"Lynching the Elderly and Disabled?"
(Grand Rapids, Michigan: 2/18/2003; by Ron Panzer)
Why should we be concerned? With 1.6 million people residing in 17,000 nursing homes (11,000 of them for-profit businesses), the opportunity for actual harm to our nation's loved ones is staggering. A recent Congressional study found that 550,000 residents were in homes cited for instances of severe abuse.1
"Lynching" ("hanging" for those who don't know their history) the elderly and disabled would be a shocking thing to do. But merely "euthanizing" the elderly or disabled, at least to some, doesn't seem to sound so bad. But what is "euthanizing?" or "assisting someone to die?" or "hastening death?" It means different things to different people.
Utilitarian vs. Service Oriented Approach to Health Care
There are two completely opposing visions of what health care is supposed to be. One vision takes a utilitarian approach to evaluating life and encourages the killing of undesirable patients through various means; the other vision reveres life without the need to evaluate it, recognizes the intrinsic worth of life and refuses to incorporate the killing of any patient as a valid medical practice. Those who cherish the lives of those they serve embrace a vision of love and caring; they naively find it extremely difficult to admit or believe that others may have such a completely opposite view to their own; they are therefore quite easily misled, manipulated and controlled by those who consciously wield the utilitarian vision from their positions of power. This is now the common scenario in health care administration - health care worker relationships.
The utilitarian approach subjectively evaluates whether or not a person has the ability to be "productive," whether or not his or her life has "quality" in the eyes of the utilitarian observer or whether or not his life simply costs too much for the respective health care agency to treat. This approach looks to corporate profit when there is any question about whether or not to treat a patient. The utilitarian observer may be a physician, nurse, respiratory therapist or any other health care professional. "Love" is given no consideration in the decision-making process. In fact, any suggestion to consider "love" as a factor in decision-making would be ridiculed.
Yet how striking is the difference between the utilitarian approach to observing a patient, how one perceives a patient, and the "loving" approach. For it is the "loving" approach that motivates many nurses, doctors and other professionals to enter into what was once objectively termed the "caring" professions in the first place. Yet "loving" a patient would be considered "unprofessional" by the modern utilitarian approach.
The utilitarian observer who resides at the extreme opposite end of the spectrum may choose to take the role of executioner. Those executed through various means, are the elderly, the disabled, the chronically ill, the congenitally "defective," and various targets of exploitation.2 Various other targets of exploitation will include anyone who poses a threat to the financial plundering of the spigots of money pouring out of the federal and state treasuries through Medicare and Medicaid into the pockets of the unscrupulous white-collar criminals.
According to Linda Peeno, MD, those health care practitioners who execute the vulnerable (whether they act directly or through foreseeable consequences of their decisions) are actually rewarded when they make decisions or take actions that result in the death of patients and thereby increase the profit of the corporation.3
Charles Phillips, MD reveals that large HMOs such as Kaiser and others are training their physicians as "gatekeepers" who deny effective treatment to patients in order to increase the corporation's and the physicians' income. Physicians in Kaiser are vested in the corporation's profit in ways that are unimaginable to the general public. Not only do they profit when the corporation profits, they are instructed how to limit care provided, even when patients are not the elderly or disabled, or even the chronically ill. Dr. Phillips reports that the perversity of HMOs such as Kaiser goes much farther than most would even suspect. In his report, he reveals that the Kaiser health system has fabricated its own unique and unscientific medical lab values!4
The reported Kaiser practice is so astounding that most individuals would not believe it possible, however this is just another example of how the utilitarian administrators take advantage of the naiveté of the unsuspecting and plunder health care under the noses of others. Medical lab values are established by rigorous laboratory and scientific analysis, yielding the "normal" ranges of human physiology. These scientifically established values are used in medicine to diagnose diseases.
By widening the range considered "normal," Dr. Phillips reports that Kaiser is able to deny treatment to patients in the Kaiser plan telling them that they "still fall within the normal ranges" for any specific value, while at any other standard hospital or office, the same patients would be told that their lab values are outside the normal range, that further testing is required, or that they have a specific disease requiring treatment immediately. For example, widening the range for white blood cell count would allow patients with beginning stages of cancer to never be informed of their cancer, never receive further testing and never receive treatment for their cancer until the cancer was well-developed and not curable.5 It is obvious that the savings (on tests and treatments not provided) and consequent boost in profit to Kaiser is astronomical as well as obscene.
Utilitarian health care corporations have no shame and they do not value human life. The business of utilitarian health care corporations is not "caring;" it is profiting. Yet such corporations always profess to care most about their patients, offering sugary sweet advertisements about the superior qualities of their services. Dr. Phillips, other physicians and attorneys reveal another side to these monstrosities.
Attorney, Sharon J. Arkin testified before the U.S. House Subcommittee on Health: "Under ERISA,6 an HMO can deliberately and purposely deny a claim which it knows is covered under the plan. The most that can happen to the HMO if the member sues is that the HMO will have to pay for the wrongfully-denied benefit and may possibly have to pay some attorneys' fees to the patient. That's it. If the denial is for life-saving treatment and the patient dies without obtaining that treatment, the HMO is completely free of any potential liability: It will never have to pay for even the treatment because the treatment was never received and the family cannot sue for wrongful death. That, of course, builds in an incentive to the HMO to deny care and take the chance that the patient will never sue and, tragically, may not be alive to do so..."7
The utilitarian vision empowers the judge-health care practitioner ("HCP") with absolute executorial power, basically setting up each HCP as potential judge, jury and executioner with the power to terminate the lives of any person whose "quality of life" is inadequate, according to the subjective evaluation of the HCP or, whose continuing life would cost more than the health care system wishes to pay. The "executorial power" of the HCP-judge does not imply "administration" as in "executive branch of government;" rather, it implies power to literally execute or cause the death of the patient.
The best example of the utilitarian approach to health care comes from Holland where euthanasia is legalized. "Most alarming in the Dutch studies has been the documentation of several thousand cases a year in which patients who have not given their consent have their lives ended by physicians. About one quarter of physicians stated that they had "terminated the lives of patients without an explicit request" from the patients to do so."8
A health care professional's license, up until recently, has empowered him to act for the welfare of all patients entrusted into his or her care. The Hippocratic oath, proclaiming the physician's duty to "do no harm," was an unwavering basis upon which all other decisions were to be made by the physician. That has completely changed in the past few decades as more and more hospitals, nursing homes and hospices swallow the utilitarian approach to health care. This "cutting edge" philosophy arises out of the managed care business environment that not upon patient welfare, but upon fostering cost containment, increased profit making and stockholder dividends.
Hospitals: Failing to Protect
Hospitals are now making sure the elderly, disabled or otherwise "unworthy" die by instituting "futile care protocols" that have nothing to do with the futility of treating a patient, as the name implies. Yes, "it used to be that people were afraid of being hooked up to machines when they wanted nothing more than to go home and die a peaceful, natural death. The early bioethics movement deserves great thanks for helping do away with that form of abuse by pointing out that patient autonomy means the right to say no to unwanted interventions."9 But the current almost universally implemented "futile care" protocols are instituted in order to make sure the hospital can assure the death of the elderly and disabled and get away with it legally!10
Nursing Homes: Failing to Protect
If they don't "get them" at the hospital, the duty-to-die advocates can rest assure that the nursing homes of our nation will do the job: "government auditors have found evidence that U.S. nursing homes employ a significant amount of workers who have criminal records."11 One proposed solution is proposed by Congressman M Thompson (D-St. Helena) who has introduced "The Senior Safety Protection Act, H.R. 208, which would allow long-term care facilities to perform federal and state background checks on all potential direct care workers at no cost to the prospective employee or to the facility."12 But even without the criminals killing them off, the elderly and disabled have a full range of other methods of getting killed. Understaffing and callous management of these facilities results in a myriad of problems for the residents. It results in some of the worst civil rights violations of our time!13
The Greatest Civil Rights Struggle of Our Time
The Blacks, Hispanics, Jews, or other ethnic groups that have historically experienced discrimination are not being targeted for abuse and extermination in the USA. The elderly and disabled are. There are overwhelming reports that violent criminals working or residing in our nation's facilities,14 along with staff who believe in the "right-to-die," are suffocating them,15 overdosing them,16 dehydrating them,17 starving them,18 raping them,19 beating them,20 literally leaving them to hang and die on their bedrails,21 letting them rot to death with gangrene22 or leaving them to die of untreated infections23 There are so many ways to absolutely make sure the elderly and disabled die that we cannot count them all!
