July 9th Hospice Patients Alliance Newsletter - Two Cases

Ron Panzer
2018-07-14

Hi,

I wanted to share a couple of cases with you. We have personally verified these two accounts which demonstrate just a little bit about what is happening within our healthcare system. As noted before, the changes at the federal level (regardless of "Obamacare" changes) for Medicare and Medicaid recipients are affecting how care is delivered or not delivered.

While having advanced practice nurses and physician assistants provide medical services actually helps many patients get the attention they need, sometimes better than physicians who may be pressed for time, as we said before, many patients are finding it hard to see a physician when they need to.

On the other hand, many advanced practice nurses have several years of training beyond their bachelor's degree, and have acquired a Master's degree or even a PhD in their field specializing in certain areas. They can be quite expert in their field.

Nevertheless, the medical schools are not graduating enough physicians ... intentionally limiting the number of graduates. This is contrary to the needs of the population. We need more physicians as well as advanced practice nurses, physician assistants and nurses.

I want you to understand how real the problems are in the healthcare system, how rationing is actually happening, and how patients' lives are being endangered. The first case involves a 30 year-old patient born with a genetic condition that limited her development.

Without going into too many details (for confidentiality purposes) the patient's lungs, heart, several organs and body remain at a pediatric level -- something akin to a 10 or 11 year-old body, even though she is now 30 years-old. She is unable to move her arms or legs at all (but can use fingers to control a computer through adaptive equipment) and relies on a ventilator to breathe but is able to speak and is quite intelligent.

The patient has respiratory complications that eventually have led to recurring infections, and pneumonia, etc. The standard of care for this disease process is that no matter how old the patient is, the patient is to be cared for by pediatric physicians in the hospital and elsewhere because the disease is considered a "pediatric" condition, because physicians who treat adults are not knowledgeable about how to treat these patients, and because the size of equipment must be appropriate for pediatric patients.

This patient had a ventilator provided to her in the past at the pediatric side of the hospital and that ventilator was set specifically for her lung size and needs, as well as respiratory condition. When she recently went into the hospital because she had developed pneumonia again, the hospital administration (that in past years has always treated her on the pediatric side) suddenly changed its policy and insisted that she be treated on the adult side, no matter how many protests the patient and family made!

An adult respiratory therapist who was unfamiliar with her ventilator entered the room and told the patient he was going to put the patient onto "their" ventilator -- an adult ventilator not set to the patient's needs at all. The patient and family were alarmed and refused, but the therapist yanked the patient's own ventilator circuit (that brings air to the patient) off and switched the patient onto the hospital's adult ventilator and then he promptly left the room!

Having the patient on the adult side rather than pediatric side is a violation of CDC (Centers for Disease Control and Prevention) standards (which comprise some of the legal standard healthcare agencies must follow). Disregarding the patient's right to refuse what hospital staff wish to do is a violation of federal and state law. Putting the patient on a ventilator that is not set to her needs is a violation. Walking out of the room without watching to see how the patient adjusted to the change is a violation, not only for what is called "abandoning" the patient, but utter negligence.

So what happened? The patient immediately grew even more anxious, her eyes rolled up toward the back of her head, and she started to turn blue and passed out. She was completely unconscious.

The patient's mother screamed for a nurse and yelled, "I'm going to put her back on her ventilator and I don't care what you say!" The nurse (who had been forbidden by administration to use the patient's own ventilator but recognized the need to save the patient) said, "Go ahead." After about four minutes, the patient came back and shaking with fear told her mother, "There was just blackness, nothing."

Needless to say, the patient and family were horrified and justifiably so. They didn't and don't trust the hospital staff or the administration there. Yet, the hospital physician who was working at the time came in and apologized for what happened and told the patient and family, "I don't care what administration says, I'm going to call over to the pediatric side and speak with your regular physicians and follow what they say," and she did.

That saved the patient's life who was then properly treated and returned home a few days later. What would have happened if the patient's mother had not switched the patient back to her own ventilator? There is no doubt that she would have died.

However, that physician who followed the standards of care and followed pediatric protocols (even though the patient was on the "adult side" due to administration's directives) is now in trouble with the hospital administration.

Why would an administration that knew the CDC standards very well as well as how dangerous it would be for the patient, act in this way? Well, when something doesn't make sense, you have to ask yourself, "What does make sense?"

Obviously, the patient is one of those patients that goes "in and out" of the hospital each year or so and increases the "average cost per patient per year" for the hospital and reduces the financial incentives to the hospital. Many, many administrators really do not care at all about the patients, no matter how many times they speak in public about how caring they are and what "the mission" is. They are all about how much money the hospital can take in. They're all about their own huge salaries and are not there to serve the patients' best interests, though many physicians, nurses, and other staff are (and therefore also find themselves in trouble with the hospital administators).

The second case also involves a quadriplegic patient who is cared for by home care nurses. The agency administration keeps sending out incompetent nurses who have actually harmed the patient in various ways over the past year. Some of the nurses have accidentally rammed the patient's legs into a table when maneuvering his electric wheelchair; some have failed to raise his legs to reduce swelling in the lower legs; some have not made the wheelchair recline and change positions when he's up in his wheelchair so that he avoids getting pressure sores.

