Hospice Patients Alliance: Consumer Advocacy


Why Hospice Organizations ...
DON'T Want You to Know the Truth!

With the publication of the 8/20/01 USA TODAY articles about hospice, several hospice industry lobbying groups have gone "ballistic" denouncing the article as a twisted, unbalanced version of what is happening in hospice today. The reality is that hundreds of articles promote a "Mary Poppins" view of hospice so that the public has no idea of the problems that can arise in hospice, until it is too late. The USA Today article provides the balance that is needed by presenting the other side of the story, so the public is forewarned that sometimes, things can go wrong in hospice. We see that situation very clearly from the letter to the Editor sent in from New York State.

Hospice states, "We don't do weekends!"

Hospices are required to provide services necessary to meet the needs of the patient and family related to the terminal illness. Hospice industry representatives state that the industry adheres to the highest of standards of care, but L. Rodger from New York state wrote a letter to the Editor of USA Today (8/25/01) stating that the hospice her father was enrolled in did not provide services on the weekends! She explained [by phone to Hospice Patients Alliance later on] that her father had had good pain control while in the hospital, before admission to hospice, but was in severe pain from Wednesday through Sunday. That her father had good pain control in the hospital seems to indicate that the pain could be controlled by medication.

Linda reported that the hospice RN visited at the time of admission on Wednesday, slapped on a pain patch and never came back to adjust the pain medications to make sure the pain was controlled. She stated: an aide visited on Thursday and Friday am for a brief period of time, and nothing at all more! She also reported that the hospice never informed the patient or family that the required service: continuous nursing care, could be provided under the criteria that pain was out of control; that the hospice never provided continuous care to assure the pain was controlled (it was not); she reported: when begged for assistance, the hospice refused to send anyone out at all. She and the family managed without the hospice and the hospice finally called on Monday, only to learn that Linda's Dad had passed away while the hospice was busy "not doing weekends."

Well, apparently patients all have to die during the week, and certainly are not allowed to have problems or crisis symptoms on the weekend, or even during the week in this case. Linda was appalled that the hospice did not even try to control her father's pain, which was so severe he could not be touched or moved once under the hospice's services, and no services were provided on weekends, even though all hospices are reimbursed for every day the patient is enrolled in the hospice. Linda was so disgusted with the hospice's services total lack of concern and even though she loved her Dad, felt that her father's death on Sunday allowed him to go on to a better place and that he did not have to suffer any more excruciating pain under this hospice's care.

We wonder what services such a hospice provided to justify its billings to Medicare for every day the patient was enrolled (including weekends) in hospice ... or did the hospice only submit bills for the days during the week: Wednesday through Friday? Those who are familiar with hospice would know that submitting bills for only weekdays and not the weekends is not possible, because patients are "enrolled" officially into hospice only one time normally and the bills are not sent for this day or that day, but for all the days from admission into hospice up till the end of hospice services at "discharge" from hospice due to the patient's death or transfer to another hospice.

Linda's father's case is not at all unusual. We hear about similar cases, variations on the theme of hospices underserving patients, from all over the USA. While there are excellent hospices and staff out there, the "rogue" hospice makes it difficult for the patients and families they enroll. Patients and families have no guarantee in the real world, that they will automatically find an ethical hospice. It is a matter of chance which type of hospice you or any other family will use.

When Hospice Administrators or Staff
Fill out Forms Incorrectly
  ...   and Intentionally Submit False Information
      for Fraudulent Purposes, Should They Go to Jail?

Hospice spokesmen complained [in the USA Today article]:  

"If you fill out a form incorrectly, and if you do it intentionally, you can end up in jail. Hospices have been taking a beating."

