A family matriarch is seriously ill and has been admitted to an Intensive Care Unit. Loved ones are by her side, but she is lucid, understands her medical condition, and can make decisions. Should she become mentally incapacitated, signed documents have been presented designating the eldest son as Power of Attorney, and there is a Do Not Resuscitate order based on previous meetings with her family and doctor.
Up to now this widow has lived independently, stopped driving two years before, maintains her home, cat, and garden, and belongs to church and several civic organizations. With only decreased hearing, she proudly reached 90 years old preserving enhanced quality of life.
Now she faces a life threatening emergency, but wants medical science and well-trained physicians and nurses to get her through this ordeal so she can return home to her cat and garden. She maintains hope as there are viable treatment plans and options for her illness.
This common scenario is played out daily in hospitals around our country. But at Henry Mayo Newhall Hospital (HMNH), a team descends on the patient and family imploring the need to go on palliative care to alleviate pain, suffering, and discomfort.
Attempting to define palliative care is like trying to decipher the tax code, read the fine print in a contract, or hear a drug commercial voice through soft melodious music warning of deadly side effects. For a layperson, it is not easy to unravel, can be draped in medical and legal jargon, and painted with embellishment as a treatment option.
From the dictionary, palliative care is: “A multidisciplinary approach to specialized medical care for people with serious illnesses. It focuses on providing patients with relief from the symptoms, pain, physical stress, and mental stress of a serious illness—whatever the diagnosis.”
This can apply to almost every patient admitted to the hospital!
Joined at the furthest end is hospice care for terminally ill patients which likewise has difficult to understand blurred edges and gray zones.
Palliative care is a well-intentioned approach, but in certain cases is being utilized by hospital administrators, HMOs, and insurance companies (including Medicare and Medicaid) to save money and increase profits. Not to mention, they use it as a segue into hospice care allowing them to legally cease financial obligations to the patient as it is a separate paying entity.
Several years ago, my antennae were raised when a Palliative Care Committee was established under the auspices of the HMNH administration. They wanted to control wording and oversight when creating the team in a hospital policy.
The HMNH policy is disturbing as a physician order is not a necessity for the team to intervene and discuss their option with the patient; all members of the team are employed by the hospital; criteria considers patient “length of stay”; and if the patient shows “no evidence of progress” and “documented poor or futile prognosis”, then the policy may be initiated. These latter opinions could be rendered by doctors who might be employed or contracted by the hospital thereby eliminating unbiased judgment.
At HMNH we now see implementation of a hospital administrative policy by a palliative care team sometimes before a doctor can present medical options; efforts to discontinue medical care if your stay is deemed too long or you are not improving; loss of oversight by the physician medical staff; and haste coercing patients into hospice care.
Needless prolonging of life can intensify pain, suffering, and discomfort so there is a clear need for palliative care to assist in the discussion and course of patient care.
But crafting a policy with the intent to deliberately direct the care of a life-threatened patient toward self-serving profit and cost-cutting is an exploitative outrage especially against our elder seniors.
Hearing soft melodious music as hope is extinguished through a concerted effort by HMNH administrators is not what a proud matriarch should face.
Gene Uzawa Dorio, M.D.