Getting bitten by hundreds of fire-ants24, having one's lungs paralyzed,25 being burned,26 frozen27 (all depending upon the climate when they are left outside unsupervised and uncared for), allowed to bleed to death,28 or maybe even drowned29 - these are just some more ways to make the "problem of the elderly and disabled" go away. They make for an occasionally shocking report and prod the morbid curiosity of readers, thus selling more newspapers, but have not yet succeeded in forcing our nation to address the issue. Sham ombudsmen programs in each state give the illusion of protection, yet such ombudsmen do not have the power to enforce regulations or cite agencies. Those who sincerely try to improve conditions quickly find a "brick wall" blocking their progress.
Events like these occur every day somewhere in every state of the nation and are commonplace. Almost everybody is familiar with stories about the neglect, abuse and wrongful deaths of our elderly, disabled or mentally impaired. How many ways can we exploit them? Billing them (or Medicare, Medicaid, or other insurance) for services which are not rendered, misappropriating their tax payments into the U.S. treasury for funds used to reimburse the industry through Medicare and Medicaid, convincing them they have the "right to die" and are better off dead? Placing them in facilities that choose not to hire adequate staff while pocketing revenue designated for staff salaries and hiring.30 These are the things being done nowadays.
Corporations Engaged in Fraud: Failing to Protect
And who is running the facilities that care for the elderly and disabled? Who is running the large hospital chains? Many nursing home and hospital corporations have been billing the government for services not rendered to the elderly and disabled (fraud), misappropriating government reimbursement derived by tax payments into the U.S. treasury made by those very same elderly and disabled individuals along with the rest of the U.S. citizenry.31 One need only look at the lengthy listings of corporations that have entered into "corporate integrity agreements" and settlements with the U.S. Justice Department (or those who are completely excluded from participating in Medicare)32 to realize how widespread the problem is.33
Mega-corporations like Beverly Enterprises, Kindred Healthcare (formerly Vencor) and HCA - The Healthcare Corporation (formerly Columbia HCA) are notorious enterprises that were found guilty of defrauding many millions of dollars from Medicare and Medicaid.34 HCA's, chairman, "Dr. Thomas Frist, ... consistently denied back in 1998 that there was any "systemic fraud or abuse."35 But just two years later, "HCA ... agreed in 2000 to plead guilty to criminal conduct and to pay more than $840 million in criminal fines, civil penalties and damages for the alleged unlawful billing of Medicare, Medicaid and other federal health care programs."36
In December 2002, HCA agreed to "pay the federal government $631 million more to settle fraud claims" on top of the hundreds of millions already agreed to be paid back. Even Senator Charles E. Grassley (R-Iowa) asks the same question raised here: will "the taxpayers get their money back from any fraud perpetrated by HCA?"37 In other words, has the Justice Department rewarded HCA by allowing them to keep many millions of dollars stolen when agreeing to a settlement less than the amount fraudulently taken from Medicare? Without a doubt, the answer is "yes." Are huge health care corporations capable of influencing the government including the Centers for Medicare Services and the Justice Department? Sen. Grassley certainly thinks so: he "suggests that the balance is shifting too far, and that the feds are getting too cozy with providers"38 such as HCA.
Disheartened Healthcare Workers
Health care workers who care about their patients and the quality of health care look at the widespread fraud in the industry and are disheartened. Those health care workers who are dedicated to serving patients become frustrated at every turn when attempting to provide the quality of care that was inculcated in the professional training schools and which is the goal of every quality improvement committee in the nation. It is the corporations' management that frustrates the health care workers achievement of increased quality of care; the indisputable priority of corporate management is increased revenue, not increased quality of care!
They set up sham quality improvement committees to perform "busy work," while simultaneously making it impossible to accomplish the goals. I have seen administrators who professed to support quality improvement, but who implemented patient care protocols that they knew were directly in violation of the standards of care and which they continued to implement even after being informed of the violations by myself and other nurses.
Is it any surprise that those health care workers who entered the field out of love and a dedication to service are absolutely outraged and disgusted? Is it any wonder that those dedicated workers repeatedly find themselves in conflict with management, labeled as "troublemakers," and forced to leave their chosen field of work (due to harassment or outright termination of employment) for fighting for the rights of patients to the quality care supposedly to-be provided.39
Rachael Weinstein, RN Director, Clinical Standards group within the Centers for Medicare and Medicaid Services writes: "studies indicate that current working conditions have led to the decline in enrollments in schools of nursing, an increase in the number of those leaving the profession, and an older nursing population remaining in active employment."40
Is it any surprise that the words and actions of sanctimonious right-to-die zealots condescendingly convince the elderly and disabled that they have the "right" to die and actually are better off dead? Is it any wonder that depression is extremely common among the elderly? The U.S. Administration on Aging reports: "depression can occur "out of the blue," for no obvious reason, or it can occur as a response to adverse life circumstances."41 No kidding! We have seen all of the "adverse life circumstances" facing the elderly and disabled in health care facilities, so depression, even despair, is not unexpected.
Diane Meier, MD, says, "Existential despair, not physical pain, is what motivates many patients to consider" ending their lives.42 However, "when they are treated by a physician who can hear their ambivalence, understand their desperation and relieve their suffering, their wish to die usually disappears."43
The utilitarian approach to health care takes advantage and exploits the existential despair of the ailing, the frail, and most of all, the vulnerable. The "prophets" of death, such as Peter Singer, Ronald Cranford and others, go around pushing the new right-to-die agenda, never admitting their real agenda and never warning the gullible public that the approaching reality for all of them, is a "duty to die" and for the utilitarian health care practitioner: a "right to kill."
The Florida Supreme Court wrote there is "a very legitimate concern that the "right to die" could become a license to kill," and that "there are times when some people believe that another would be "better off dead" even though the other person is still fighting vigorously to live."44 "Assisting the disabled and elderly to die" is just the thing needed by our society proclaim the "oh-so-wise" medical experts who go from county to county courthouse helping to make sure some disabled person gets killed with court approval.45 And looking at the scorecard, some of the elderly and disabled are concluding they just may be better off dead. At least their despair of finding rescue from the dread conditions imposed upon them by our society causes them to think that way. Hope for some is not forthcoming.
State Regulators: Failing to Protect
Can the elderly and disabled trust that the State inspectors will come to the rescue and make sure care is properly provided? Definitely not says the U.S. General Accounting Office. In fact, the GAO found that "complaints alleging that nursing home residents were being harmed have gone uninvestigated for weeks or months."46 Charles Phillips, MD writes about sham inspections: "Inspectors come in only to find something nearly useless - like fire extinguishers not having been tested - and cite the organization for a violation of the unimportant while completely ignoring un-requested euthanasia."47
Internationally known patient advocate Ila Swan writes about her own experience dealing with the nursing home industry:
The GAO also found that nursing homes rarely make reports of abuse to the police and those that do make a report, wait two days before contacting the police. That delay often results in evidence being lost, further harm to the patient and failure to successfully prosecute the criminal victimizer.49
State Attorneys General and Regulators: Failing to Protect
Can the elderly and disabled trust that the state Attorney General and the Departments of Health Services will force the nursing homes to provide quality care by citing and demanding payments of hefty fines? Absolutely not! Ila Swan "checked to see how many fines against nursing homes were outstanding in her state and found over $2 million in fines billed for citations but only $19,000 collected.50 "How is that possible?" you might ask. The answer, as usual, is found by "following the money trail," and this money trail leads in a circle from nursing home owners into the pockets of the politicians governing our nation at both the state and federal level and then back from the government into the pockets of the nursing home owners.51
A 1998 government report exposes the priority our society places on protecting the elderly: of all federal money spent on preventing or dealing with abuse, only 2% is spent on elder abuse, while 7% is spent on domestic abuse, and 91% spent on child abuse. "Up to five million cases of elder abuse, neglect and exploitation occur each year," and "not one single employee in the federal government is devoted full time to address elder abuse and neglect."52 Judging by what we do as a society, we are horrified at the abuse of children, but couldn't care less about the elderly. And for every case of elder abuse reported, five times as many go completely unidentified and unreported.53
Management Imposed Understaffing
What about staffing? Can the elderly and disabled hope for adequate staffing at the facilities that eagerly advertise themselves as "better than your own home, hoping to entice the unwary into their clutches. No, with "over 90 per cent of all nursing homes understaffed," "simple understaffing can have tragic consequences."54 The elderly and disabled live in terror of either entering a facility or in terror of the thought of remaining in one for even one more day.