Well, any person who fills out a form incorrectly with the intent to commit health care fraud, is defrauding the government. Do you fill out forms incorrectly on purpose when dealing with Medicare? Would you fill forms out intentionally wrong if you knew it was a felony crime? Just as in any other business, if you fill out a form incorrectly, knowingly, and it results in felony fraud taking place (stealing millions of dollars from Medicare over time), and you knew about it, that is called health care fraud. Should any person, even in a hospice, be charged with a felony crime if they knowingly commit felony crimes? Of course they should! Hospice staff are subject to the laws and even hospice administrators are subject to the laws. It is not too much to ask that hospice administrators and staff also follow the laws of our nation and the states! ... unfortunately some hospice administrators believe that they do not have to fill out forms correctly when dealing with our health care system.

"There is no kind of dishonesty into which otherwise good people more easily and frequently fall than that of defrauding the government."
   -    Benjamin Franklin

Hospice Organizations do Not Want You to Know
About Fraud in Hospices

The Hospice Industry is a white-collar criminal's dream environment, because there is almost no real oversight of what is going on. And, the public image of hospice as so "compassionate" ensures that any real effort to prosecute a rogue hospice will be met with reactions like, "how could they go after such compassionate people?" Of course, the public does not hear about all the violations occurring in the rogue hospice. ... they only publicize the wonderful services. Remember, even a rogue hospice will do some good hospice services, otherwise they'd be immediately detected and shut down.

For example, one well known large hospice had over 200 pages of violations written up in the State inspector's report, but the public has no idea about that. The public also doesn't know that the same types of violations which were cited a few years earlier were again found at this same hospice: the violations were never corrected! Even though a hospice puts in its "plan of correction" after being cited by the state inspectors, not all hospices fix the problems found. The rogue hospices just go through the motions of appearing to comply.

This same hospice is very well known in the state and most people don't even know that other hospices exist, since this hospice advertises constantly in radio and TV: they have big political connections, million dollar donations coming in, and are working to take over the entire hospice services for the state and surrounding region. Similar activities are occurring in rogue hospices all around our nation. How do we know? We receive a continual stream of complaints from every region of the nation. And these complaints come not only from "laypersons" but also from doctors, nurses, attorneys and other very well educated and objective observers.

The type of hospice that such a "rogue" hospice runs is virtually the opposite of the type of care provided by the ethical hospices. That is why some ethical hospice adminstrators complain about the USA Today articles...these administrators are simply naive and don't realize what the rogue hospices intentionally do to violate the standards. It is a characteristic of the honest, that they cannot believe that others are dishonest and would actually knowingly scam Medicare, Medicaid and exploit the patients themselves for financial gain. The honest project their own honesty on the rogue hospices, not wanting to believe the reality of what is going on in the industry.

This hospice works to get exclusive referrals from medical groups and hospitals as well as nursing homes, thereby basically shutting off the referral sources for the other hospice agencies in the state (which are competitors). Their goal:   to have almost all the terminally ill sent to their hospice agency so they get the biggest market share and to destroy the other hospice agencys' foundation, making them irrelevant or nonexistent. Make no mistake about it: the rogue hospice is fighting a competitive business war to stifle the competition and win the financial game. They brag about running their hospice "as a business" but have intentionally violated standards to increase revenue/income.

Sure, the state may come in periodically every two or three years, or eight years (as in some hospices), and they may cite the agency for a deficiency (even though criminal activity was occurring), but the state almost never shuts down any hospices that commit fraud. The federal government (US OIG) almost never shuts down a hospice [or nursing home or hospital] that commits fraud. They "settle" with the hospice, often getting back only a percentage of what was fraudulently taken, thereby rewarding the white-collar criminals for stealing from the taxpayers, through Medicare and Medicaid fraud.

Hospice administrators complain, "Hospices have been taking a beating." Well, that is news. That is really big news, because it is extremely difficult to find any news about hospices taking a beating. Where did this beating occur? What hospices are or were involved? Out of over 3,300 separate businesses/hospices how many have had any major problem with actual charges being brought against them for fraud? Not that fraud isn't happening, but we would like to know about any charges actually brought against hospices for the fraud they commit, because the government's efforts to stop fraud in hospice are totally underfunded and quite ineffective. Staff at the US OIG report that they have a backlog of thousands of health care fraud complaints from all over the US involving the entire health care industry. When the US OIG started up its Operation Restore Trust (3/95) to investigate fraud specifically in hospices, a few years back, the hospice industry was up in arms, and successfully got the federal government to back down.

