced coma. This resulted in more fluid buildup in his lungs.

When (name of doctor) prescribed the morphine, he did not prescribe an emergency kit to be kept near his bedroom which could reverse any respiratory suppression caused by the morphine. He knew he would have a severe adverse reaction: and, he knew that with his renal insufficiency, failure to get lasix and COPD, he could overdose very quickley on the morphine and that the antagonist Naloxene should have been available in case of an allergic reaction or overdose. As it happened, he did have an adverse reaction and he did overdose...dying shortly after receiving the IV morphine.

For the reasons stated above, a copy of this letter is being forwarded to (name of State) Drugs and Narcotics Agency for futher investigation into the misuse and abuse of a Title II controlled substance and the actions of (name of doctor) who is registered with the US Drug Enforcement Agency to prescribe and administer narcotics in accordance with the Controlled Substance Act.

On the first day of administering morphine to our father, the hospice nurse advised family members who were present to contact all family members so we could visit our father while he would still know us, because within a few days he would be comatose, and then he would die. In other words, the treatment plan was actually an involuntary euthanasia plan, because our father had been alert, oriented, and mobile up to this point, and demonstrated no symptoms of a person facing imminent death from illness. The Doctor literally described the onset and progression of an intentional morphine overdose.

On the third day of the morphine program, our father's wife contacted the Hospice nurse and advised that our father was unable to swallow his usual medications. She was advised by the Hospice nurse that his difficulty in swallowing was a result of the morphine and if he could not swallow his medications, not to worry about giving them to him. Our father was faithful in taking his medications, including his vitamins, because he intended to live as long a life as possible and to be as healthy as possible throughout the length of his life. Because of the dire necessity of certain medications, i.e., medications for pleural efusion, blood pressure and heart condition, it is another suspicious and unusual circumstance that these medications would be discontinued with no concern on the part of (name of doctor) or (name of corporation/hospice).

According to the pharmacist that dispensed the morphine injections , he was not aware of our father’s allergy to morphine and stated that the doctor had not informed him of past adverse reactions to the morphine.

At one point, during the 10-days my father was on morphine, our father could not be awakened by family members or the Hospice nurse and (name of doctor) was notified of our father’s condition by the Hospice nurse. Rather than have the hospice nurse call local emergency medical personnel, (name of doctor) traveled from his county of residence, to my father’s home to examine him himself. It is more curious that during the visit, before leaving our father’s home, (name of doctor) authorized the hospice nurse to increase the dosage and/or frequency of morphine injections being administred to our father and advised family members who were present at the time that his dosage could be increased. This, even though our father had no complaint of pain at all.

Our father, on another day, awoke from his comatose state, but due to his inadequate food and fluid intake and in the absence of receiving his regular medications, was extremely weak and ill. At this point, he found a pen and paper and mananged to write a note of his own free will and accord, in the presence of not less than three family members stating that he wanted the morphine discontinued because it was making him sicker. The morphine was continued against our father's will.

The family member who wanted to conrol daddy’s treatment plan., (name of son) took the note from our father, and in a display of anger, slapped the note between his hands and told our father, "we are going to continue as planned." A local minister visited with our father that evening, and our father repeatedly told the minister that he did not want to be given any more morphine.

To ascertain our father’s mental state and awareness of what he was saying, the minister asked our father a series of questions, to which he answered all correctly, e.g., "who is the President of the United States," "what is your birthday," "how old are you," etc. The minister, however, had been told by the hospice nurse emphatically that the morphine was necessary to help our father’s breathing difficulties and urged our father to continue the morphine injections. This minister was made a victim, herself, in that she will have to live with the fact that she unwittingly contributed to the calculated murder of a good man for the rest of her life: Our father relied on this minister's word (who had relied on the nurse's promise that our father needed the morphine), and therefore our father subsequently submitted to the morphine (although he had previously vehemently refused them over and over again).

The following day, our father managed to sign a medical release form for his medical records from the VA Hospital, directing his medical records be sent to him in care of his daughter (name). He stated to another of his daughters that he wanted all of his children to know the truth if he died. Sadly, the records did not arrive until two weeks after his death; too late to get an injunction to stop the morphine from being administered to him, and too late to save his life.

Our father drifted in and out of consciousness for another day and was then rendered completely comatose by the morphine. For two days, at a minimum, he recieved no fluids or food and remained comatose. No IV fluids were administered to prevent premature death by dehydration and starvation. A statement obtained from one family member who was present at our father’s bedside during the last two days of his life stated that by the last day of his life, our father was receiving morphine injections on an hourly basis. He did not revive, again, and passed away on _____________, 2000.