There are many other examples of routine tasks that are not being done by these incompetent nurses. Even when these problems are reported to management, nothing is done. Just a few years ago, nurses who harmed patients would have had their employment terminated, but now they are kept on. Nurses who report these valid concerns are told, "You should not be laying blame on others." Yet, within the past year, the management has provided seminars where staff are instructed to first raise "concerns" directly with the other staff, and then if no positive changes occur to resolve the problem, staff were told to speak to management.

You can see the "catch 22" contradiction here, can't you! Why would management keep sending nurses who were incompetent and refuse to discipline them to get them to straighten out? Why would management condemn those nurses who care about the standards and say nothing to the nurses who violate them?

Again, an agency may wish to have a patient (who has been enrolled in their services or facility for many years) actually die through various forms of neglect or lower adherence to the standards of care, and be able to accept new admissions for care. Nursing homes do this type of thing as well so that those on the waiting lists can become a new resident at their facility.

There are thousands of examples like these that show that when the standards of care are intentionally not followed, the patient's health declines sooner or later and death is imposed. These are methods of stealth euthanasia that most people do not think about.

Sometimes the violations of the standards are done intentionally by staff. We call those staff "closers" who kill and do not care at all and shouldn't be working in the field at all. You may doubt that they exist, but they do. Every now and then articles are written about such nurses or physicians, but tragically, they are more common than one might imagine.

One method that is often surreptitiously used to end patients' lives is "palliative" or "terminal" sedation. We have written about this many times, but a new article that promotes its use was recently published that openly declares that this method is a legal method of ending life even where assisted-suicide or euthanasia is illegal. See Palliative sedation, an end-of-life practice that is legal everywhere at:
http://www.post-gazette.com/aging-edge/aging-edge-reports/2018/07/05/Palliative-sedation-an-end-of-life-practice-that-is-legal-everywhere/stories/201807050128
The misuse of sedation with the intent to end life is very common, though this treatment should only be used when patients actually need sedation to relieve anxiety or as a way to reduce otherwise unsuccessfully resolved extreme pain.

While there are many wonderful physicians, nurses, and other staff who are truly dedicated to their patients, many are not. We need to be aware that the healthcare setting does not always provide staff who care or who can be trusted. Patients, family members, and others who serve as patient advocates need to be aware so they can act to protect the patient and assure that their needs are met.



For those who are new to our email list and the website: Very important: Please add hospicepatients.org to your list of approved email senders to your email account so our emails reach you and are not placed in a spam folder or deleted by your email service.

When looking for information on the HPA website: You will find our “Main Topics” section explaining all the basics about hospice services at:
http://hospicepatients.org/maintopics.html

You will find many other articles by Ron Panzer, President of Hospice Patients Alliance, at:
http://hospicepatients.org/articles-from-heart-of-ron-panzer.html

Through the years, we have added hundreds of pages covering many topics as people have questioned us for 2 decades now. If you can't find something, use the Search function for the website at:
http://hospicepatients.org/search-hpa.html
and if you still can't find the answer, email us and we'll be happy to get the answers for you.

To quickly sum up the changes that have occurred within the hospice industry, see the following well-researched articles, detailing what most hospice staff do not know at all (and most of the public doesn't either). You may be surprised to learn what is really happening! Check out the references if you have questions about what is written.

Four Part Wesley J Smith, JD/Ira Byock, MD Expose´:

1. Time to Wake Up to the Realities of Hospice, Mr. Smith!
http://hospicepatients.org/time-to-wake-up-to-the-realities-of-hospice-mr-smith.html

2. Getting It Right (Contra Smith and Byock) - Part One
http://hospicepatients.org/getting-it-right-part-one-evaluating-smith-on-hospice.html

3. The Call and the Counterfeit - Getting It Right (Contra Smith and Byock) - Part Two
http://hospicepatients.org/the-call-and-the-counterfeit-getting-it-right-part-two.html

4. Remembering the Religious Foundation of Cicely Saunders' Hospice Mission
http://hospicepatients.org/remembering-the-religious-foundation-of-cicely-saunders-hospice-mission.html

There is a wonderful, authentic mission to serve those at the end-of-life which was shown to the world through the works of physician Dame Cicely Saunders -- founder of the St Christopher's Hospice in London, England. This is the pro-life mission we support.

However, there is a counterfeit that fails to serve the true needs of patients like your loved ones (or you and me down the road) who depend and trust that they will be cared for.

Please let us know if you have any questions, comments, or wish to hear about other topics. For more detailed information about how and why the hospice industry has gone astray, please see the Stealth Euthanasia: Health Care Tyranny in America book which is available online to read for free:
http://hospicepatients.org/this-thing-called-hospice.html

If you have questions or comments, please let us know.

All healthcare is meant to be pro-life, otherwise it is not healthcare!

Ron Panzer
for Hospice Patients Alliance
www.hospicepatients.org

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