"Lynching the Elderly and Disabled?"
(Why We Need An Elder Justice Act)

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 about 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.

Widespread Abuse

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!

Next Page: Abuse and Neglect of the Elderly and Disabled: Related to Fraud
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