The folowing are several significant facts which should be considered in an investigation into our father’s death: Our father was nearing the time when he would need to be re-certified in order to continue with Hospice. Some family members had begun to question the cancer diagnosis (which lab tests or other medically scientific tests failed to diagnose at all). Our father had related to several family members that (name of corporation/hospice) nurses had told him that the hospice was in financial difficulty and that was why they were shorthanded and could not be more available to him. (This financial difficulty was a self-created situation since the hospice was signing on more patients in order increase its profit.)

Approximately one month prior to his death, our father had called 911 and went to the hospital for breathing difficulties while under hospice care without notifying hospice in advance, allegedly contrary to their hospice rules. Our father called 911 to get emergency medical assistance because his many calls to hospice for medical assistance were not returned at all! It is my understanding that, according to Medicare guidelines, hospice would be responsible for payment of any hospital expenses incurred by our father for medical care for symptom control. If our father were to continue to use 911 as an alternate emergency avenue when the hospice failed to provide the promised 24 hour nurse on call, as it so often had in the past, it would have resulted in a great expense for the hospice.

Our father advised several of his children that immediately after his visit to (name of hospital), the hospice nurse advised him that they had a meeting and decided to discharge him, because he had gone to the hospital against hospice rules. Actually, the hospice had been responsible to provide emergency symptom management, but failed to do so, and to retaliate against our father when he simply wanted medical care for his illness, is the opposite of what hospice is supposed to do. The mental distress this caused our father was enormous. One week later, (name of corporation/hospice) accepted him back into their care, and a few days later they started him on morphine and ten days later he was dead.

Another curiosity is that during our father’s more than one week stay in (name of hospital), and subsequent overnight stay in the VA Hospital, he did not once complain of experiencing any pain whatsoever. If our father was then, two weeks later, in dire need of medication for unbearable pain associated with cancer, that seems odd indeed. Again, there was no medical proof he had cancer, no lab tests, no formal diagnosis (except on the falsified hospice enrollment forms and death certificate) and no pain.

One more curious and suspicious incident is that on the last day of our father’s life, in the last hour of his life, a hospice nurse arrived with an IV pump. She said it was a morphine pump. She had great difficulty in getting the IV needle inserted properly into our father's veins because of his physical dehydration and deterioration by that time. Within a few minutes of getting the IV going, she came put of his bedroom and announced his death to the family. This incident absolutely demands investigation.

We know that nothing we do can bring our father back. We also know we are not going to let this matter rest until our father’s death certificate is corrected in all respects, and those responsible for his death are held accountable.

Sadly, our father is representative of those at greatest risk of becoming victims of involuntary euthanasia - he was a veteran who proudly served his country. He was poor, elderly, disabled, and disadvantaged. Our father fought with all the abilities he had at his disposal to hold on to life. His determination to live had seen him through medical crises before, to go on to long term recoveries, but his extraordinary determination was not able to overcome the forces of a doctor and a hospice equally determined to end his life.

Our father, though elderly, ill, and, at times, very lonely, was a caring and beloved person, respected by those in the community, who never did one thing to harm anyone, yet he suffered a death less dignified and a thousand times more painful, emotionally, physically, and mentally, than a murderer on death row receives.

I hope the information contained in this letter and the enclosed medical records and statements are sufficient to initiate an investigation into the death of our father. If there is any further information you need please give me a call at the number provided at the top of this letter.


(name of daughter)

Note: This case was reported to the State and local authorities who have to date done nothing. The state and local DA's office have had several months to investigate, but have conducted no such investigation. Further, the hospice and the hospice doctor have separate continuing business relations with the county coroner who would do part of the investigation for the DA's office. The DA's office has not investigated. They plan no action at all. We wish to know if hospices have a license to kill. It is evident, that in our father's case they did.

Note: Hospice Patients Alliance has received this report from a family which is willing to publicly speak about this case. HPA does not take a position on any specific hospice, but condemns the abominable lack of even minimal compliance with the most basic of health care standards, resulting in the needless death of this family's father and thousands of other helpless patients throughout the US. We condemn the hospice's violation of human rights and patient's rights described in this actual case history. In addition, it is deplorable that the local District Attorney and coroner's office refused to act at all. When a DA chooses to not enforce the laws, our land is truly lawless, and especially within the hospice killing fields!

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