Hospice Patients Alliance: Consumer Advocacy


While most of us cannot know all the intricacies of medical science, all the extremely detailed research on the most up-to-date care, we can have a general understanding of the standards of care. Physicians are licensed in each State to practice medicine. While the standards of care vary for each specialty within medicine, each physician is required to maintain professional competence, to act honestly and with integrity, to fully inform patients about all treatment options, and to actually provide care that meets the standards of care. The general idea is that all physicians must provide the care which could reasonably be expected from any competent physician under the specific circumstances of the case. There are generally accepted protocols of acting for almost every situation which may arise in medicine.

If you are using hospice services, the Attending Physician is required to meet the standards of care in hospice, even if the Attending Physician is not a hospice specialist. Providing adequate and appropriate medications to relieve any and all symptoms the patient may be experiencing is expected. The clear standard is that the care provided must actually be adequate to meet the needs of the patient and the family. The hospice medical director is specifically required to intervene if the patient's own physician does not provide the necessary care to meet the patient's needs. Please note that even though this is a requirement, it does NOT always happen!

Certain hospices arrange that the hospice medical director takes over completely when the patient is enrolled in hospice. This is not how the hospice regulations envision hospice to be provided! The attending physician can remain the physician who is making the medical orders, while the hospice medical director should serve as a "check" on the attending physician should there be difficulty in getting good symptom control. By removing the attending physician from the picture, some "rogue" hospices are allowed to violate standards of care without the knowledge of the attending physician who would not agree with such violations. It is important to insist that your loved one's own attending physician remain the physician who writes the orders. The hospice does not have the authority or right to force you to give up the attending physician.

One of the most important standards for hospice is to make a good-faith effort to do one's best to control pain and uncomfortable symptoms during the dying process. Narcotic medications, sedatives and other medications may be used to achieve this goal. However, leaving the patient in pain without intervening is one of the most serious violations of hospice care standards. That's why one should be able to retain access to both the attending physician and the hospice medical director, for with two physicians, you have a greater chance of achieving the goal of symptom relief. Of course, it is sometimes difficult to achieve full pain control immediately, and different dosages, medications or treatments may be necessary to reach full relief.

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