"Lynching the Elderly and Disabled?" would be the title of a news report that just might, might, catch the attention of the public and might get a politician to actually do something about it. But probably not. "Eldercide" as a term doesn't get much mileage nowadays. The elderly don't seem to count for much to those who enforce the laws. And the disabled? "Disabled-cide" just doesn't cut it. Language is power and the language is not yet created or accepted which can convey the horror, exploitation and abuse occurring throughout our nation. Action to relieve the plight of the elderly and disabled is long overdue.
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.
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 focuses not upon patient welfare, but upon fostering cost containment, increased profit making and stockholder dividends.
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
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 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.
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.
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.
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:
"My mother was abused, neglected, hospitalized twice in a months time, raped and dropped on the floor many times. They tried to intimidate me by telling me "that I put her there because I did not want her." I, like thousands of other families, put her in the nursing home with no preconceived ideas of good or bad care. I truly believed she would receive "nursing care." What a joke!"
"I then tried the system, Ombudsmen, DHS, my city and county counsels, my senator, the police and finally went to the Grand Jury who not only verified every one of my complaints but found an additional 15 life threatening conditions that I had not mentioned. Then the grand jury was told that they were a county grand jury and had no jurisdiction, apparently some more political payback for the contributions these politicians receive from the nursing home industry! I feel it was political interference to have the grand jury back off. The entire system failed. I then sued and my mother won the highest non-punitive damage award ever in California."48
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
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
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