Hospice Patients Alliance: Consumer Advocacy


Mother Killed by Hospice with Morphine Overdose

Case Three


Note: the following is the account given by a daughter showing how her mother was medically killed by a hospice, its medical director and its nurses: involuntary euthanasia. Names have been withheld to maintain confidentiality.



My mother was recently a hospice patient in _________. She had chronic lung disease (C.O.P.D.) which we all expected would eventually take her life. However, while under hospice care she died of "acute morphine intoxication." This has been confirmed by an autopsy by the coroner's office, and now is being investigated by the county D.A.

Since she was under hospice, and also considered terminal, I don't know how serious it will be taken. However, I now know that this is not an isolated case, and feel that it's probably happening to others as well. What I find particularly disturbing is that my mother did not want to take the roxanol (liquid morphine), and that's what caused her death.

The hospice nurses kept insisting that it would help her breathe, although everything we read stated that morphine would actually slow down her breathing and could even stop it completely. The nurses claimed that in small doses, morphine actually would make her breathing much easier. Consequently, she finally agreed to take it, and my brother and myself were encouraging her to do so based on what the hospice kept telling us. We trusted them! Throughout the patient records, it mentions our concerns regarding the roxanol.

My mom agreed to become a hospice patient primarily because she totally depended on bottled oxygen to breathe. It was difficult transporting her to and from physicians. It also appeared they actually did little besides adjust her medications.

Since hospice claims to have "physician services" available, and her attending physician appeared to be in favor of her signing up for hospice, she agreed. Initially, we began to have problems getting the proper medications. Many of the meds she took for breathing problems did not appear to be on the hospice "formulary". This appeared quite odd since the meds she took were standard for her condition. I also had been told that the hospice handled all supplies, ie. underpads, gloves (for dressing changes), etc. Whenever, we asked for anything, they were always out. They also claimed falsely that these items were not generally covered. I finally spoke with their social worker assigned to the case for a clarification to determine what was covered. After that, they supplied all necessary items. However, I did request a written list of items covered, they could not supply.

Although my mother had difficulty breathing, she was completely alert and aware at all times. After we finally received her medical records from the hospice after her death, it was noticed that they had written "comfort measures only" to be supplied. However, they did not see to it that my mother was kept comfortable. They denied her the basic medications which would have helped her manage her C.O.P.D. symptoms!

I'm still trying to determine exactly what hospice does supply, since they supplied so little. Through the duration of her hospice care, there were many issues which we felt needed physician input. We had no contact whatsoever with either the attending or the hospice physician regarding my mom's care. (I did meet with the attending physician at his request to try to resolve who should be responsible for prescribing her medications. At the end of the meeting, he told me that the hospice has their own physicians and they should be handling her case.)

Approximately one month after we initially signed with the hospice, a home health aide who was assisting my mom get back into bed, cut her leg quite severely with her acrylic fingernails. The vein was actually exposed. We have a friend who is a dermatologist who felt the wound was bad enough that a wound care specialist should be contacted. We requested a physician visit from the hospice. They initially ignored the request. When we became persistant about having a physician evaluate the wound, they arranged for their hospice physician to stop by our home. He evidently stopped in front of the house, then received a page from the hospital and left. Throughout her care, we never saw or spoke to him.

Several weeks after the leg wound incident, her breathing became much more labored. We told the hospice nurse we suspected pneumonia since she'd had that before with similar symptoms. We were told by the nurse it absolutely couldn't be pneumonia since there was no fever present. We once again asked for a physician to evaluate our mother, but once again the request was ignored.

Approximately two weeks prior to her death, her right hand swelled and the fingers became very sore and puffy. The nurse suspected either an infection or a bite. It was extremely painful. We once again requested a physician, and once again the request was ignored. Instead, they ordered an antibiotic in case it was an infection. My mom refused to take it without speaking to a physician.

Since her breathing was becoming more labored, the hospice nurse began to really push the roxanol. My mom finally relented and began to take small doses of 5 mg every 4-6 hours or many times less frequently. (The prescription on the bottle allowed for 10mg). Since my mom was extremely petite (she weighed approximately 75-80 lbs.), she was very concerned of overdosing on medications.

The day before her death, the hospice nurse came into our home, and said that the attending physician said my mom could have 20mg of the roxanol every 2 hours. That was 4 times the amount we had been giving her. Since her breathing was still labored, and the prior doses didn't appear to be helping her much, the nurse administered the larger dose (the medical records now state that she gave her 10mg, although at the time, she said it was 20). The last thing I remember my mom ever saying was "but I just had some". She had been alert and aware prior to the dose being administered.

