Hospice Patients Alliance: Consumer Advocacy


Case Two

HMO Commits Fraud - Enrolls Non-terminal Patient in Hospice; Causes Infection and Makes Patient Terminal by Withholding Antibiotic Treatment ... Resulting in Fatal Infection, Also Overdoses Patient on Potassium, Shuts down Heart Function but Never Informs Family that High Dose of Potassium is Lethal!



(A Medical Doctor's Analysis of this case Follows Below)

Note: This account of an involuntary euthanasia comes from a family whose father was lied to, misdiagnosed and treated with inappropriate medications and even inappropriate surgeries, denied needed care for an infection resulting from [the HMO]'s own actions, and overdosed on potassium resulting in death. In this case, the family itself was instructed by [the HMO] to give the potassium resulting in cardiac failure and death, and for the family, ongoing anguish and regrets. Names have been withheld to protect confidentiality of the individuals involved.





Misdiagnosis and Inappropriate Treatment Equivalent To Assault and Battery

Vickie Travis reports:

Last year, my father fainted and was transported to __________ Hospital in ________, this state. At the time his medical insurance was with _______. The attending phyician in the emergency room made a major mistake and deduced that our father had serious heart problems. As it turned out our father was having a panic attack, which can resemble a heart condition, but you are supposed to check the patients vital signs, and this was not done.

Thus our father was placed on life support and sent to the intensive care unit. We were informed by the head of ICU that first night that our father did not have a heart problem and that he was "perfectly fine." However, as his children we did not have the legal right to release him; as our father was heavily sedated, he could not release himself from the hospital. A legal nightmare began at that point for us!

The attending physician transferred my Dad to _________ hospital's acute care unit, without permission from my Dad or our family, where the doctor had a tracheostomy tube inserted and a gastro-intestinal tube placed (both of which were totally unnecessary and medically not indicated).

I was, however, able to prevent the doctor and hospital from transferring my father to the doctor's own private nursing home (where he could personally continue to collect money for room, board and unwanted medical care). At this point we had family members with him nearly 24 hours a day ... we had to! When we learned that the attending physician was attempting to gain conservatorship over our father, we were shocked and were forced to go to court. This doctor had at this point indicated that our father suffered from everything from Leukemia to Parkinson's disease, and the doctor also refused to honor our father's demand to be released from the hospital.

My sister became the legal conservator at this point. Still the family had to take legal action to have our father transferred to _________ Medical Respiratory Center to undo the serious damage to our father's body that was done by the attending physician. This doctor falsely made claims of her affiliation with __________ Medical Center and forced a contract with them to receive payment for referrals in order to have our father transferred to their hospital. The hospital there did what they could, but they did not get him completely off oxygen.

Beginning of HMO Failure to Provide Care

Finally we converted part of the family home into a care unit for our father including specialized medical equipment, heating and air conditioning, and an emergency electricical generator. We thought that we were prepared for just about everything. He was transferred to the family home where the family signed him up for [the HMO] Senior __________. He became a home health patient.

After the family paid for $350.00 per day for nurses that did not provide proper care nor did they exercise his body, the family members took care of him. With six brothers and sisters we all took shifts and were fully trained (probably more so than the licensed professionals that we had hired). We now laugh at the quality of care by these "profesionals," because we did a far better job. As is normal with a large family there were squabbles amongst us children.

Some family disagreements arose and in order to stop the family fighting, a private conservator was hired to oversee the family matters. Under his direction I became the official designated caregiver. Now, I drove 100 miles each day to and from the house to care for my father. I left my home at 5 in the morning and returned home after 10 at night. I was dedicated and honored to have the chance to be of assistance.

HMO Commits Medicare Fraud by Enrolling Non-Terminal Patient in Hospice

[The HMO]'s "assistance" amounted to a nurse visiting once a week and asking me how my father was doing. Occasionally they brought bandages for his stomas. When his Medicare funding for home health ran out he was transferred to their hospice plan even though he was not terminal.

HMO Intimidation to Force DNR Status and HMO Abuse Begins

The hospice nurse repeatedly terrified my father. Who could blame him for being afraid after the treatment that he had already received? The nurse yelled at him, "you're going to die" and "you'll never walk again." During this time, [the HMO] staff intensively pressured us to make my father's status DNR, or "do not resuscitate." This was against my father's and our family's firm convictions. He, and all of us as well, wanted him to receive all medical treatment that would be appropriate when necessary and under all circumstances to resuscitate him. This was documented in writing several times.