[See Wall Street Journal article, 10/13/97: "Medicare a bottomless well" --- "Abuse, corruption small part of escalating costs" "] "Yet when Medicare overseers tried to tighten eligibility rules for hospice care, a firestorm of protest ensued." "Fearful of being portrayed as cold-hearted, regulators retreated from their attempt to police the use of hospice services, and Congress hasn't taken it up."

Federal efforts at uncovering fraud in hospice have been a huge failure. Investigations into hospices have been suspiciously shut down without any reason. If hospices are taking a beating for violating the laws, it is justified, but actually hospices have not been taking a beating, and are among the least regulated industries in health care. They are virtually untouched by law, even though they protest loudly when even slight efforts are made to rein in the health care fraud occurring in hospice.

Hospice Organizations Don't Want You to Know that
Regulations Mean Nothing to the Rogue Hospice

Hospice spokesmen like to complain that they are overloaded with regulations, and if they "intentionally fill out a form wrong," they might have trouble from state or federal regulators. In the hospice industry's view, no problems arise out of intentional mismanagement by the hospice agencies. In the hospice industry's view, no serious problems exist. They would like the public to remain uninformed and ignorant about the serious problems confronting end of life care. They will not admit to the wrongdoing by white collar criminals in the hospice industry. State or national hospice groups will be the last to admit any wrongdoing in hospice agencies, because the hospice agencies pay the dues to the hospice association. Basically, the hospice associations would not exist without the agency members, so they will not "bite the hand that feeds them."

The hospice industry has very cleverly cultivated positive media coverage in TV, radio and the print media. Hospices raise money together with media of all types. They proclaim how compassionate end of life care is when a hospice is involved, which is what hospice is supposed to be. However, when anything goes wrong, they do not admit responsibility for the hospice agency's wrongdoing, but either scapegoat what they call a "misbehaving" nurse, physician or other staff member or they completely deny that what happened - actually happened!

Hospice Agencies Don't Want to Lose Donations

Hospice industry representatives are very concerned that they might lose donations to the local hospices if people knew the truth about abuses by hospices. They have worked very hard to make the public believe that all hospice agencies are one big "hospice" ... some amorphous end of life care setting that provides care to all throughout the US. They often say, "donate to hospice" rather than "donate to our individual hospice corporation, which just happens to be paying our administrators hundreds of thousands of dollars, in the case of larger hospice corporations." They do not tell the public that very large hospices often pay up to a hundred thousand dollars (or more) each year to big city attorneys to advise them how to skirt the regulations or get out of trouble when wrongdoing is discovered!

Hospice industry spokesmen do not tell the public that their hospice is a business, determined to make money in the case of some large and ambitious for-profits but publicly profess their dedication to "serve the public" while they enrich themselves and their stockholders. In the case of some very large nonprofit hospices, even they can pay their administrators hundreds of thousands of dollars while denying basic services to the patients and families.

Do all your donations to hospice go to end of life care? Or do they go to end of life administrators who enrich themselves at the expense of the patients and families? Why don't the big hospices release information about the salaries they pay to their top administrators? Why don't they tell you about the administrators who are driving around in Mercedes Benz convertibles or Porches, while their staff are generally underpaid and overworked? Why don't they tell you how they fire experienced hospice nurses so they can hire inexperienced hospice staff at lower salaries? And then let's see them explain why inexperienced nurses are sent out on cases that require expert palliative care! Why don't they tell the public about how they dump patients who live too long! Do hospices tell the public about the "behind the scenes" confrontations between hospice staff who protest violations of the standards of care, only to be told by mangement that the policies in place will be continued, even though they violate the regulations covering hospice.