She went into a coma that afternoon. I immediately paged the hospice nurse and was told that the coma was part of her "actively dying" and that the morphine had nothing to do with it. We wanted to call 911, but when you are with hospice, you are instructed to contact the nurse instead. We also knew that she did not want to be placed on a ventilator and were afraid that would happen if we called 911. At the time, neither my brother nor myself had any idea there was a drug to counteract a morphine overdose. Nor did the nurse volunteer any such information.

The nurse never came out that day. The following morning while my mom was still in a coma, the hospice nurse returned. She insisted that my mom needed some more roxanol. My mother's breathing rate had slowed down considerably and I vehemently said "no," telling the nurse that I still felt as though the morphine had caused the coma. She denied that and even stated that morphine can go "in and out of the system quite quickly." She said my mom was actively dying, it had nothing to do with the morphine. The nurse told me that "it was "inhumane" to allow her to struggle for breath as she was. The morphine would only help make her breathing easier." I finally reluctantly agreed to a very small dose. I'm not certain of the amount given, but my mom died later that evening. Now I know that the morphine killed my Mom.

The coroner was not called as is the rule in the area we live. My brother and I began looking more into the morphine issue, and contacted the coroner's office. The autopsy report took 10 weeks, but confirmed our suspicions. The coroner confirmed that my mother had bilateral pneumonia, which never was treated.

The physician who prescribed the increased morphine level to be given was the hospice physician. He had never seen or spoken to my mom. There was absolutely no contact with the family. It is my understanding that in _________, it is illegal for a physician to write a narcotic for a patient he has never evaluated. We are contacting the medical board on this issue.

I also began looking up some information on roxanol/morphine, and how it's utilized with COPD patients. What I found in every journal I looked at was that roxanol is "contraindicated for use with COPD patients''. Consequently, we don't really know why it was given. She did not have cancer, and was not in severe pain.

I also attempted to get her records from the hospice. They have been absolutely impossible to work with. It's nearly impossible to get them to respond on any issues. They refused to release records to me until I filed a complaint about it with the county department of health services. When they did send out my Mom's records, they did not send the complete record and were careful to actually remove certain pages from the record that were particularly incriminating. When I again requested specific documents which I learned had to be part of the record, they sent some, but again, failed to send everything. They still make it extremely difficult.

This story goes on and on. The bottom line is that my mother was "euthanized" against her will and against our wishes by the hospice, its physician and nurse who were supposed to be helping her live out her remaining days to the fullest, not kill her!

The hospice has continued to insist that the morphine had nothing to do with her death, and that my mother died from her lung disease. According to the official coroner's findings, my mother's morphine levels were extremely high. The morphine intoxication was the only cause of death. It had nothing to do with her lung disease.

This has been extremely hard on my whole family. We all had hoped and prayed that we would have Nana with us for another Christmas. The sad part is that without hospice, we probably would have. I had brought her to live with us, thinking that we could help extend her life, and allow her to be around loved ones. Instead, she was overdosed on morphine by those we entrusted to help with her care.

As I mentioned before, I don't believe this is an isolated case, and would like to do whatever I can to prevent this from happening to another nana somewhere.

Name of daughter






Note: There are several issues involved in this case. The Hospice was required to provide the supplies needed for this patient's care related to her terminal illness. Also, morphine is contraindicated generally with C.O.P.D. patients and especially in an elderly patient, medications do not "go in and out of the system quickly" as the nurse incorrectly stated. Every nurse and physician knows that the elderly do not metabolize or excrete medications as quickly as the younger patients. In this case, the breathing rate became quite slow, according to the daughter's report, and yet, the hospice nurse still gave the morphine, knowing it would slow the breathing down more and then stop the breathing.

The attending physician had told the daughter that the hospice has its own physicians, and that the hospice medical director should handle the case. That is completely incorrect. Most physicians are not well informed about the specifics of hospice regulations. The hospice regulations actually envision a check and balance system with the attending physician making the orders for medical care and the hospice medical director serving as a check to make sure that the patient's symptoms are managed well.

For a hospice to remove the C.O.P.D. patient's medications for breathing management is absolutely abominable and the opposite of standard hospice care regulations. The C.O.P.D. symptoms were the symptoms that were causing discomfort to the patient, not pain, such as in cancer, so the patient would have been much more comfortable receiving the medications her attending physician had ordered. It is obvious from the daughter's account, that the hospice had no intention of managing the patient's C.O.P.D. symptoms but was bent on euthanizing her by giving her morphine when her breathing had slowed down below acceptable standards.

Hospice Patients Alliance has received this report from a daughter who is devastated by the medical killing of her mother (involuntary euthanasia). HPA does not take a position on any specific hospice, but condemns the abominable lack of even minimal compliance with the most basic of health care standards, resulting in the needless death of this family's mother and thousands of other helpless patients throughout the US. We condemn the hospice's violation of human rights and patient's rights described in this actual case history.

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