Hospice Patients Alliance: Consumer Advocates

Reporting Unwanted Euthanasia to Federal Prosecutors
(Local DA Often Won't Investigate Murder of Terminally Ill)

Euthanasia Not Rare

We are receiving reports from families (in different states around the country) about hospice physicians and/or staff who "euthanized" their loved one against the patient's and families wishes; in other words, these families report that their loved ones were actually murdered before their time of natural death actually had arrived. It is well-known that some physicians order very strong narcotics which cause respiratory depression and shutdown/death even when pain is not being experienced by the terminally ill. (See article on "Questionable Deaths" at: www.hospicepatients.org/questionable-death.html )

Some physicians admit that their motivation is euthanasia, in order to "put the patient out of their misery" or end their "meaningless" (in the eyes of the physician) life. Outrageous as it may seem, death is seen by some physicians as the solution to a terminally ill patient's struggle with depression, debility or discomfort. (See Journal of the American Medical Association article cited in "Questionable Deaths." Euthanasia is the easy way out. Killing the patient is easier than providing good hospice care!

Medically-Induced Coma is First Step to Euthanasia

Shocking? Of course. True? You bet. We receive complaints all the time about hospices that refuse to provide required services to patients and their families. The response of some hospice staff, when families start inquiring about why their loved one is not receiving home health aides or has shortness of breath after walking around, is often, "why don't we just give him (or her) some more valium (or Ativan, or other sedative) to help him relax?" The patient in these cases is not anxious, but needs a home health aide, or needs oxygen; he or she does not need to be sent into a medically induced coma from which he will never return at the current level of sedation.

After sedating the patient, the patient is given more unnecessary sedatives and often given narcotics, and a medically-induced coma can be achieved from which the patient never awakens. Even a healthy person given such dosages of sedatives and narcotics would be comatose! For a terminally ill patient, if the patient does not have anxiety, restlessness or agitation, why are they getting sedatives? In many cases, the answer is that the doctor or nurse is "into" euthanasia. However, if no unnecessary sedatives or narcotics had been given, the patient would in many cases have remained fully alert and lived much longer.

Yes, it is true that some patients are anxious or agitated. In those cases, a sedative is totally appropriate. And in some cases of pain, a sedative helps synergistically to act together with the pain medications to reduce pain. But why are some physicians and nurses sedating patients who are not actively dying and basically sending them to their death earlier than the disease would take them? Hospice is supposed to be about compassionate care for the dying, not killing them.

Terminally Ill (and their Families)
Actually Lose Their Access to the local Justice System

When a patient is diagnosed with a terminal illness, they don't just lose their expectation of a long life, they sometimes lose the respect and rights to justice that come with being a "normal, healthy" citizen of the United States. There is no law that says, "a terminal person will be denied the rights of ordinary citizens." But, as soon as someone is pronounced "terminal," in the eyes of some people, their life has less meaning and less value. For these individuals (including local prosecutors), a person who has a terminal illness no longer matters and is not considered worthy of equal access to the law, equal access to justice and equal protection by the law enforcement community. It's almost as if some people think, "they're going to die anyway, so what does it matter if their rights are violated? what's a few months or a year, one way or another?"

Physicians Protect Each Other

If a hospice physician euthanizes his patient, who is going to believe that he murdered the patient? The pat explanation given for outraged family members' accusations is, "they're grieving." "It's natural for them to feel that way." "We forgive them ... they don't know about hospice." But what if the accusations are true? Who is going to believe the family then?

Hospices have incredibly strong ties to the local community. Naturally so. However, these strong ties include political, economical and personal motivations for those in the community. Local newspapers get advertising money from the local hospices. Local hospice doctors are respected members of the professional community serving a "good cause." Who would dare to question the integrity or motivation of a hospice physician?

It is important to remember that physicians basically still function within the "guild" system. That means that physicians consider other physicians part of their "brotherhood" which protects all of them collectively and individually. When a physician messes up, many other physicians keep quiet. If a physician with integrity speaks out against the physician community or hospital practices, that physician can be (and some have been) blackballed and ostracized, ... basically run out of town with their patient referrals dried up.