Hospice Organizations Don't Want You to Know about
Competition for the Dying Among the Hospice Agencies

How many smaller hospice agencies have complained to us here at Hospice Patients Alliance, that the big hospice corporations are trying to drive them right out of business! How do they do it? By making exclusive referral arrangements between their large hospice and the local hospital and nursing homes. The US Office of Inspector General has confirmed that even illegal kickback arrangements are employed to secure such exclusive referrals. See OIG Kickback Alert and OIG Fraud Alert. Make no mistake about it: there is fraud in some hospices and fierce competition among separate hospices for dying patients who are seen as "revenue sources." Each hospice is a separate legal entity, ... separate business seeking revenue. It is not "one big happy family." How many hospice spokesmen will tell the public of the dismay some hospices experience when rogue hospices enter their area! See the Washington Post archives for the 6/14/98 article "Hospices Big Business, Thanks to Medicare; Exploitation of some patients is alleged" written by Charles R. Babcock, or a review of that article.

Hospices Don't Want You to Know that
Hospice Staff Who Protest Fraud or Wrongdoing
In Hospice are Harassed, Intimidated or even Fired

Many hospice staff write in to tell us how they were harassed or intimidated for speaking out about simply meeting the standards of care. When they question administrative hospice policies that enrich the hospice, but abandon the needs of the terminally ill, they find themselves under attack by management. This type of management tactic is confirmed by research done by the American Nurses Association, showing that nurses in almost all niches of health care find that they are unable to properly perform their duties in many settings, due to short staffing and other management decisions that interfere with the provision of optimal patient care.

See:

HMO/Managed care style management has entered into hospice administrations as well. We have personally witnessed and experienced harassment and intimidation by hospice administrators who did not wish to comply with the standards of care. The same type of management style that has blackened the reputation of health care agencies nationwide, has firmly entered into hospice management practice, directly harming not only patients, but also health care professionals, including doctors, nurses and other staff who wish to fulfill their licensed duties to the patients they serve. For more information on problems employees have when they "blow the whistle" on intentional wrongdoing in industries, see the National Whistleblower Center.

Submitting false claims to Medicare and Medicaid are much more common than the public believe. In hospice, false claims occur when they bill for services they never rendered or even offered to the terminally ill. Reimbursement is on a per-diem basis, but if the hospice refuses to send out staff when needed, they just keep collecting daily reimbursement without providing needed services. Whistleblowers in many industries are routinely harassed, intimidated or immediately terminated from their jobs for revealing the truth (long after staff try to convince management to stop stealing from the government and private sources of reimbursement). See The False Claims Act in Whistleblower Litigation from the law offices of Mark Kleiman, Esq.

Huge Medicare and Medicaid budgets offer white collar criminals/opportunists a dream environment where they are not only rarely caught, they are almost never sent to jail, and if forced to repay funds fraudulently taken from the government, they are not required to pay all of it back. For example, if they steal $48 million, the US OIG Compliance Integrity Agreements only require them to pay back $45 million, thereby rewarding them with a payment of $3 million to steal from the government. One nursing home chain got to keep $285 million, while only paying back $175 million out of $460 million of fraudulent billings to Medicare. (see: list of largest nursing home chains where some of these corporations are listed as having filed corporate integrity agreements that allow them to keep millions of dollars of false claims, according to the US OIG).

The variation between ethical hospices and
Rogue hospices is like night and day!

Those members of the public who have experienced an ethical hospice cannot imagine the horror of having a rogue hospice fail to provide care for their dying loved one. Those members of the public who only know what they experienced at the hands of a rogue hospice, can't imagine that ethical hospices even exist. A balanced view needs to exist, so that real reform can be started to repair the damage done by unethical hospices who exploit the good name of hospice built by the ethical hospice agencies and staff.