What about the terminally ill and others who enter a hospice? Can the elderly, disabled and others who enter hospices rely upon the public assurances that at least these agencies will be adequately staffed? No. Interviews with hospice administrators reveal that hospices also "are already experiencing staffing pressures."55 "Many hospices and their associations have notified ... the U.S. DHHS Center for Medicare Services that the shortage of nurses is having a significant impact on access to hospice services and that hospices have had to deny services to eligible patients because they do not have adequate staff to provide nursing services.56 Hospices and patient's families report that understaffing can be a problem that undermines timely delivery of necessary care. In some cases, the promised care is never provided at all, with terrible consequences.57
Hospices: Failing to Protect
Hospices have also been involved in fraud, just like the nursing homes (though you would never think that from the PR the hospice industry keeps spitting out). The US Office of Inspector General issued a warning to the public about fraud58 committed by hospice agencies, many of them involving failure to provide adequate services to the patients being served. Even a hospice executive director, Mary Labyak, admitted when asked: "are there bad guys among hospice organizations?" (Labyak): "there have been some bad guys who have set out to manipulate Medicare and who have chosen to do it through hospice."59 "Manipulate" Medicare is just a fancy and politically "correct" way of saying outright fraud has occurred in hospice.
"Justice" in the U.S. Justice Department?
According to the Washington Post, the competition among hospices is cut-throat and hospices fight over patient referrals. To me it appears the new rogue hospices are as different from the dedicated hospices as vultures are from eagles. These new utilitarian based hospices are like vultures circling over dying animals in the desert, waiting for their financial kill! Vitas was using questionable practices and paying "finders" to locate terminally ill patients! In 1998 Vitas Corporation (based in Miami, Florida) the largest for-profit hospice chain in the nation was under a major investigation by the Justice Department for fraud. What happened to the investigation is unclear, however we note that Janet Reno, also of Miami, Florida, was Attorney General at the time, that Westbrook, the CEO of Vitas, helped raise millions of dollars for Pres. Clinton and the Democrats at the time, even sleeping over at the White House.60 The author of the article, Charles Babcock, told me in 2000 that the Justice Dept. apparently shut down the investigation without any explanation. The questions linger: "what was the truth involving this largest of all hospice corporations?" and "why was the investigation shut down?"
One plausible answer is the constant corporate bribery flowing from corrupt corporations into the hands of politicians with their hands out who in turn, reward the corrupt corporations by shutting down most investigations into their criminal activities.61 For example, "it is estimated that in just one state Florida loses $1 billion to Medicaid fraud each year. However, more than half of Florida Medicaid fraud investigations are closed without any formal state finding that a health care provider was overpaid."62 The question remains: why?
Whether in a hospital, nursing home or hospice, the elderly and disabled don't want to be neglected, abused or treated to whatever other insult our society is going to throw at them! If they enter a facility, they enter in order to get help in relieving their symptoms, not to be killed or be neglected while a hospice milks the federal government for cash from the Medicare cow. The elderly and disabled simply wish to be treated respectfully as human beings.
Families: Failing to Protect
But the elderly or disabled do not always willingly enter a facility. Family members or others may obtain legal guardianship over an unwilling vulnerable individual (elderly or disabled) and put them away into a nursing home or hospice, then seize all their assets: home, bank accounts, stocks and bonds and whatever else there may be!63 In fact, "in almost 90 percent of the elder abuse and neglect incidents with a known perpetrator, the perpetrator is a family member, and two-thirds of the perpetrators are adult children or spouses."64
Facilities, whether nursing home or hospice, rarely question the adult children or spouse of a patient being transferred into their facility. As a business, they must look to the bottom line and naturally make sure that more residents or patients come in to keep the money flowing. They are simply pleased to have another patient filling a bed and allowing them to bill for more services. As the agency's census increases, so does the revenue streaming into it.
Physicians: Failing to Protect
If the victim is forced into hospice enrollment, whether in a nursing home or hospice's own facility, the criminal/guardian has the added convenient protection of being able to permanently silence the victim by having an overdose administered "out of mercy," or by "terminally sedating"65 the patient into a coma from which they never recover and which allows them (intentionally of course) to die from dehydration.66 The practice of terminal sedation is a "hot" item eagerly learned by physicians;67 44.5% of rank-and-file physicians said doctor-assisted suicide should probably or definitely be legal."68
Nurses: Failing to Protect
Will the elderly and disabled find nurses to protect them from this onslaught of physicians wishing to "assist" them to death (when they deem appropriate)? Apparently not! Even more nurses, 46 percent of them, want to make it legal to "assist" patients to death. Only ten years ago, the percent was closer to 36 percent!69 And many dedicated nurses are leaving the field out of disgust for what management is foisting upon them. At this time, it appears that among the health care professionals, nurses and physicians are about equally divided into two camps with totally different world visions, values and ideas of service.
Is it possible that those health care professionals who subscribe to the loving/caring vision of health care as a service are leaving the field in greater frequencies than those health care professionals who subscribe to the utilitarian view? While I am not aware of any study to have addressed this topic, I believe this to be the case and conclude that as time goes on, a greater percentage of nurses working in the field will subscribe to the utilitarian view, while those nurses no longer working in the field may have a greater percentage favoring the loving/caring approach.
The Courts: Failing to Protect
When another family member objects to the abuse of a patient in a facility he or she can be banned from visiting the victim (with the force of a court order backing it up) and voila: the perfect crime! The courts cooperate superbly, and the criminal who put the victim away, stole the assets and has everything to lose by exposing the truth, controls the entire process! The court-appointed guardian perpetrator becomes the "executor of the estate" of the victim, so, no other person, even if they are a family member, has legal access to the medical records that just might provide a clue to the murder and/or theft of funds.70
Facilities will only release the medical records if the criminal (personal representative of the estate) gives permission to release the evidence of his crime. Not something you would want to bet on! And the public's reaction to accounts of such horrible victimization? Either they don't believe it could happen to them or the time worn response: "So what!"
If the elderly and disabled cannot fully trust all health care professionals who work with them, how are the elderly and disabled to know when they are receiving proper treatment? How are they to know when they are being informed of all the options? How are they to know that they won't be killed in their sleep or euthanized when they take their medications? How are they to know which type of health care worker stands at their side? Is she or he helping them or killing them? And does it matter? If there is only one health care worker willing to kill them, all the caring of the other health care workers may not save them from execution!
These are outrageous fears that the elderly now have to confront, in addition to all the problems associated with old age or disability. In Holland where involuntary euthanasia (the un-requested killing of the patient) is occurring in the thousands each year, "the elderly are afraid to drink their orange juice for fear of being poisoned. Those with incurable diseases are afraid to go to hospitals to have their distresses relieved."71
State and National Right-to-Life Organizations: Failing to Protect
One would think that there might be somewhere the elderly and disabled can turn with a reliable assurance that their interests will be respected and defended. What about the state and national "right-to-life" organizations? Surely, they would come to the rescue of the elderly and disabled. Surely, they would publicly fight the killings of the elderly and disabled occurring in the nursing homes, hospitals and hospices. Surely. But what is remarkable is that those "right-to-life" organizations that make a big point of "opposing" euthanasia and physician-assisted-suicide actually do absolutely nothing to expose the killings of patients in hospices in our nation. Not one state or national right-to-life group has issued a public statement about abuses by the hospices of our nation, since they refuse to criticize the hospice agencies that they deem to be their natural allies in the fight against euthanasia.
When I addressed the issue of involuntary euthanasia occurring in hospices with some right-to-life leaders, they said they simply did not believe the problem was significant. Yet they admitted it might be occurring in small numbers. My question is this: if the killing of patients is occurring even in small numbers in hospices, why won't the state and national right-to-life organizations at least fight against that or publicly condemn those cases? They say they condemn euthanasia and offer all sorts of well-written reasons why they are against it. But why do they remain silent about the hospice killings?
The obvious answer is that they don't wish to offend those individuals who support right-to-life as well as hospice and palliative care. Many in the palliative care community also support the right-to-life organizations. Perhaps the right-to-life groups do not wish to offend their donors. They know all about the "chilling effect" sharing the truth would have on the level of donations coming in to their coffers. Perhaps they care more about assuring that flow of donations into their hands than they care about protecting the vulnerable by bringing out the offensive reality: there are very real problems, very serious problems in the hospice industry, just like every other niche within the health care industry!
