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Friday, October 17, 2014

The Business of Dying in America: A Personal Narrative Against the Privatized Healthcare Industry

Photo Credit - www.palmbeachpost.com
Talk about missing a passion. The passion is called writing, discussing politico, current events, news, economic and finance information here at Independent Underground News & Talk. Glad to be back with fingers to keyboard today, however, we do feel the loyal fans of IUNT deserve a bit of an expectation of what occurred.

To be as frank as possible, life happened.

About four weeks ago, some unexpected news of a close family member facing a fight for life literally felt upon our doorstep. The news was quite a shock. Learning the diagnosis was Stage 4 pancreatic cancer was devastating.

Pancreatic Cancer is a life-changing disease where as noted on Hirshberg Foundation website:
"According to the American Cancer Society for all stages of pancreatic cancer combined, the one-year relative survival rate is 20%, and the five-year rate is 6%. These low survival rates are attributable to the fact that fewer than 20% of patients' tumors are confined to the pancreas at the time of diagnosis; in most cases, the malignancy has already progressed to the point where surgical removal is impossible."
No pink ribbons, coffee cups, cars or tennis shoes or a organization where marketing cancer seems more important than the cure like Susan G. Komen Foundation, exist for this awful disease.

Instead the purple themed, properly named true informational resource called the Pancreatic Cancer Action Network upon the first call for assistance, not only answered our many questions but mailed a thick package of reference materials and clinical trials to combat this illness.

While navigating the various twist and turns, along with the roller coaster type ups and severe downs of Pancreatic Cancer as caregivers, the large fault lines of our American privatized band-aid patched healthcare system have been critically exposed for all of its faults.

A Jaded physician while speaking to family, completely dismissed a notable trait called compassion when discussing the patients' prognosis. To say this was shocking was an understatement.

This particular physician kept pushing Palliative Hospice care on the relative again above and beyond the patient objections and clear will to fight. One could be led to believe on the physicians' insistence, a kickback of sorts existed on the backend if patients immediately believed the advice and sought out hospice, to die. It was a erry experience indeed.

Recently, the Washington Post penned a four part series ironically named "The Business of Dying". In our for-profit even if the facility is dubbed "non-profit" the inherent goal of maximizing revenue over People healthcare or associated choices, clearly exist.

Notwithstanding the relatives' clear diagnosis of Stage 4 pancreatic cancer and their deep willingness to try and beat the odds, one part of the Washington Post series titled "As more hospices enroll patients who aren’t dying, questions about lethal doses arise" stuck out in a similar manner as a sore thumb while listening to the insensitive pontificating physician.

The post article detailed about the misdiagnosis on purpose to fit the terminal diagnosis requirement of hospice care of Bud Coffey, 77.
On March 17, just a few days before he was enrolled in hospice, Coffey’s primary care doctor listed three diagnoses: an “unspecified disorder” of the kidney, the aortic aneurysm and chronic back pain. The report also noted numerous kidney stones.

The list of diagnoses did not mention cancer. The diagnosis of an unspecified kidney ailment arose after a scan showed a two-centimeter spot on his kidney. Even if it had proven to be cancer, a spot that small is generally considered to reflect an early stage of the disease, doctors said. In rare cases, it could have spread.
On March 20, Coffey’s primary care doctor referred him for hospice care, “essentially for pain management,” because he was taking Percocets and still felt some pain, according to records.

“Hopefully they can manage his pain better,” the notes on his medical record say.

The doctor referred the family to Community Home Care and Hospice, which in May 2012 had been acquired by Curo Health, a company formed through acquisitions by a private equity firm.

When a few days later Coffey was formally enrolled at the hospice, however, his diagnosis appears to have changed. The hospice’s insurance verification form lists the diagnosis as “kidney cancer,” according to a copy of the document. For the hospice to be reimbursed by Medicare, the diagnosis must involve a terminal condition that is likely to lead to death within six months.

Then, throughout the rest of his two weeks under hospice care, workers for the hospice referred to “the cancer,” his family said.


Three days before he died, the hospice nurse recorded that Coffey “has not been eating well…has been talking to people who aren’t there…did not recognize a family member today.”

The family, worried, requested that the hospice send a nurse who could stay with him. The request was denied, the family said.