Hospice representatives know that the relationship between hospice and patient and family is based on trust, just as it is in any health care setting. What they don't want to admit is that some hospice agencies and some staff don't deserve the trust of the public. White collar crime, health care fraud is taking place in hospice just as it is in other health care arenas. Health care fraud investigators have told us, "fraud in hospice is rampant." It is one of the least regulated industries in health care. Nursing homes and hospitals are much more stringently regulated. Many hospices are never inspected unless there is a complaint from the public. One hospice in California did not get inspected for eight years!

When hospice administrators suggest that the public contact state regulators if there is a problem, they know that state inspectors are very few and unable to even begin to cover the territory assigned to inspect. A complaint from the public may be acted upon by the state six or more months later, long after the patient has died. And what is the result of such complaints? Hospice agencies just put in writing a "plan of correction" and the state moves on, assuming that corrections will be made, sometimes inspecting again to give the appearance that they assured that the standards of care were being followed. Nothing could be further than the truth. It is common for the same type of complaints to be received about hospices, long after they supposedly "corrected" the problem in the first place. State regulation of hospices is a dismal failure and the hospice agencies and lobbying groups know that they have no fear from state regulation.

When hospice administrators complain about "too many regulations" they are only covering up that if there were fewer regulations, they could get away with even more skimpy care. How many families call desperately stating that the hospice nurses don't come out when they needed them! How many have reported that they were told "the nurse will be out tomorrow or the day after."

We know, however, from our own experience and that of many hospice nurses and staff who have contacted us that some hospice administrators do intentionally violate standards, order staff to falsify medical records to cover up their wrongdoing, lie to families and staff about what the standards of care are and even, in some cases, euthanize patients who have become "too expensive" to care for, i.e., their need for services is beyond what the hospice wishes to expend compared with what the hospice is getting as reimbursement.

And is the government very concerned? Well, state Medicaid and federal Medicare budgets would be greatly relieved if patients are eliminated at the costliest time of their disease process: the last three months of life. While enrolling terminally ill patients in hospices saves the government budgets millions of dollars, euthanasia or physician-assisted suicide would save much more. There are many officially unreported cases of euthanasia going on in nursing homes and hospices.

In 1992, California's then Attorney General Daniel E. Lungren commented on a proposal to legalize euthanasia and stated, "This measure would result in some unknown savings due to decreased utilization of the state Medi-Cal program and other public programs, including county programs." That's about as cold an analysis that could be given, especially when we're talking about medically killing people who just happen to be patients as the way to save money (called "decreased utilization" of health care budget dollars).

Why don't industry representatives tell the public about the "clever" maneuvers rogue hospices use to avoid scrutiny by other medical professionals? For example, the regulations require that the medical director of the hospice act as a counter-balancing force to make sure the medical needs of the hospice patient are met. What do rogue hospices do? They mislead physicians in the community to think they must "sign off" on the case when their patient enters hospice. In this way, the hospice medical director has a free hand to do whatever and no snoopy attending physician will ever know the details of the care and services provided or not provided.

The hospice regulations [see 42 CFR ch iv, part 418] envision that the patient will have two physicians monitoring the quality of the care: the regular attending physician and the hospice physician. Each one acts as a "check and balance" to the other so the patient's best interests are met. These hospices manipulate the patient to give up their regular attending physician and use the medical director so there is no check and balance. Are the hospice industry spokesmen broadcasting this common "clever" rogue hospice technique to avoid detection of improprieties. Then if anything goes wrong, the hospice physician and hospice nurses make sure that the medical record only states the positive. How come pages suddenly come up "missing" when outraged families request the medical records for their loved one's case?