Hospice Organizations: Failing to Protect
Well, where can the elderly and disabled find assistance then? If right-to-life groups refuse to fight against euthanasia occurring in the hospices, what about the well-known hospice organizations such as National Hospice and Palliative Care Organization and Last Acts? Again, these organizations receive donations and fees from those in the hospice industry. They can't afford to bite the hand that feeds them. Although they profess to advocate for the highest standards, they will not and have not taken a public stand to condemn the hospice killings. When even the slightest criticism of hospice occurs, they mount well-organized publicity campaigns to deny any wrongdoing at all, as if hospice is immune from the faults of the rest of the health care industry!72
Stealth Right-to-"Die" Organizations in Hospice
What about other hospice leaders? Even Dr. Ira Byock, well-known hospice proponent and founder of the Dying Well and Partnership for Caring organizations, admitted the same thing to me privately when I discussed these types of problems with him back in 1999. The large mainstream hospice organizations such as Last Acts73 have never admitted to these killings and are excluding the disability rights advocacy organizations from participating in policy decisions that directly affect the future of end-of-life care and in particular, the disabled.
"Last Acts is now promoting beliefs, policies, and practices that are in direct opposition to those of advocacy organizations run by and for people with disabilities ... None of the disability rights organizations are involved in the well-financed policy groups currently defining "end-of-life" care in a way that allows the intentional killing of disabled people, especially cognitively disabled people, through the denial of basic, non-extraordinary care such as food, water and antibiotics"74
The disabled and elderly know that their lives are directly being threatened by current changes in the health care system. Ron Seigel, Vice-President of the Michigan Citizens With Disabilities Caucus, warns "doctors overrule patients' right to live." "Under such policies, there seems to be an unclear line between denial of treatment and outright killing;" when food and water have been defined as medical treatment ... patients who are considered inferior quality lives might conceivably be starved to death."75
Standards of Practice Thrown to the Winds
Unfortunately, the right-to-die advocates have already infiltrated hospices76 as well as the big hospice organizations and are committing euthanasia (or attempting to commit euthanasia) under the radar and around the country without publicly admitting what they are doing, whether legal or not. Misuse of standard hospice practices can easily result in "hastened" death, i.e., "medical killing," murder, or the official term "homicide."77 Medical records and death certificates are easily falsified,78 and the right-to-die activists around the world readily admit that they will lie if necessary to cover up what they are doing. One of the right-to-die movement's leaders, Dr Philip Nitschke, stated that, "assisting suicide can attract a life sentence in jail" so, he says, "the best advice is to do it and say you didn't."79 Any "angels of mercy" accused of killing a patient will only say, with much feigned conviction, "it was out of mercy;" that they killed the patient or "I wanted to relieve the patient's suffering."
What was once an absolute outrage to health care professionals and the public alike is now looked upon as quite acceptable practice to growing numbers who subscribe to the utilitarian view of life and health care as a business. The "standards" of care, once strong bastions of morality, faith in God and the law, now shake and tremble like saplings blasted by hurricane winds. When it comes to health care practice involving the elderly and disabled, in practice there are no standards of care: only "standards" written into the law books, ignored by many. A health care professional that cares about maintaining the standards of care can burn out quickly under the prevailing winds of corruption; they will certainly come into conflict with the utilitarian administrators of the agency they work for.
Hospice: The Sacred Cow of Health Care
Further, hospice is the sacred cow of health care: nobody in a position of power wishes to criticize it. The federal government created it in order to save money, and both state and federal governments actively promote it, again, to save expenditures in the budget. Hospice services are extremely cheap when compared to acute hospital care.80 The health insurance companies and HMOs are promoting it to increase their profits; the media receives advertising dollars from the industry and even fundraises together with hospice for hospice. Why would the media wish to seriously criticize hospice? Is there anyone left to speak for the victims? Obviously not. And the public's reaction? Again, "so what!"
While there are certainly many wonderful health care professionals in every niche within the health care industry, there also are many rogue health care agencies, corporations and even corrupt government regulators. We regularly receive complaints from caring hospice staff abaout rogue hospices that have mistreated patients and violated standards of care. White-collar criminals may go unpunished while elderly and disabled who just happen to have the misfortune to enter a rogue agency where hastening death is promoted ... well, they apparently just die a little sooner than would naturally occur. "Well, everybody's got to die one day," the right-to-die zealots proclaim. Does anybody care? Does the government care? or is this a savings for them? No more Social Security Checks have to be paid, no more nursing home, hospice, hospital or in-home care bills.
Reports coming into Hospice Patients Alliance repeatedly confirm the pattern that most county prosecutors will refuse to investigate a hospice killing.81 Probably the most blatant cover up of serial killing in recent U.S. History was exposed by CBS's 60 Minutes which reported it occurred in a Florida hospice. CBS reported that two physician medical examiners and a forensic scientist at the county coroner's office had made official determinations that 19 deaths in a hospice were homicides. However, the county prosecutor refused to act and contacted the State Attorney General's office for assistance in covering it all up. The state then re-did the autopsies to make sure they were all ruled "natural deaths" (despite overwhelming evidence to the contrary)!82 Every patient advocacy organization in the nation knows that this type of killing goes on. Every county prosecutor and coroner in the nation knows it too; if they deny it, they're lying.
The July 2001 report by U.S. Rep. Henry A. Waxman of California states that "abuse of residents is a major problem in U.S. nursing homes" and that "over thirty percent of the nursing homes in the United States -- 5,283 nursing homes -- were cited for an abuse violation that had the potential to cause harm." "Nearly 10% of the nursing homes in the United States -- 1,601 nursing homes -- were cited for abuse violations that caused actual harm to residents or worse."83
While the nursing home industry unanimously complains about inadequate funding, constantly begging for increases in reimbursements from the government, US News and World Report states that "the nursing home industry is profitable and growing, with operators spinning a far brighter tale for Wall Street than for Capitol Hill. Many nursing homes are earning exceptionally healthy profit margins, often 20 and 30 percent." The U.S. General Accounting Office reports "Medicare payments to most free-standing nursing homes substantially exceed facilities' cost."84
The industry commonly over-reports losses which when analyzed, simply indicate their practice of padding their list of expenses, "self-dealing" and overpaying their executives to the tune of millions of dollars.85 And when the government finally does pay them more, it doesn't go to pay for services to the elderly, the disabled or the staff that serve them.86
U.S. "Justice" Department Practices Encourage Fraud
Industry giant Beverly Corporation's C.E.O., William Floyd received87 $1,288,897 in 2001 (plus stock options worth $2.3 million more) at the same time Beverly was paying back $77.5 million in 2001 and $175 million for a 2001 settlement to resolve charges that the company defrauded Medicare of $460 million dollars. The government let Beverly keep (paying them to steal) the other $285 million that they had stolen.88 It is an obvious obscenity that a company can pay its executive in millions of dollars while at the same time admitting it defrauded Medicare of hundreds of millions of dollars. It doesn't take a rocket scientist to figure out where the money to pay the executive came from!
Another industry giant, Kindred Healthcare Inc., with total 2002 revenue of $2.5 billion89 (formally known as Vencor), was charged with a long term massive fraud: "The Justice Department demanded $1.3 billion for fraudulent billings. Eventually the parties settled for repayment of $130 million."90 That means the Justice Department rewarded Kindred Healthcare by "paying them" (allowing them to keep) $1,170,000,000 (Yes, that's $1.17 billion dollars) to steal from the government! These kinds of government-rewarded mega-felonies are commonplace in the healthcare industry. In FY 2001 alone, Edward Kuntz, Kindred's CEO, was paid $ 10,139,677 in cash compensation (salary, bonus plus other) plus stock options valued at $2,700,000."91
The Justice Department investigates Medicare fraud; who investigates the federal Justice Department? How is it conceivable that their actions result in the mega-million dollar windfalls that regularly reward those who have defrauded our nation's treasury through Medicare?
When a whistleblower files a complaint about fraud in health care, they risk their careers to protect the patients entrusted to them. These whistleblowers are intimidated, threatened and blackballed by employers from working in their field, employee-protection laws notwithstanding!92 The False Claims Act has allowed whistleblowers to come forward and force a judicial determination of the fraud being perpetrated by these corporations.