For the entire time my Dad was enrolled in [the HMO]'s hospice "program," his nurse refused to change the foley urinary catheter nor would he change the trach tube. These urinary drainage catheters are usually changed a minimum of once per month and sooner if they become blocked. The nurse also told the family in the presence of our father that if we wanted the g-tube changed that he would have to stand over our father on his bed and rip it out of his stomach without any anaesthesia and then use an hard object to shove in a new one. [The HMO] even refused to provide an adult-size wheel chair for our father, but they did provide a small, child size one that my father was obviously unable to use.

I repeatedly requested physical therapy assistance for my Dad and was told several times that they had been billing Medicare for physical therapy, but no one that performed any physical therapy on my Dad other than myself. [the HMO] said that they did in fact have a report from a physical therapist. If they had a report, it would be fiction, because no physical therapist ever came out to work with my father, even though they were billing the government for therapy services. He was also supposed to have a respiratory therapist, and they did bill for that also. But there was none.

There was a man that came out to check the equipment twice, but that is all. As for assistance with bathing, there was an health aide that every fifteen days or so would call and say she would be out to help us. She seldom showed up. I was his bather and again it was an honor to serve my father. Of course we complained to [the HMO] about their not honoring their contract with our father. We were always informed that they had budget and scheduling problems and "nothing could be done" to help us.

Still, we as a family continued to go forward and our father kept getting healthier and much stronger. Finally [the HMO] officially upgraded his health as they commented that it certainly didn't look like he was going to die any time soon. He was being transferred to the palliative section of their home health department, but not until they actually formed a palliative section, so we patiently waited.

HMO Nurse Causes Fatal Septic Infection and Sepsis

When they finally got this department created for their patients, the nurse was ordered by [the HMO] to finally change our father's catheter and trach in order to finalize his work and complete his reports. He came out to the house under duress and without washing his hands nor wearing gloves he proceeded to change the foley catheter and then immediately, still without washing his hands nor wearing gloves attempted to change the trach tube. After a lot of blood being spread around, the nurse informed me that he was unable to change the trach tube because it was stuck and was now a detriment to our father's health if he continued to do so.

We later were informed that [the HMO] rules require two nurses to change a trach tube. My father did develop an infection, and to us, it is obvious it resulted from the complete failure to follow sterile technique required to change an indwelling foley urinary catheter and the tracheostomy tube. Finally a new nurse came to see our father. She actually examined him, but we never heard from the bather again. The new nurse did try to get us to help her go after the nurse for his terrible medical treatment of all of his patients. She did change the catheter and the trach was changed. For several weeks we demanded that our father be treated for his infection, but [the HMO] refused.

HMO Practices Medicine Without License
Does Not Have Actual Doctor Making Orders, Directing Care

We took a urine sample for [the HMO] and the nurse finally took it with her. Previously we were always informed that they could not take a urine sample nor a blood sample without a doctor's order. Unfortunately, [the HMO] never did assign a doctor that we knew of to our father. No HMO doctor ever examined our father, nor did any doctor specifically make the orders that decided what care our father would not or would receive (usually not). The new nurse did take care of the wheelchair matter but it took a few weeks because as we learned, [the HMO] had falsely recorded in their computers for several weeks before our father's death that he was already deceased! That matter was never corrected by [the HMO].

For the next three weeks the new nurse repeatedly told us that our father did not have an infection and that we "did not know what we were talking about." Those were her words. She also pressured us again to make our father a DNR patient, however our father and we did not want that and we refused to cave in to [the HMO]'s manipulations. We all wanted our Dad to be resuscitated if his breathing or heart stopped. He had been getting better. We just wanted his infection treated to allow him to recover!

On Monday, September 11, 2000 when I arrived at the house I saw a drastic change in his health. He was seriously ill. [the HMO] threatened me that if I tried to treat him with antibiotics that they would have me incarcerated. So, to my regret I did not. Throughout the day and that night we repeatedly contacted [the HMO] begging for medical assistance. We were informed by one nurse that our father had a septic infection and that it was very serious. Apparently this information was tied into their computer problem that said he was deceased. After it was clarified that he was very much alive, the nurse asked what antibiotics he was on. We explained that we had been repeatedly told that no antibiotics would be given. The nurse told us that she did not know what to do about the matter then, and she did nothing to make sure our father's infection was immediately treated!