Why is that we regularly get complaints about hospices refusing to even take in patients who are on expensive TPN (total parenteral nutrition) even though the patient is certified to be terminal and the hospice is supposed to admit these dying patients? Why is that we get complaints about patients being euthanized in hospices after the patient has been in hospice "too long" and the hospice reimbursement limits have been reached? Why is that in virtually every case where the family complains that the hospice exploited them or did not provide proper care... the hospice administrators deny any wrongdoing at all, falsified medical records-accounts of what happened during the patient's stay with the hospice and told the outraged family members, "you're obviously having a difficult time in grieving ... we can offer you counseling." It is the height of gall for hospice administrators who know something went wrong to suggest to outraged families that the problem is with the families' grieving, rather than the wrongdoing of the hospice!

Not all hospices do wrong. Many hospice professionals are extremely dedicated and would never even contemplate wrongdoing. However, the standard of practice in any industry varies. There are hospices or staff that do not meet the standards of care. The US Office of Inspector General has confirmed that there are serious problems in the industry. Hospice staff confirm there are problems.

How Rogue Hospices Escape Detection

Those hospice professionals who are offended by reports of rogue hospices, fraud in hospice, or poor hospice services are not aware how the "rogue" hospice operates. Many hospice professionals are not even aware of fraud in their own hospice. Why? Only those involved directly to see what is happening in a specific case would know: RN case managers who know that services are not being provided as required, social workers who do not visit the patients and families as often as charted, and others who write up "visit forms" for visits that never occurred. We receive reports from inside hospices where social workers only telephoned hospice patients for one minute and then charted that they visited for an hour or two!

Rogue hospices do not perform poorly all the time, in all areas of practice. That would simply be stupid and would result in that hospice being fairly quickly detected. Rogue administrators are quite clever, however unethical they may be. They pretend to be just like the ethical hospices around them, claiming to adhere to the highest of standards, and they vary the violations of standards of care that they allow, so that it is more difficult to be detected; then they claim that it was a staff error which is being corrected (if they are found out). Giving good hospice care to some, while exploiting others, confuses the public and allows even state inspectors to naively believe in the integrity of the hospice's program. Some hospices with the best reputation in the public's eye, may have the worst reputation among other hospices in the area, and may have the worst quality of services actually delivered. Staff members from one hospice may care for the "damaged" patients or families who had to endure horrible treatment at a rogue hospice, before transferring to another hospice, simply seeking good palliative care for their loved one! We have received many reports from hospices about rogue hospices who severely violate the standards of care.

Hospices Don't Want You to Know the Truth
So that Patients and Money Keep Coming In

The overall plan for state and federal health care is very much entwined with the idea of hospice services for the terminally ill. The government saves too much money not to promote it. The government, the hospice organizations and all the separate hospice agencies want to expand the public's usage of hospice services. The government saves money compared to sending these patients to acute care hospitals, and the hospices make millions of dollars. These hospices are businesses and nobody can deny that: they have a bottom line and they have to make money to continue operations. Ethical hospices do not make lots of money, but can break even.

Rogue hospices are making lots of money, because they take money/reimbursement for services they don't render. They don't want the public to know, because trust in the hospice is necessary for families to allow their loved ones to be enrolled in a particular hospice. Patients and families need these end of life services, but what they really need is real hospice care, known as "palliative care," including the full range of services hospices are supposed to offer. Hospices know that if the public image is maintained as "pristine" and pure as Mary Poppins, then the patients will keep coming in, and so will the money, but if the public is informed, they will avoid the rogue hospices and select the ethical hospices.

More Evidence of Serious Wrongdoing In the Hospice Industry

Just remember that for every problem that does come to light, there may be hundreds of other cases just like it that do not get reported, or who are silenced by "settlement agreements" with binding gag orders, so the families cannot speak out about the abuse, neglect or worse by the hospice involved. Many problematic deaths in hospice are deliberately not prosecuted by many district attorneys around the nation, who do not wish to rub the powerful political connections the wrong way. District Attorneys are political creatures, in many cases, and if they burn the wrong powerful person, their own political aspirations may go up in smoke. So they often choose not to prosecute hospice cases involving prominent local physicians, nurses or hospice agencies.

