The Exploitative Henry Mayo Newhall Hospital Palliative Care Policy

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.


  • Carol Rosenberg says:

    My mother had a visit from a member of this committee, but fortunately my sister and I walked in and threw her out. My mother was coherent but uncooperative, so this group deemed she should be put on hospice! Since when is being difficult grounds for hospice? Dr. Dorio was a huge help in allowing my mother to make her own end of life decisions. I complained, but no one cared. No one has the right to walk into someone’s room and tell them it’s time for them to die.

  • Gene says:

    Thank you Kiza

    You and I both know some members of the HMNH Board of Directors. Unfortunately many of them have their vote compromised and financially conflicted. Until this adverse influence is removed, the Board will not respect what I write, what the public states, nor initiate any honesty in the care of our dying loved ones.


  • Kiza Hilton says:

    Dr Dorio, Thank you for this information, especially since my mother-in-law is at the end of her life and goes to HMNMH for treatment. I hope your letter ultimately results in respectful, socially-responsible policy changes by the hospital board, that honestly benefit our dying loved ones. Kiza Hilton

  • It is the legal duty of a primary treating physician to determine what happens to her patient. That is what it means by “primary.” And as such, the primary is referred to as the captain of the ship. The Palliative Care Committee should not be able to superseded the primary treating physician, save under specifically created protocols. Where to draw that line should not be a product of political power in the hospital / administration. Policy must be a product of a thoughtful, transparent process under by the ethics committee and approved the Chief of Staff and the medical executive committee. Thus, the timing of when a palliative care team enters the picture should be decided by the primary treating physician and/or a carefully developed protocol.

    It is best for the patient and family when the primary treating physicians acts in concert with the palliative care team and for the primary to clearly define, in her written physicians orders, the type, purpose and degree of palliative care team intervention. The primary treating physician, the captain of the ship, must set the parameters. If the captain fails to refuses to set those parameters, then the team will have to do as they deem appropriate.

  • H. E. Butler III M.D., F.A.C.S. says:

    Put this matter on Facebook? Do other citizens of our Republic face this ethical issue? H

Leave a Comment