HMO Director of Home Health Laughs At Us When We Pleaded for Help

We all kept calling the various departments of [the HMO] and finally reached the head of [the HMO] home health. The head of [the HMO] refused to have medical assistance provided and laughed at us and said, "if you don't like the care your father is receiving under our HMO, get coverage under a different health care plan." Our father's conservator also unsuccessfully attempted to get medical care for our father that night.

Our father developed severe edema and his catheter was entirely plugged up with a grainy material. [the HMO] told us that if we wanted to do anything about the plugged urinary catheter, that we would have to take care of it ourselves. Urinary catheters that become plugged can back urine up into the kidneys causing kidney failure and death. We learned that night how to remove a foley catheter because he had become a medical emergency at this point. However we replaced it with a common sheath catheter as not being trained in insertion of objects into a bladder we did not want to cause any more harm than had already been done. As it turns out, my Dad passed away within a few hours.

Unfortunately, because an HMO physician never saw or participated in any way with the medical decision-making made by [the HMO] with regard to our father, the paramedics could not declare his death until a day later, September 12, 2000 when [the HMO] finally found a doctor to come up with a cause of death that would not implicate [the HMO]'s actions in causing his death and who was willing to sign the death certificate. This man that had never even seen our father but over the phone decided that our father died of Parkinson's Disease, which he never had!

Were We Used by the HMO to Harm Our Own Father?

During the course of our father's "treatment," the HMO had made sure that our father got 100 MeQ of Potassium every day. We thought that this was just standard medication, however, we later realized that potassium is often given as a replacement when a diuretic like Lasix (furosemide) depletes the potassium found in the blood. We were later informed that potassium given when not medically indicated, can cause severe adverse reactions, including shutting down the heart. Drug references warn that potassium can cause death. Now we wonder if the HMO had us help our Dad take his pills, including the potassium, so that our Dad could die from the potassium he took. There were no lab tests for several months, and we now have learned that periodic lab tests are necessary to determine the medical need for added potassium. In fact, now we learn that some "angels of death" like Jack Kevorkian have used potassium to kill their patients.

HMO Falsifies Death Certificate to Cover Its Tracks

It thought that no one can die just from Parkinson's Disease, but then who am I, I was only there. The current death certificate falsely states that he died of Parkinson's disease!. In the presence of impartial witnesses, at the time of death the bodily fluids were properly collected and taken to an independent laboratory for analysis. The following day, again with proper chain of command and great legal documentation, under the direction of the mortuary director, photographs were taken by my husband and myself of the blisters and oozing sores that broke out on our father the day of his death.

The laboratory informed us that our father had two different types of bacterial infection, common in cases of septic infection, and that in our father's condition they certainly were serious enough to have killed him.

I requested an investigation by [the HMO] as to why our father received this type of treatment and they denied that right. Following through [the HMO] chain of command I finally reached a supervisor that asked me "What is it going to take to make you go away." I informed her as I do everyone to this day that I want [the HMO] to change the way they treat their patients. She in turn offered me $219,000.00 to go away.

HMO Threatens to Retaliate if We Go Public

I refused. [The HMO] supervisor then threatened me that "your family will most likely receive medical retaliation unless you keep quiet and don't talk about what happened." That of course has spurred me on. How dare they threaten me for such a matter. The arrogance of this organization is revolting. Finally, under duress because [the HMO] was not acting in the spirit of the law, The this state Board of Managed Health Care had a formal investigation conducted by [the HMO]. Unfortunately, [the HMO] refuses to release to the family or to the State of this state the results of their investigation. Whether the State or other government agencies are going to force the issue to get the investigation report is still unknown.

Needless to say, all of this has been extremely hard on our family. We all find ourselves extremely angry, hurt and depressed by the unspeakable violation of our father as a human being. The HMO not only caused terrible suffering for him, but killed him, quite literally. This is something that we will never let go of. For our father's sake, we will fight this type of HMO atrocity to the very end.