How many physicians are willing to testify to the obvious truth in medical malpractice cases against other physicians in their own community? Basically none. Doctors have to be brought in from outside to testify to medical realities and basic truth, because of the "white wall of silence." Expert physicians who serve to testify against other physicians need to get paid large sums for their court appearances, and for good reason: they may not be able to have a thriving medical practice after the guild of physicians gets through with them.

When a physician makes a decision to testify against other doctors, it can be like throwing away his or her career. (The "white wall of silence" references the white lab coats doctors wear, just like police officers have the "blue wall of silence.") It's basically a matter of loyalty to the local physician community group or guild, over adherence to the law or loyalty to the public's welfare or rights as patients. This is not at all to say that all doctors commit euthanasia or medical malpractice, certainly not. What is clear is that even excellent doctors will keep quiet when it comes to the incompetence of other doctors.

Local Prosecutors Often Use Delay Tactics
And Never Investigate Illegal Euthanasia/Murder

What is a family member to do when he or she knows her loved one was murdered by the hospice physician and nurses? A local District Attorney will often hesitate to investigate murders/euthanasias of local hospice patients, because they believe that the patient would have died anyway, possibly fairly soon, so why bother investigating? And, they may feel that they don't want to alienate the local hospice and the doctor. There are political connections in every community. We believe that murders of patients should be reported to the local District Attorneys, but also to the U.S. Attorney in your area and the FBI. Basically, keep reporting the crime until you find a law enforcement agency that will listen to you.

Some district attorneys may hesitate to investigate a hospice murder (euthanasia done involuntarily). They may think that "everyone supports the local hospice." How could a district attorney "go after" the hospice? And if he's wrong, won't he look like he's got "egg on his face?" The case has to be extremely strong, strong enough to show criminal intent ... compelling enough for a local DA to even consider investigating. But even then, most won't go ahead with a full investigation or any investigation. If they have any political aspirations of their own, going after a well-connected doctor and the hospice would likely effectively ruin any chances for political advancement in the future.

Think about it: we know that murders of terminally ill patients sometimes occur in hospices, just as they occur in hospitals. But how many prosecutions of such murders are carried out? How many doctors convicted? Have you heard or read of any, even one? There are reasons you haven't heard of any. The reasons are the political connections hospices and doctors cultivate in their communities, and the ease with which doctors and nurses may falsify medical records to create the impression that "everything was done according to the standards of care" (when it wasn't). If you believe the medical record was falsified, and you have evidence to support that, you need to report that to the investigators at the United States Attorneys Office and the U.S. Drug Enforcement Administration.

Need to File Complaints to Board of Medicine,
Board of Nursing and Find Plaintiffs' Attorney for Legal Advice

One important point to remember though, you will need to send a detailed complaint to the State Board of Medicine as soon as possible, because in some cases, the DEA will wait to see the findings of the State Board of Medicine. You can also file a complaint to the State Board of Nursing if a nurse was involved in administering a fatal dose of narcotic. It is wise to consult a medical malpractice attorney before filing your complaint to the Board of Medicine and it is also important to get a medical review by an independent physician.

If you wish to stop the involuntary euthanasias (medical killings of patients), you will need to get a copy of the medical record for an independent medical review of your loved one's case. Your attorney can assist you in that, because most hospices will fight tooth and nail to never give you the medical records if something truly terrible happened. If you don't have or know of a medical malpractice attorney in your area, you can contact your local bar association and ask for a referral to a plaintiffs' only attorney.

It is very important that you try to find an attorney who files claims as a plaintiffs' attorney to represent you. If you get an attorney who handles medical malpractice, but regularly represents the corporations, you may not get the legal representative you deserve! Hospices have been known to falsify documentation, delete information, send incomplete records, stall and many other tactics that infuriate the families of the victims. A plaintiff's attorney will be able to successfully overcome the obstacles that hospice corporations routinely throw in the way of families seeking the truth (and a full, accurate copy of the medical record).