" 'We believe many other hospitals and health care facilities have profited from cost reporting fraud, and they have little chance of being caught without insiders stepping forward.' Fewer than 20 percent of costs reports are audited in any given year. The Medicare program must depend on the good faith of hospitals to submit accurate claims. 'Nothing less is required if the Medicare reimbursement system is not to be turned into a cat and mouse game in which clever providers could, with impunity, practice fraud on the government,' a 1996 federal appeals court decision held."93
While the Enron, Worldcom and other recent corporate scandals make big headlines because they defrauded investors, Beverly, HCA and Kindred are almost unknown to the public. The conclusion? Defrauding investors of billions of dollars is very serious; defrauding Medicare of billions of dollars is routine! Criminals who steal from investors go to jail; criminals who steal from Medicare get rich and flourish!
Abuse and Neglect of the Elderly and Disabled: Related to Fraud
All the while these mega-health care corporations defraud Medicare of billions, their actions and inactions directly result in the abuse, neglect and even killing of the elderly and disabled in our nation's healthcare facilities. It is clear that administrators of these criminal enterprises number among those who care more about their own financial gain than caring for the elderly and disabled which their corporations purportedly serve.
Whether or not these administrators call themselves "right-to-die" advocates, their actions directly deprive the elderly, disabled and other patients of the care they deserve and result in many of the horrific deaths agonizingly experienced by the elderly and the disabled. By diverting funds paid out by Medicare, Medicaid and other health insurers for care services, the executives of these corporations create obscene self-compensation schemes, approved by boards of directors made up of other executives like themselves. Meanwhile, the patients suffer without relief!
One could easily and believably assert that a new type of organized crime runs many health care corporations; it also obviously influences what the Justice Department does. Of course, we just call that influence "corporate lobbying," "campaign contributions," or the deceptively reassuring "soft" money. "The nursing home industry--which often sees its fiscal health ebb and flow depending on Congressional action--donated more than $1.4 million in the 2002 election cycle."94
The larger nursing home chains own the majority of nursing homes in the United States,95 and the Justice Department has determined they have committed long-term fraud. While not all nursing homes are making this kind of profit, it is clear that there are numerous cases of fraud perpetrated by industry leaders.96 "Cases involving ... health care fraud have been the primary source of recoveries by the U.S. Justice Department for several years now."97 And the money for this fraud comes from not only working men and women of the USA, but also from the elderly, disabled and chronically ill who have paid their own share of taxes and facility fees.
Even more troubling, "despite more federal dollars, nursing homes haven't spent them on what is considered the best way to improve care: more staffing."98 More importantly, that translates into inferior care for the patients whose very lives depend upon the care they receive. For example, "both Beverly and Kindred were subsequently forced to admit that money that was supposed to go to care was diverted to elaborate corporate schemes and offensive executive salaries."99 More patients die when understaffing exists.100
Death with Dignity is Caring Service: Not Killing
It is imperative that the laws against killing anyone, including the elderly, disabled and chronically ill be enforced. The killings must stop. There is no death with dignity when patients are killed; these are not so-called "mercy killings." Many cases have shown that the right-to-die zealots who murder patients or approve of hastening their death do not believe the patients' lives have any meaning.101 With organizations and hospice professionals openly promoting euthanasia within the hospice setting, the elderly and disabled are right to be confused and worried: are they going to be cared for or killed?
With blatantly pro-euthanasia names such as "Hospice for Hemlock"102 and others that offer no indication of their pro right-to-die agenda ("Compassion in Dying,"103 and "Partnership for Caring,")104 the elderly and disabled may be afraid to enter hospice. The former "Choice in Dying" which merged into Partnership for Caring started out openly as the Euthanasia Society of America; the Partnership for Caring doesn't advertise that.
Compassion or Imposed Death?
Another organization, "Compassion in Dying, has depicted itself as being broadly interested in improving the care of terminal patients when it appears their only interest is to make assisted suicide/euthanasia seem part of the spectrum of legitimate medical care."105
The elderly and disabled don't know if they will be cared for or "assisted to their death" within a hospice. Partnership for Caring provides a wealth of helpful information about improving hospice and palliative care, working with many mainstream hospice groups but also adds the assisted-suicide philosophy into the mix, sort of like a smorgasboard of end-of-life care: we can care for you or we can "assist you" by killing you! Examples of such imposed deaths are posted on the Hospice Patients Alliance euthanasia issues page.
It's quite remarkable that the hospice that is holding disabled and non-terminal Terri Schiavo, ready to be euthanized through withdrawal of all tube feedings the moment a court gives the order allowing it,106 is the same hospice where Mary Labyak has served as Executive Director ... the same Mary Labyak who serves on the board of Partnership for Caring which is perceived as a "mainstream" hospice advocacy organization, but includes assisting patients to their death as one of the services they believe should be offered. Every professional working in hospice knows that federal regulations only permit a "terminally ill" patient to be enrolled in hospice. "Terminal" is defined as a disease which will likely cause the death of the patient within six months, given the usual course of a disease. No physician is reported to have diagnosed Terri Schiavo with a terminal illness, yet the hospice is "experimenting" with how far the regulations can be violated with impunity, in the attempt to execute the disabled and helpless Terri Schiavo. The federal regulations do not permit "experimental" violations of the law!
Nancy Valko, RN, writes "it is sadly ironic that so many people are arguing against capital punishment lest one innocent person die but offer no similar opposition to withdrawal of food and water and/or basic care from patients despite the many publicized and non-publicized cases of cognitively disabled people who get better even years later."107
In an apparent contradiction to the pro right-to-die stance of Partnership for Caring, board member and prominent hospice physician Ira Byock, MD conjectured years before PFC was formed: "what happens if assisted suicide and euthanasia become legal in today's environment? I submit that in the absence of adequately funded palliative care programs and residential hospice settings, it will become our responsibility to recommend assisted suicide to those who lack basic financial or family resources. What a horrific way for society to respond to the needs of the destitute and dying." And hospice organizations unanimously agree that funding is inadequate.108
While Partnership for Caring and other hospice organizations actually do contribute much that is praiseworthy to the end-of-life care in our nation, their current acceptance of euthanasia and physician-assisted suicide is a policy replete with opportunity for exploitation and harm to helpless patients. In Dr. Byock's own words, warning about financial pressures encouraging the killing of patients, i.e., "assisted suicide" is "horrific!"
It goes without saying that many who end up in hospice are the elderly and disabled. It appears Dr. Byock's prediction is quite accurate: there is a current financial pressure to limit expenditures for health care in order to balance the federal and state budgets. HMOs and health care insurers also wish to limit expenditures in order to increase profit: the obvious answer? passive euthanasia and physician-assisted killing. Of course, the right-to-die zealots have come up with more pleasing language: "aid in dying."
Creating the Legally Sanctioned "Right-to-Kill"
The shortsighted, the naive and the evil: these are the proponents of the right-to-kill movement. Actually, there is no "right to die" movement: it's about the right-to-kill - you - or whomever they wish to eliminate in the health care concentration camps of the 21st century. Let's be frank: they admit they wish to be able to kill old Aunt Jane, disabled veteran Joe and ailing Uncle Bill, who just happen to be helpless and whose intrinsic worth as a human being is not "acceptable" to the right-to-kill zealots' idea of what a "quality" life is. Any system of health "care" that can calmly contemplate the killing of the week, the old, the depressed or "expensive" is evil, a word not mentioned at all by the self-proclaimed bio"ethicists" who eagerly promote the "right-to-die" agenda. It is no surprise that they do not mention evil; they do not concern themselves with real ethics, only the manner in which the greatest profit can be made by themselves and the mega-corporations they support. Rationing health care is another name for determining that the unworthy of life will be executed or made, one way or another, as we have seen, to die.
And what is the absolutely ideal location to push the "right-to-die" onto the unwilling? Hospice! Hospice utilization has been growing by about 10% annually for several years.109 The government and hospice industry do not publicize the financial pressures which may push patients into hospice. They only proclaim their dedication to providing "compassionate care." They do not publicize the real reason the hospice benefit was created by Congress: "Congress established the Medicare hospice benefit as both a cost-containment mechanism to limit the program's high costs for beneficiaries in their last year of life and a quality improvement tool to improve care for the dying."110 Let's be real: if there had been no cost-containment capability in creating the Medicare hospice benefit, the Congress would never have created the Medicare hospice benefit!