We refuse to accept any financial bribe to keep quiet from [the HMO] or anyone else in this matter, thus we choose not to handle this through the civil courts. Numerous people in this community have come up to me and informed me of similar events that have occured to their family at the hands of this HMO. I sincerely am attempting to turn these needless deaths into good by making these arrogant corporations that purport to be not-for-profit health care organizations reform themselves.

If they can't do that then they should be put out of business once and for all! The patients' relationship with the health care professionals and [the HMO]s should be one of trust. You may not be aware that many highly educated people are refusing to seek basic medical care. I thought that was silly, but now I understand and I am very sorry that I do. And my father had to suffer so terribly for all of us in our family to directly learn this lesson!

I respectfully request any of you who read this to bring this matter to the attention of the American government officials and the general public. I am confidant that our entire family will be willing to cooperate with you in most any way that you request and will provide you with any and all documentation that you request.





A Medical Doctor Speaks Out and Analyzes This Case



Note: The actual HMO name and other identifiers have been removed, but this is the actual analysis provided by a medical doctor very familiar with [the HMO] in question.


The doctor writes:

[The HMO] organization is as sly as it is evil. They communicate to each other through oral agreements rather than written policy. They try to set up the individual front line person as the bad apple if anything goes wrong, official policy always spinning out great concern for the individual patient.

Let's start with some historical perspective and you will better understand my specific comments about each choice [the HMO] made with your father. Through such history you will see that the government is not a passive observer.

The Pearl Harbor attack not only set off war with Japan it also set off price control in the United States. Job salaries were fixed. Workers could be attracted or rewarded, however, with unlimited health benefits. The war years created the health packages of today.

But this approach also put the quality of care offered by health plans in the hands of the employers. It set up the unholy alliance between employers and insurers which put the worker at risk. Health care rationing - if done with craft and cunning - could be conducted under the illusion that patients were in a Health Net ..., etc.

Then President Johnson initiated Medicare itself in 1966. It was almost the nation's memorial gift to the legacy of assassinated President John F. Kennedy. Kennedy had the dream. Johnson was the legislative ringmaster and master barbequer who could launch this part of the Great Society.

But by 1973 Medicare's funding was already in trouble. So under President Nixon Prepaid Health Plans were deceptively renamed "Health Maintenance Organizations" and given funding and help to rapidly expand. [the HMO] Act of 1973 helped transform [the HMO] from a small to a large organization.

Next an ERISA protection act out of Congress made them impossible for patients to sue HMOs organizations. It confirmed diplomat status to [an] ethically challenge[ed] industry. It was at this point that Patient Rights were taken away, the restoration of which still puzzles Congress in the year 2000.

This state, in the mid 1980s - fearful that OB doctors were pulling out due to high malpractice insurance - in the mid 1980s passed a ... Cap which limited the amount physicians would have to pay for bad decisions to $250,000 plus actual patient damage. Fewer lawyers since have found the cost of a medical malpractice case worth the investment in experts and time delays.

[The HMO] added in mandatory arbitration in their enrollment contracts. And, because [the HMO] is the largest employer of arbitrators, the decisions are once more weighed toward [the HMO] and against the patient. But this ... [is] not informed consent. The trusting patient signs to arbitrate what has been secretly designed as tightly rationed care. It is a death trap designed by the withholding of vital care rather than the aggressive act of IV euthanasia.

We are now dealing with a royal court which owns the premiums. Patients are but serfs hoping for an occasional help from the castle. Sick patients are barbarians trying to ask too much of the King. This is why I keep a picture of a castle on my desk - representing Fortress [the HMO] (a term expressed by a frustrated patient which I since borrowed). It is a dark castle and can easily represent a Death Star when my communication symbolism varies. (I am not sueable for all of these comments because I have kept track of the deaths! In fact, [the HMO] calls itself internally a "mean machine.")

All of this has made [the HMO] cocky and nearly invincible in this state. And ... [the HMO] would love to be perceived as a "national model," ....

Back in this state it is as if we had allowed a Nazi like regime to flourish in the middle of a "civilized" state. [The HMO] makes money off well people; [the HMO] loses money off sick people. Hitler could build armies off of [a] well Aryan race and could only lose money off those in ghettos who could not be allowed to work due to being of the Jewish race. And it as the trains pulled up to the Gas Chambers, sadly it was physicians decided who among the condemned could work for a while.