On his last day, the family said they were, under the hospice’s direction, giving Bud Coffey 40 milligrams of liquid morphine every three hours, a substantial increase over his previous dosage, according to notes taken by the family. They had also stopped giving him his breathing medication, the family said.

He died peacefully.

“Patient died at home with family at his side,” the hospice notes say. “Wife reported he was calm when he stopped breathing.”

The next day, the hospice doctor signed the death certificate, listing the cause of death as renal cell carcinoma, or kidney cancer.

The family said the doctor never examined Coffey during his time on hospice, and that based on the manner of his death and other information, the cause of death was not cancer, and not the aneurysm which would likely have caused a sudden death, but the effects of a drug overdose. That much morphine could have been fatal, independent doctors told The Washington Post, but the lethal threshold varies from person to person.

The family was stunned by his sudden decline, Jeff Coffey said. His father may have been, too.

On March 24, he wrote an e-mail to a childhood friend.

“I know that usually hospice is called in only when death is imminent, but hospice was called in this time to monitor my medications, vital signs, etc,” he wrote. “I still feel like a teenager and if I didn’t know what was happening inside me [the aneurysm] I’d feel like I was a perfect example of good health.”
The Business of Dying is real. Real sickening, disturbing and downright disgusting when dealing with a relatives' illness.

On the families or patient behalf in our case, no delusions of grandeur exist. Instead a clear understanding confirms the stark reality pancreatic cancer is more likely than not, will win the battle on a statistical basis alone. However, if the patient is willing to fight, why should this right be sidestepped in conversation for one persons' highly questionable goal, who is not the patient facing the disease.

And the possibly of alleged kickbacks for referrals to hospice palliative care over engaging in an active fight against the disease of advanced cancer, is not to far out of the ordinary:as a 2013 Eastern District of Pennsylvania branch of the FBI case cites:
"Eugene Goldman, M.D., 55, of Philadelphia, was sentenced today to 51 months in prison and a $300,000 fine for conspiring to violate the anti-kickback statute and violating the anti-kickback statute in relation to his role in a kickback scheme arising from his employment as the Medical Director at Home Care Hospice Inc. (HCH). 
U.S. District Court Judge Eduardo Robreno ordered Goldman to immediately begin serving his sentence and also ordered three years of supervised release. Goldman also faces mandatory exclusion from participation in any federal health care program. 
The evidence at trial proved that from approximately December 2000 until approximately July 2011, Dr. Goldman served as the medical director for HCH and regularly referred Medicare or Medicaid patient beneficiaries to HCH. HCH was a for-profit business in Philadelphia that provided hospice services for patients at nursing homes, hospitals, and private residences. 
In December 2000, the defendant and one of the co-owners of HCH entered into a written contract to create the false appearance that all payments to Dr. Goldman from HCH were for services rendered in Dr. Goldman’s capacity as medical director for HCH, when in fact the large majority of payments from HCH to Dr. Goldman were illegal payments for the referral of Medicare and/or Medicaid patients to HCH. 
From January 2003 to July 2011, Dr. Goldman received approximately $309,000 in illegal payments for patient referrals. In January, February, and March 2009, Dr. Goldman was captured on tape receiving kickbacks for patient referrals."
Other events on the relative twisted road on learning about the advance stage 4 of pancreatic cancer solidified by a series of medical missteps in which clear symptoms were dismissed by medical auditories or "poo-pooed" as depression, still stings hard right now while watching this valiant fight for life.

Would a Nationalized instead of Privatized Band-Aid scraped together system of rag tag healthcare in America bring more sensitively to the patient and less laser focus on the profit help end what we have seen for the next patient? Possibly.

Either way, even if America was in the future to become the last of Worlds industrialized countries to evoke a Nationalized Healthcare System, it would likely be too late to save our relative. However, reflecting not only our relative situation with advance cancer, America's in general increasing cancer diagnosis and death rates, and notwithstanding the Business of Cancer as evident by the stark spike in "Cancer Treatment Centers" an roundtable 360 degree review of the effectivest of the healthcare in the USA is seriously warranted.

And, in light of the recent Ebola Virus Outbreak, starting in Dallas Texas Presbyterian Hospital and expanding across the country as a result, we need to come to the reality that maximizing profits over people care is not a good business model for continuing to pursue. 

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