The public "angle" to "sell" hospice is that hospice is the compassionate way to care for those facing a terminal illness, and yes, the palliative care offered in hospices is the best way to serve the dying, however, what they don't admit publicly is that to save even more, the elderly, disabled and other patients are being killed outright, under many different circumstances; that is what they don't wish you to know.
The lives lived by the abused and neglected are miserable, with much unnecessary suffering, when society looks the other way! And with all the problems we've reviewed that might happen to the elderly and disabled, isn't it clear that what actually happens to them is like playing Russian roulette? They live in terror of entering a facility or remaining in one. They know; they don't have to pretend that these facilities are all "just fine." They know that entering any health care facility in the nation, while possibly being a lifesaver, may also be a quick path to the grave!
The Public: Failing to Protect
Now back to the original question in this article: what does it take to get the public's attention? What headline would really awaken the sense of horror at what is increasingly happening to the disabled and elderly? I have listed more than 20 different ways the elderly and disabled are currently being killed, and noted that the public still doesn't seem to care. Yes, perhaps "lynching" is the only type of killing society could get alarmed about. Of course, we already do that with bedrails. I guess it's just hanging from a rope that is unacceptable! Our society has become so callous that we cannot call ourselves civilized when we allow the abuse, neglect and killings to continue.
A humane society's role is to protect the vulnerable. That is the vision of a loving service-oriented health care system. That is the image of health care that the health care industry markets to the public. However, there is a "schizophrenic" kind of disconnect between the idealized image promoted in the advertisements and press releases of the health care industry and the constant stream of government investigations reporting severe and longstanding problems with fraud, criminal abuse, neglect and killing of the elderly, disabled and chronically ill.
The image portrayed purposely by the industry itself (which is utilitarian in administration) is that of its opposite: the loving caring service-oriented field where all decisions are based upon love, caring and the patient's welfare above all. The portrayal of the industry in this way directly contradicts the actual actions and decisions taken by the industry every day, moment to moment, in every state of our nation. Industry administrators consciously exploit the goodwill created by those dedicated health care professionals who still abide by the values and standards of the loving and caring vision of health care. However, decisions are not based first and foremost, upon the patient's welfare in all situations. Decisions are made first and foremost upon what will reduce expenditures for services and increase the revenue stream flowing into the corporation! Once expenditures for service are "approved," then service is provided.
I remember an unforgettable incident back in 1990 when a fellow nurse was caring for a just-admitted 23 year-old migrant worker who had been rushed into a local acute care hospital, suffering from a heart condition, rare among those so young. Once admitted to the hospital, doctors and other consultants evaluated the patient. They declared he needed treatment and should be admitted. However, my friend was astounded when the hospital administrators essentially threw her patient out of the hospital by discharging him back to his home since he had no insurance coverage that could adequately cover the treatments he would require.111 We both sat there with disbelief in our eyes until the reality hit us: "welcome to health "care!"
Our society has failed miserably when it comes to the elderly, disabled and chronically, or even acutely, ill. Judging by the actions of our society, it must be concluded that we are not a humane society. The problems in health care could be much reduced if industry owners and administrators subscribed to the same values as the workers who comprise the industry, who serve directly in the field.
We must choose to cherish and care for our fellow citizens, including the elderly and disabled, because they are literally "we, the people." As disability rights organization, Not Dead Yet, so eloquently put it, the constitutional rights of the elderly and disabled are being "trampled as health care providers rule their lives too burdensome."112 Whether through abuse, neglect or direct euthanasia, the elderly and disabled confront a formidable evil alliance of those responsible and willing to kill them or let them die, one way or another!
Disability rights activist Harriet McBryde Johnson, a lawyer and a voice for those who are disabled, writes: Prof. Peter Singer,113 of Princeton University "is the man who wants me dead. No, that's not at all fair. He wants to legalize the killing of certain babies who might come to be like me if allowed to live. He also says he believes that it should be lawful under some circumstances to kill, at any age, individuals with cognitive impairments so severe that he doesn't consider them "persons." ... "At this stage of my life, he says, I am a person. However, as an infant, I wasn't. I, like all humans, was born without self-awareness. And eventually, assuming my brain finally gets so fried that I fall into that wonderland where self and other and present and past and future blur into one boundless, formless all or nothing, then I'll lose my personhood and therefore my right to life. Then, he says, my family and doctors might put me out of my misery, or out of my bliss or oblivion, and no one count it murder."114
The utilitarian vision does not recognize the soul; it does not recognize God; it does not recognize an ethics derived from a basis of love or religion; it does not recognize any worth to a life that might contain intense suffering. Those who suffer, such as the elderly, disabled, chronically ill, and others, are "better off dead," they argue without making any sense to those who live with a completely different world-view. The utilitarians fail to recognize that the elderly and disabled have their own right to live.
The Constitution does not say that "all men are created equal, except the elderly and disabled or ailing." It doesn't say that any person should be executed simply because they exist, yet that is exactly the goal of the right-to-die zealots, the utilitarians and the big-business interests of mega-healthcare corporations that worship at the altar of their own personal greed and corporate profit.
Congressional Law: Failing to Protect
And that brings us to one area we have not discussed: the law. It is through the law that the utilitarians wish to impose their dark vision of health care upon the rest of us. While ERISA provisions exempting HMOs from liability were originally set into law by Congress to encourage the proliferation of HMOs, which would promote "health maintenance" and prevention of disease, the HMOs found that the fruits of their efforts made to promote health, prevent disease or maintain health were lost when participants in the HMO plan transferred to another company or plan. In other words, an HMO's efforts to maintain health and prevent disease were not rewarded with any financial gain, in fact, costly services provided regularly ended up benefiting the HMOs or other insurance plans which acquired the participants as plan members upon transfer. Without any financial incentive to continue health maintenance as envisioned by Congress, the HMOs altered course toward the lean, cost-cutting, treatment and life-denying lords of health care that we see today. The HMOs today bear no resemblance to the ideal envisioned by Congress years ago!
The ERISA exemption entitles HMOs to kill, maim and otherwise harm with impunity. And now the type of unconscionable abuses found in some of the worst HMOs is making its way quickly into all areas of healthcare. When patients and families seek relief through the courts, based upon the rule of law, "the patient will find that the usual state law Tort Claims115 are also preempted by ERISA, so any claims against the HMO or Employee Benefit Plan for medical malpractice, wrongful death, fraud, etc. will be summarily dismissed."116 It is the Congress which originally gave this immunity to HMOs and it is the Congress that can and must remedy this loophole which allows the chronic plundering of the citizens of our nation, by subjecting them to abuse, neglect, denial of treatment and outright killing in health care facilities.
If all the victims of this evil alliance of killing were to be lined up together and placed in one mass grave, it would fill an entire city and would be called the worst incidence of mass killing ever known. Because each death is conducted, rather, each "killing" is conducted individually, in a separate location, known only to separate individuals who are isolated from all the other individual cases, each case appears to be "an isolated incidence." However, these are not isolated cases; they are all part of the pattern of victimization of the vulnerable.
The First Amendment in the Bill of Rights states that "Congress shall make no law... abridging ... the right of the people ...to petition the government for a redress of grievances." Yet, the ERISA exemption for HMOs prevents the redress of grievances and creates a class of invulnerable mega-corporations that can manipulate the patients in their care without any real oversight or regulation. Without access to the courts to correct the wrongs perpetrated by some HMOs, the people are made to be a subservient class of citizens,117 without the rights guaranteed by the Constitution, and capable of being maimed or killed without even a whisper of outrage from the courts or society!
In many states, the obstacles to filing legal action against health care agencies or other providers (to seek justice from the courts) are almost insurmountable for the common citizen. While wealthy individuals have full access to the courts, many victims or families of victims simply do not have the funds to hire an attorney. Legal assistance on a pro-bono basis is as rare as a flight by the fabled Pegasus in downtown Chicago. The creation of an under-class of the legally shutout victims of health care is a foreseeable consequence of the various legal protections for HMOs, health care agencies and the financial power of these entities. Corporations hire law firms on retainer as a matter of course; individuals are unable to hire them at all.
Victims and families of victims find it extremely difficult to find any attorneys to represent them when an elderly or disabled person is harmed or killed in a hospice or other facility. Attorneys will almost universally proclaim the validity of the claim, but universally reject the case on the basis that recover is limited and is not worth filing a suit. Prosecutors almost universally refuse to prosecute cases involving hospice as well. When there is no potential for legal action, whether in criminal or civil court, against the victimizers, the victimizers are free to do anything at all they wish to do, including murder! The utilitarian vision of health care is currently free to wreak havoc without regard to the harm it unleashes upon the public.