The Final Solutions to the very sick [HMO] patient include: 1) encouraging them to get mad enough to dis-enroll; 2) calling them Hospice too early to bring in more federal monies to the organization; 3) calling them deceased (but still charging Medicare) so that services would become more difficult to obtain; and 4) withdrawing the support needed to fight infection and let disease be the internal gas chamber. Your father (and thus your family) experienced every major tactic.

To disguise all this to families and the front line care givers (who might only be hourly and have no pledge of silence to [the HMO]'s methods), [the HMO] system burdens such care givers with too many patients to do good care. Then, cutting corners falls to the care giver to simply get through the day's tasks and try to get home to the family. The choice given is take care of the patient correctly or see your family. This is how they morally break almost everyone in the organization. But morally broken leads to financially restored.

Meanwhile, [the HMO] holds out to be nonprofit and therefore devoid of evil intent. But the ... Medical Group is the dog that wags the [the HMO] tail. And ... [the parent corporation] is for profit. Bonuses are created when care is withheld. It is called "productivity." Bonus are protected when there is silence about error. It is called "collegiality." All of this is done without any paper trail.

Now let us go to your situation. I will comment as a physician who observed [the HMO] carefully for 18 months within the Firm. I am still listed on staff so that [the HMO] can only come at me through bylaws or bombs.

Excerpts from your letter: 1. "it is a crime of willful homicide to intentionally kill someone that had both verbally and in writing repeatedly stated that they wanted their life saved in any and all circumstances."

My Comment: the worst level of homicide is that which is calculated over the greatest period of time and requires the cunning of those with the highest education; (interestingly to me [the] CEO ... was an [Ivy League] College premed graduate of the class of 19__);

2. "My father was on home health. We were informed by [the HMO] that due to his Medicare benefits running out for the year that he had to be transferred to [the HMO]'s Hospice program. His care from [the HMO] consisted of his nurse visiting once a week and asking me how my father was doing."

My Comment: this is Medicare fraud; a patient can only be transferred to Hospice when a specific physician makes a specific decision that someone has less than six months to live; this is a way to get more money for [the HMO];

3. "His care from [the HMO] consisted of his nurse visiting once a week and asking me how my father was doing. He [the nurse?] was also verbally and mentally abusive to our family."

My Comment: I will assume that the nurse was abusive to your family. Often the [the HMO] attitude gets expressed through those in the front line particularly when they feel that a patient is breaking [the HMO] (by being sick). A nurse can mistakenly feel that he or she has become the gatekeeper holding back the plague.

4. "I believe that he was under great stress because he kept stating that [the HMO] did not have any services such as physical therapists or instruction nor respiratory therapists to assist us nor could my father have a wheelchair that he could fit in, nor was there any physician for him to see because there were budget problems and they were cutting back."

My Comment: Every front line worker is given an impossible load. That is how rationing is accomplished. The [the HMO] morale is similar to an army of zombies. The lack of a physician is more Medicare fraud. Nurses cannot just make up care orders on their own. And [the HMO] is very much making money this last year.

Questions: Did your father take any medications? Who was the physician who wrote them? Were any of them split?

5. "As it turned out [the HMO] did bill for these services to Medicare and also there are supposed to be reports for these services at [the HMO]."

My Comment: This may be the best case using the Medicare Fraud hotline or getting a percentage of the recovery for false billing under Qui Tam approaches.

6. [He was] "Strong enough that we were told that it was obvious that he was not going to die any time soon and that he was being upgraded to palliative care. It took about a month for [the HMO] to form their palliative care department, as we were repeatedly told by the [the HMO] staff and so we patiently waited."

My Comment: Your father had a silent physician who did not like to come for home visits. Such a physician did not need a "palliative care department" in order to act. There was no reason to delay care. But this is simply another form of giving up on your father. The VA is also excited about its new "palliative care" program. Funds for all this come from withholding intensive treatment from patients.

7. "Another nurse in the hospice department, and this is not public information due to the fact that she requested we not mention her involvement, came to the house and advised us as to how to care for a sore that had opened on my father's elbow. She could not touch him but she did instruct me in proper care for this type of wound. It was not a pressure sore."