"Oakland medical examiner concludes death by poisoning"
[by hospice nurse]

By Jennifer Chambers / The Detroit News, "Waterford Township -- After finding God, Anne Nicolai, RN wanted to make peace with herself and the world. So, the hospice nurse wrote an e-mail to her boyfriend in which she detailed how she killed three elderly patients under her care, each with a fatal dose of morphine.....

Oregon Physician Reveals Dangers of Legalized Euthanasia and Physician Assisted Suicide: warns of threat to hospice mission
2/19/2001:   -   Dr. N. Gregory Hamilton, President of the Physicians for Compassionate Care, warns that patients in Oregon are beginning to fear entering hospice, not knowing whether they will be cared for or killed. Dr. Hamilton warns that allowing physician assisted suicide into hospice may destroy hospice itself.

" Hungarian Police Arrest Hospice Nurse in Euthanasia Case"
Saturday, February 17, 2001; BUDAPEST (Reuters) - A Hungarian hospice nurse suspected of performing euthanasia on more than 30 terminally ill patients was formally arrested in the first such case known in Hungary.

PBS Report on Investigation of Medicare Fraud in Hospices
"Correct Care?" Transcript of a report from The News Hour with Jim Lehrer (June 19, 1997) examining an investigation by the federal government, named Operation Restore Trust, into instances of Medicare fraud that have occurred in some hospices nationwide.

Review of a 1998  Washington Post  report on the effect on some Hospices when being operated by for-profit corporations which are taking over health care. Some hospices are being adversely affected by the "for-profit" mentality of some for profit corporations. Although some for-profit hospices are continuing to provide excellent care, others have failed to provide proper care.

Click here to see the U.S. Office of Inspector General's
DRAFT COMPLIANCE PROGRAM GUIDANCE FOR HOSPICE INDUSTRY FROM OFFICE OF INSPECTOR GENERAL (JULY 1999). Hospices are coming under increasing scrutiny from the Federal Government. This report details areas where unfortunately some hospices are not complying with the regulations assuring top quality hospice care.

O.I.G. Fraud Alert about Illegal Hospice Kickbacks
between Hospices and Nursing Homes

From the U.S. Federal Register 1998 April 24;63(79);20415-7)
This fraud alert from the U.S. Office of Inspector General identifies types of violations of the Medicare anti-kickback statutes seen where nursing homes and hospices might illegally "pay" each other to influence referrals to their respective agencies (rather than other agencies). Such referrals may not be in the patient's best interests.

Involuntary Euthanasia Case 1
Lucid, Poor, Elderly Veteran Euthanized Against His Will

Involuntary Euthanasia Case 2
HMO Commits Medicare Fraud, Kills Patient and Falsifies Death Certificate

Involuntary Euthanasia Case 3
Hospice Kills Family's Mother with Morphine Overdose

Involuntary Euthanasia Case 4
Hospice Kills Parkinson's Patient by Dehydration, Terminal Sedation
and Morphine Overdose

Daughter of Father Killed In Hospice
Complains to Do-Nothing District Attorneys


" Dial M(edicare) for Murder"
(Washington Times, 2/19/2001 by Paul Craig Roberts available for $1.95 from archives) "...Some people are obliged to die because they cost more to care for than they are worth to society. Insurance companies, HMOs and government budgeters force doctors to ration care according to the patient's worth and prospects. ... Pay incentives and red tape associated with treatment approvals force doctors to treat patients with regard to cost. This means expensive procedures and treatments are rationed and that the most efficacious treatments are often denied until it is too late. The destruction of the doctor-patient relationship and erosion of the Hippocratic oath are direct consequences of do-gooders who think they can help people by having government subsidize medical care. The unintended consequence is euthanasia." .... "Anyone who thinks his life is going to be respected as he grows old can wise up by reading The Culture of Death: The Assault on Medical Ethics in America by Wesley J. Smith."




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