Steps to Reform
However, evil is not the only force in the world. While our health care system is not perfect, it still contains many dedicated workers who truly care about the residents and patients they serve. There are those working to protect the elderly and disabled. Their voices are not always heard and their wishes are not always carried out, but they are trying. We must move forward with hope that correction of the evils mentioned can occur. We need effective enforcement of the regulations that are supposed to protect the vulnerable. We need county prosecutors who are willing to prosecute the murderers and rapists of the elderly and disabled; we need courts that will put these monstrosities in jail for life, just as they would do when any other group of citizens had been victimized.
It does not take a majority of health care workers who harm, neglect or abuse patients; it only takes a few who are left unpunished, unrestrained who continue to terrorize the elderly, the disabled and other patients in facilities across our nation. While some debate the numbers of those creating havoc in our system, there is no question that the combination of corporations exploiting the system along with individuals who are willing to abuse, neglect or harm those entrusted to their care results in truly horrific circumstances.
Some suggest that further study is needed and that we need a dispassionate discussion of the issues. Others say that, "now is not the best time to get this issue discussed or to get action from Congress." There are always other problems, other concerns which have seemingly overwhelming importance: wars, scandals, budget concerns and turf wars between doctors, malpractice insurance companies, lawyers and patients. But there is no excuse for any further delay.
How long shall these atrocities go uncorrected?
How long shall the vulnerable suffer?
What is needed first and foremost, is a decision to choose the right path, which is a path dedicated to service to and protection of the vulnerable. The elderly, disabled and other patients need justice. We must decide to correct the wrongs occurring on a daily basis. The people know they need a law protecting their rights as patients. The people know when they go up against an HMO and find they cannot take legal action at all, or find their search for justice otherwise blocked, that there has to be a change. The ERISA exemption took away patient rights that up till that time had existed. A new patients rights law would restore patient rights and justice to the system, stopping a decades long trend of exploitation of patients within the system.
We must make a strong resolve to end the abuse! Individuals within society must stand up and be advocates for the vulnerable. Passing a law is not enough. Enforcement of laws protecting the vulnerable must occur and that is where the public's role comes in. We cannot just trust the bureaucrats, police, or prosecutors to protect the vulnerable. We must speak up when they cannot!
We need an independent investigation of the behind-the-scenes manipulations of the Justice Department that result in policies rewarding criminal corporations who defraud Medicare. Years ago, almost all health care agencies were nonprofit since they were uniformly founded upon missions of service and caring. We need to re-think the very entry of for-profit corporations into health care. The for-profit corporations have implemented policies that have been disastrous for those entrusted into their care. The worst cases of fraud in health care have involved for-profit corporations manipulating the health care system to personally profit and reward the stockholders of their corporation.
However, if for-profit corporations are allowed to remain, then strict enforcement of the laws and regulations of our nation must be implemented in order to protect the most vulnerable of all. The ERISA exemption for HMOs needs to be reformed; it has become the license under which HMOs kill. Hopefully, the recent ruling by the U.S. Appeals Court for the 2nd District in Cicio v. Vytra Healthcare expanding the right of patients to sue HMOs will survive certain appeal to the Supreme Court.
And those who seek tort-reform at this time, are truly seeking to stifle the only voice left to the weary and suffering victims of health care abuse. Those who support tort reform's proposed cap on punitive damages argue that their proposals would still allow payment for all medical bills and rehabilitation for the lifetime of the victim. What is left completely unmentioned, is that there are no payments of medical bills or rehabilitation when the patient has been killed. Tort reform basically allows health care corporations to kill any patient and merely "pay off" the family to make them go away. The "cap" is the maximum price the corporations would have to pay (only in those cases where a plaintiff actually bothered to file legal action), whether the patient still lives or is killed outright. With patients who have complex medical conditions, killing them is cheaper than caring for them!
2/2003 Ron Panzer
Congressional "Nursing Home Abuse Report: Elderly Abused at 1 in 3 Nursing Homes"
2 See other endnotes in this section for numerous examples of patients being killed through various means.
3 "In the spring of 1987, as a physician, I caused the death of a man. Although this was known to many people, I have not been taken before any court of law or called to account for this in any professional or public forum. In fact, just the opposite occurred: I was "rewarded" for this. It bought me an improved reputation in my job, and contributed to my advancement afterwards. Not only did I demonstrate I could indeed do what was expected of me, I exemplified the "good" company doctor: I saved a half million dollars! - Testimony of Linda Peeno, MD before the U.S. House of Representatives, Committee on Commerce, Subcommittee on Health and Environment: 5/30/1996;
All references to Kaiser HMO are copyright 2003: Charles Phillips, MD
from HMOs - Licensed to Kill, draft version; Fresno, California and Inside Kaiser's E.R. - An Exposé
7 "Statement of Sharon J. Arkin, attorney: Partner, Robinson, Calcagnie & Robinson,
Newport Beach, California, on behalf of Association of Trial Lawyers of America
Testimony Before the Subcommittee on Health of the House Committee on Ways and
Means: - Hearing on Patient Protections in Managed Care -
8 "Teach options to assisted suicide instead," Honolulu Advertiser: 2/9/2003 by Herbert Hendin and Kathleen Foley who are physicians and authors of "The Case against Assisted Suicide: For the Right to End-of-Life Care;"
9 " 'Doc Knows Best' "It'll be too late for you, if he's wrong," National Review online: 1/6/2003;
10 "Cambridge Quarterly of Health Care Ethics," Fall 2000: "Hospitals are likely to find the legal system willing (and even eager) to defer to well-defined and procedurally scrupulous processes for internal resolution of futility disputes."
12 "Senior care bill
calls for FBI checks, Thompson legislation seeks crackdown on elder abuse;"
13 "The findings demonstrate that there are significantly more problems in facilities with less than 12 minutes of registered nursing care, less than 45 minutes of total licensed staff care, and less than 2 hours of nursing aide care per resident per day." - "Testimony of Nancy-Ann Deparle, Administrator Health Care Financing Administration On Nursing Home Staffing Before the Senate Special Committee on Aging," 7/27/2000;The Greatest Civil Rights Struggle of Our Time; by Ron Panzer, President of Hospice Patients Alliance
"Former nurse's aide sentenced,"
'Angel of Death' talked of easing patients suffering;
"Ex-California hospital worker sentenced to life," 4/18/02, CNN.com;
"Lorain woman indicted in death of her invalid father,"
"Life, death tug of war in Florida courtroom," WorldNetDaily.com: 11/13/02;
"Survivors of lost loved ones tell stories of broken trust,"
"A Different Kind of P.O.W.," The American Reporter: Vol. 8, No. 1956 10/21/2002
"Nursing Home Claims: Lessons from the Losses"
GeneralCologne Insurance Issues: June, 2001;
Time Magazine--'Fatal Neglect'--October 27, 1997: "In possibly thousands of cases, nursing home residents are dying from a lack of food and water and the most basic level of hygiene."
"Doctors overrule patients' right to live," Detroit News: 4/6/2001;
"12-year term imposed in rape of woman who is mentally ill,"
"Assisted-Living Facility Accused Of Covering Up Rapes - Man Accused Of Attacking Many Women," NewsNet5.com: 5/21/2002;
"Patient's death ruled homicide,"
"Nursing homes chief gets 1-year sentence,"
"Residents should be outraged about Cooley,"
"Nursing Home Claims: Lessons from the Losses"
"Violence in nursing homes a growing concern,"
21 bedrail - choking
"Entrapment Between Bedrails And Air Mattresses Can Be Lethal," J Am Geriatr Soc 2002;50:1124-1125.