My Comment: a nurse can touch an elbow. But [the HMO]'s style of retaliation on its own staff prevents those who would like to help from doing anything. After all, this is the prototype Medical Firm.

8. .... We insisted that our father be treated for his infection and demanded that a urine specimen be taken or a blood sample. We were informed that it could not be done because she needed a doctor's prescription for tests like that and our father did not have a doctor."

My Comment: Your father did have a doctor so this was a lie. The doctor was probably the head of the Home Care Program and preferred to hide. (Medi-Cal is also famous for its "verbal control" physicians who like to go unnamed.) This is more fraud.

9. "Bear in mind that by this time there were no less than three people now present when anyone from [the HMO] came to the house that were witnesses because of the foolishness that they were pulling. We were fully aware that they were lying to us about services that were available and treatments but we chose to make it as simple as possible for our father."

My Comment: Lying is possible when the pre-calculated risk of being discovered is a small fraction of the cost of achieving the goal of the lie - to withhold care. Only the rare family can summon three witnesses in a home and pursue the issues like you have.

10. "Two weeks later we were informed that the wheelchair still hadn't arrived because our father was listed as deceased in [the HMO]'s records. Of course we have all of this in writing from [the HMO] least you think that I have no proof."

My Comment: Putting "deceased" on the computer will be blamed on an encoder and thus is another bad apple in a good barrel. Someday an encoder will step forward and turn evidence on this bad barrel behavior. The goal of putting "deceased" on your father's name is to delay care further in the hopes that the label would soon fit.

11. "Three days later, a Monday, September 11, 2000 when I arrived in the morning to take over for the night shift my father had declined severely in health. His eyes were sunken in and blisters and oozing sores had formed all over his body."

My Comment: He was allowed to progress to bacteremia as well as widespread impetigo, both severe infections. These sores were not from pressure but from untreated infection, poorly managed tubes, etc.

12. "My father was on oxygen and that day the machine suddenly failed. New equipment was rushed to the house. I repeatedly contacted [the HMO] throughout the day and night asking for assistance. The nurse couldn't be reached we were told and were advised to wait. In late afternoon when the rest of the family came to the house everyone began calling [the HMO] for help. At one point a nurse on the [the HMO] help line told me that she was sorry that my father had passed away the previous month and asked why I was calling."

My Comment: there is no need to turn off respirators when you can contract with oxygen supply groups who know to whom to give the old machines. Most of these companies are capitated to the number served and benefit when death occurs.

13. "I was threatened with arrest if I attempted to give my father any antibiotics, which I regret not doing so to this day."

My Comment: I suppose the police might be called if you gave an antibiotic to your family to try to keep your father alive. But more than likely they would arrest the physician who would not come to the house to make a proper diagnosis. You would have probably got a police life saver award.

14. "The head nurse that evening in the home health department openly laughed at us and stated 'If you don't like the care that [the HMO] is providing for your father you can always get him different insurance.'"

My Comment: the way you get to be a head nurse or medical director in HMOs is to get with the program. You need to get the vision of medicine as a business and expenses of the sick patient as a "loss ratio" to profit. The federal government has asserted that HMOs wasted billions of dollars in chasing healthy seniors and dropping out the sick ones as fast as possible.

15. "Our father died a couple of hours later. The paramedics could not call his death until September 12, 2000 though, because they had to wait for [the HMO] to finally assign a doctor to our now deceased father."

My Comment: Your father always had a named physician in the background. And paramedics are linked to an on duty emergency physician. They were probably concerned that this might be a homicide and turned it over to the coroner's office. The coroner's deputy then would chase down a [the HMO] physician willing to sign to some benign cause of death.

16. "The doctor that never even saw my father wrote down that he died from Parkinson's Disease. Following proper chain of command, the body fluids at the time of death were taken to an independent laboratory and analyzed. We were informed that he had two different types of bacterial infection and that while they may not have at that stage killed a young, healthy adult they most certainly did our father in his weakened state."

My Comment: On the death certificate the physician must write down the last time that this physician saw the patient. The physician might have tried to use the nurse's visit for this purpose - also illegal. This should have been a full coroner's case. At least you got some evidence of the infection. I would get the license of the physician off of the death certificate.