Taking the step by step approach to achieving justice will help make it more likely that the truly egregious violations of standards of care are noted (some you may miss, not being a physician) and corrected through the government justice departments and local district attorney's office. Having a medical malpractice attorney help you will assure that the complaint to the Board of Medicine and Board of Nursing is written in such a way that the allegations are not capable of being misunderstood or brushed aside.

If you have approached the local District Attorney with your concerns about a loved one who was murdered/euthanized by a hospice physician or nurse, and did not get any response, you need to carefully evaluate whether the failure to act is because there is no case, because the local DA doesn't value the life of your loved one, or because the DA is protecting the local hospice and its staff or worried about his own political aspirations rather than your loved one's rights to justice.

Report the Crime to the
U.S. Drug Enforcement Administration

When political or other considerations cause a local DA to refuse to perform a reasonable investigation of a murder of a terminally ill patient (your loved one), there may be other avenues to pursue. In the relatively less common case where a staff member used narcotics from a personal "stash" collected by diverting prior patients' medications to end the patient's life, then the D.E.A. might get involved. Staff are prohibited from collecting and keeping narcotics rather than disposing of them properly per agency protocol. Some staff have been known to keep these for the purpose of later using them without a prescription, either for their own drug addiction or to kill patients. I such a diverted source of medications was used, in that specific type of case, you can report the crime to the U.S. Drug Enforcement Agency - Office Of Diversion Control which has the authority to investigate diversion of narcotics (in many cases, morphine, fentanyl, methadone, and other opioids).

Diversion of a narcotic can occur if a nurse — usually — has been collecting his or her own "stash" of these narcotic medications and then administers these medications that were not prescribed, or were not prescribed in the extra amounts given, or is "recreationally" taking the drugs his or herself! The DEA takes diversion of narcotic drugs very seriously.

If a narcotic was diverted, it is important to report to the U.S. Drug Enforcement Agency - Office of Diversion Control so that any physician or nurse involved is stopped from ever diverting narcotic medications, and to achieve justice for you and your family.

The sooner you report the crime, the better your chances of getting an investigation. But it is important to make sure that the medications given were truly inappropriate and unwanted by your loved one. High doses of narcotics are commonly given to reduce pain. If there was no pain and high doses of narcotics are given, what was the rationale for giving them? If you are not satisfied that there was any reasonable justification to give high doses of narcotics to your loved one, and if you believe these high doses of narcotics caused your loved one's death, you need to speak with federal investigators at the Drug Enforcement Administration. If they do not listen to you or if after listening, tell you that they can't take the case, ask to speak to the supervisor of the investigator you speak with. If they tell you the same thing, ask for the name of that person's supervisor, and keep going until you get someone to listen to you. The Drug Enforcement Adminisistration IS responsible to enforce the Controlled Substances Act. Misuse of narcotics to kill someone is a violation of the Controlled Substances Act. Demand that they investigate!

If you wish you may also contact the U.S. Attorney's office. If the local DA does not perform any investigation, isn't it obvious that the local DA has decided not to act and to stall...basically to "sit on the case." In these situations, stalling tactics can get the family to give up and simply suffer in silence. These local prosecutors just hope that you will go away and forget the whole thing. They don't want to get involved. You need a federal prosecutor who takes your concerns seriously, not someone who patronizes you and then does nothing.

If you have difficulty communicating effectively with a federal prosecutor, you may need to hire (and we emphasize hire) a private attorney who specializes in criminal law (not medical malpractice) to advise you regarding what is a criminal matter: the murder of your loved one. And sad as it may seem, you may need to retain an attorney who is not from the same local area of town where the hospice is located. The decision of who to retain as an attorney is up to you, of course. But political connections do exist in this arena as well...being realistic about many communities is wise. Some hospices are so well connected politically that they have connections all the way up to the Governor's level.

Simply speaking to an attorney for their free consultation is not the same as retaining an attorney to represent you. If you're not getting anywhere, there is no question that you need legal advice and assistance. If you're unable to pay for such assistance, there are legal aid societies and your local legal bar association may be able to help you find an attorney who may do the work for free (pro bono). If you are able to pay for an attorney, getting competent legal advice from a specialist in the area of criminal law is invaluable and could make the entire difference in the outcome.

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