"Home fined in patient's death,"
""State blocks nursing home - DSHS investigation came after resident's death last month"
"Dangerous gaps in Michigan, deaths reflect national trend,"
"Nursing home owner, worker face charges,"
"Neosho nursing home comes under fire - Watchdog group claims spotty compliance,"
23 abandoned to untreated infection:
"Va. panel places Chesapeake doctor on probation,"
24 Ant Bites:
"Mediation hearing held in ant bite death case,"
"Riverdale nursing home under investigation,"
25 Paralyzing Lungs:
"Prosecutor Says He Would Seek Execution of Nurse in 10 Deaths,"
"Home where man burned gets 4th chance,"
"Yeltons patient burned in bath,"
"Family sues over nursing home death,"
"Former nursing home owner pleads guilty,"
"Nursing home vigilance urged - Caregivers asked to watch for wandering patients,"
"Lincolnwood Nursing Home Fined For Lack of Supervision in Resident Death"
"Attorney claims a beating may have caused Schiavo's coma,"
28 Bled to death:
"Broken call button linked to death"
"Nursing home firm fined for patient abuse - Benchmark ordered to pay state $101,000"
"Nursing home violations fixed, state team finds,"
"Care workers fail to receive all of raises
"Inadequate Medicaid payments squeeze homes' level of care"
34 See other endnotes:
"HCA, U.S. Agree to Fraud Settlement - Hospital Chain To Pay $631 Million,"
38 "Grassley Calls for Tougher False Claims Act Enforcement," Medical News Wire: 2/11/2003;
When I filed a complaint in 1997 against Hospice of Michigan, one of the largest nonprofit hospices in our nation, the state regulators confirmed that the hospice had violated the standards of care. From within, I saw hospice management harass myself and others who had protested the illegal policies of the agency. They also had their huge lawfirm threaten me with legal action for speaking on behalf of the patients and having the courage to speak the truth about the unconscionable practices which they had implemented.
Stefanie Fletcher, RN writes: "the answer to the most basic question, why did I become a nurse, was the most important. Because of my desire to help people, I began the difficult journey necessary to report fraud against the government."
Mark Gaines, RN writes: "the nurses and doctors that speak up are fired! Read "Nursing Revolution" and other nursing journals to check this out for yourself. There is no legal protection for a honest professional engaging
in whistle blowing. I know of Florida nurses who have been blacklisted
statewide for being honest patient advocates."
40 Testimony of Rachael Weinstein, RN Director, Clinical Standards group office of clinical Standards and quality Centers for Medicare and Medicaid Services on Nurse Staffing Before the Senate Committee on Government Affairs Subcommittee on Oversight of Government Management, Restructuring, and the District of Columbia: 6/27/2001;
Diane "Meier, [MD], has become one of the premier opponents of
death-with-dignity laws. She now believes that existential despair, not
physical pain, is what motivates many patients to end their lives-and that most
doctors are ill-equipped to deal with the psychological components of serious
44 Florida Supreme Court: In re Guardianship of Browning, 568 So. 2nd 4 (1990) at 13.
46 "Nursing Homes: Complaint Investigation Processes Often Inadequate to Protect Residents"
"Why I Became a Nursing Home Advocate,"
"Nursing Homes: More Can Be Done to Protect Residents From Abuse,"
Open Secrets is an organization that tells you: Who
gives and who gets!
"9 of 10 Nursing Homes Lack Adequate Staff, Study Finds,"
"Finding Answers to the Nursing Shortage," Hospice Manager's Monograph:
"Medicare Advisory Bulletin,"
"Newsmaker Interview with Mary Labyak,"
61 Open Secrets is an organization that tells you: Who Gives? Who Gets? US Senators, US Reps, Statewide Officials, State Senators, State Reps.
"Health sector problems turned into crises this year,"
"cgi.citizen-times.com "Former lawmaker found guilty in embezzlement case,"
"Physicians: Leave assisted suicide to doctors, patients,"
70 Notarized statement of L Keller," of Ohio: just one account of many received by HPA concerning seizure of victim's assets after euthanasia of the victim is committed in hospice.
When Pam Yates family sued a hospice in New York and USA Today covered the story, the National Hospice and Palliative Care Organization launched an unprecedented campaign to try to force USA Today to contradict its negative story about the hospice used by the Yates' son. NHPCO requested hospice agencies and staff to inundate USA Today with letter to the editor protests, posting such requests prominently on their home page.
76 Pro right-to-die Partnership for Caring's Secretary/Treasurer and Board member Mary Labyak served as Hospice of the Florida Suncoast's Executive Director. This is the same hospice where they are trying to kill Terri Schiavo by dehydrating and starving her to death. See The Terri Schiavo Foundation for more information.
"Other Actual Involuntary Euthanasia Cases that Occurred In the Hospice Setting,"
78 "U. S. Attorney General Janet Reno observed that serious abuse and neglect is far too common among nursing home residents. Within the last year the Department of Justice has stepped up its efforts to seek out nursing homes that lie to surveyors or falsify records." Conference of State Nursing Home Fraud and Abuse Working Groups.
"Trends in medicare payments in the last year of life."
83 "Abuse of Residents Is a Major Problem in U.S. Nursing Homes," report by U.S. Rep. Henry Waxman of California, July 30, 2001 posted online at:
"Skilled Nursing Facilities: Medicare Payments Exceed Costs for Most
"The New Math of Old Age: Why the nursing home industry's cries of poverty don't add up,"
"Care workers fail to receive all of raises
"Inadequate Medicaid payments squeeze homes' level of care"
"Inadequate Medicaid payments squeeze homes' level of care"
"Health Insurer Highmark Accused of Fraud,"
"Government's probe of Columbia/HCA prompted by qui tam lawsuit,"
95 www.hoovers.com "Beverly Enterprises is one of the top nursing home operators in the US, with more than 500 facilities in about 30 states and the District of Columbia;
www.hoovers.com Kindred Healthcare (formerly Vencor) owns 55 long-term acute care hospitals and more than 300 skilled nursing facilities;
www.hoovers.com Manor Care has 300 nursing homes in 30 states;
www.hoovers.com Extendicare has about 260 facilities;
www.hoovers.com Sun Healthcare has about 240 facilities in 25 states
"Inadequate Medicaid payments squeeze homes' level of
"JAMA Article Links Hospital Staffing and Patient Mortality,
"bioethicist R. G. Frey, of Bowling Green University, has explicitly asserted that, for
humans as well as animals, the "value of life is a function of its quality." This
the so-called quality-of-life ethic leads to very dark conclusions. "Because some
human lives fare drastically below the quality of life of normal (adult) human
"Dr. Ian Dowbiggin, chair of the history department at the University of Prince Edward Island (UPEI), reveals that many leading euthanasia activists have approved extending the right to die to handicapped newborns, the disabled and the elderly -- and not just consenting adults with terminal diseases -- and that many of the people who supported eugenic measures such as the sterilization of the disabled, also supported mercy-killing and an individual right to die." from: A Merciful End: The Euthanasia Movement in Modern America," published by Oxford University Press, 2003.
When discussing the vegetative state, author Bryan Jennett suggests: "Special
attention be given to matters of withholding and withdrawing treatment in
particular, so-called artificial nutrition and hydration," The
Vegetative State: Medical Facts, Ethical and Legal Dilemmas by Bryan
Note:" This is the current state of medical "ethics;" patients who are disabled cognitively and are not brain dead (or are disabled in other ways) are direct targets for execution through withdrawal of feeding. Important to note: anybody who is kept from eating or drinking will die!
"It will only be a matter of time before the first Australians who have a disability will be given the 'right' to death by a society that does not welcome them," www.onlineopinion.com.au Dec 2, 2002 "Courage in a brave new world: A disability perspective," Quadriplegic PhD candidate Erik Leipoldt:
102 The Hemlock Society is one of the foremost proponents of the right to kill oneself (and assist others to kill themselves) and has infiltrated the hospice movement as Hospice for Hemlock, which has direct links to the Hemlock Society, inviting the public to join the Hemlock Society. [Note: The Hospice for Hemlock organization failed, its website taken down, but the link here shows how the website appeared in the past, through the web archives.]
103 The Hemlock Society, Hospice for Hemlock and the World Federation of Right-to-Die Societies all list Compassion in Dying as one of the Right-to-Die organizations.
108 "Improving Care at Life's End," Report of the California Mediated Public Policy Dialogue on Physician-Assisted Suicide and End-of-Life Issues June 2002
"formerly at: www.dyingwell.org "Kevorkian: Right Problem, Wrong Solution," The Washington Post: 1/17/1994
"Important Questions for Hospice in the Next Century,"
111 I observed this in Grand Rapids, Michigan at one of our local hospitals.
formerly at: www.notdeadyet.org lastactsflyer.html" "No Applause for Last Acts,"
118 formerly at: www.seniorjournal.com "Breaux, Hatch to Introduce "Elder Justice" Legislation" 2/7/2003
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