17. "I very nicely asked [the HMO] to change its practice of harming patients and to perform an internal investigation. I only wanted them to change. Instead they asked me what it would take to get rid of me. I told them only bringing my father back. So they offered me $219,000.00 to go away. I said 'No,' I did not want money because my father died I just don't want anyone else to suffer as he did at their hands."

My Comment: [the HMO] has a budget of about $13 billion a year. The piggy bank can do better.

18. "Then I was told that if I continued my family would most likely receive medical retaliation."

My Comment: As for retaliation, [the HMO] is a "mean machine." They retaliate against anyone who gets in the way from doctors to patients to clerks. This organization is glued together by a mutual fear. No one has any value except as they fuel the machine.

19. "So I contacted our state Board [Department] of Managed Care and under duress [the HMO] has supposedly conducted an investigation into this matter. Unfortunately [the HMO] refuses to release the results of this investigation either to anyone in our family or to the state of this state. Of course The state of this state is a wee bit upset about this matter."

My Comment: The state of this state is an obligate parasite on [the HMO] industry both for rationing care and for funding the governor. I am waiting for the Department of Managed Care to make its first systemic change. If the department really cared, it would quickly champion getting rid of arbitration as uninformed consent, suing HMOs as RICO racketeering organizations (Connecticut style), empowering patients (Massachusetts style), challenging ERISA (Texas style), speeding payment of providers (Florida style), etc. Crocodile tears over your father's care together with a speeding ticket issued to [the HMO] will not impress me.

20. "I now understand why so many highly educated people refuse to get even basic medical care. This is the most shocking breach of trust that I have ever experienced. We literally begged repeatedly for help. We were ignored and laughed at. My father wasn't dying until [the HMO] got a hold of him."

My Comment: I am considered a bit radical for calling HMOs Killing Fields. It is not a wild comment by a raving professional but a focused rage from an oath expanded to a crystal clear conscience. Thirty-two years of medical practice helps. Family contact with Ghandi and Schweitzer also helped.

21. "However, if there is some quicker way to be able to present proof to the authorities and perhaps those in government that are accepting [the HMO] funding then maybe changes will take place a little faster. ... [The Governor] is a smart man and he will turn his back on [the HMO] if the proof is made public as will any other government official with aspirations to a higher office. This information would also be of great assistance to the Homicide Detective in charge of this case. The FBI has also stated that if the appropriate laws apply to this case that they will be involved also."

My Comment: I wish I could find the government to be the innocent investigator of these things. But then you get the entanglement between [the HMO] and its congenital twin the VA system. And then you find Medi-Cal patients all forced to choose HMOs or have them chosen for the patient. Next you follow the ... [Governor]'s fund raising approach using HMO dinners to raise money just before moderate decisions. You get skeptical at age ....

I think that you belong at the next Congressional hearing about the Patient Bill of Rights. And when [the HMO] lobby tries to deflect our representatives that the answer is the [the HMO] model, you speak up. Plane fare available I'll sit one row back to applaud and confirm. Then all of the ambivalent agencies you have mentioned - also afraid of the power of the [the HMO] Firm - will have to do their duty just to be credible. Governor ... will have to join you just to get on the Newsweek cover again for his courage.

22. "You seem to me to be a means to do something meaningful to stop the needless deaths that are occurring. I have so many people telling me similar stories that have taken place in their families that I truly believe that these people, including my father died to lay the groundwork to stop the terrible things that are occurring in Managed Care today. I only personally have this horrible experience with [the HMO] and I certainly never want to have to experience it again. This could happen to anyone of us, don't you think that we should do the right thing and do what we can to stop it now before it gets worse? Is there anything else that you would like to know about me and why I wrote you this evening? I do hope that you will be able to help in this matter."

My Final Comment: you have identified the enemy any many of the tricks being used in the Art of Slow Homicide. Can you channel your energy into periods of Focused Rage backed by intense preparation? I think you can.

Signed,




/Medical Doctor's name









Note: Hospice Patients Alliance has received this report from a family which is willing to publicly speak about this case. HPA does not take a position on any specific HMO or other health care agency, 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 father and thousands of other helpless patients throughout the US. We condemn the HMO violation of human rights and patient's rights described in this actual case history.




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