By Jondi Gumz
MercuryNews.com
January 23, 2012

SANTA CRUZ - Dominican Hospital officials announced Monday that they remain wedded to the Catholic mission, despite an announcement by the hospital’s parent company, Catholic Healthcare West, to split from the Catholic Church and adopt a new name, Dignity Health.

“We will remain a Catholic hospital, sponsored by the Adrian Dominican Sisters, following the ethical and religious directives for Catholic health care services,” Dr. Nanette Mickiewicz, Dominican Hospital president, said in a brief statement Monday. “In the rapidly changing health care environment, this new name and structure position the entire organization for growth and success.”

Beverly Grova, who heads the Dominican Hospital Foundation, reiterated that message.

“Everyone can be assured that Dominican’s dedication to excellent care, quality and service has not changed, nor has our commitment to looking out for the less fortunate among us,” she said.

The change comes as the health care industry prepares for major federal reforms due to take effect in 2014.

In the past year, there have been 82 merger and acquisition deals involving U.S. hospitals, according to The Health Care Mergers and Acquisitions Monthly, a trade publication.

Just four months ago, Dominican Hospital celebrated with considerable fanfare its founding by the Adrian Sisters 70 years ago.

According to Kaiser Health News, Catholic Healthcare West leaders said the change has been in development since 2009, when the sisters raised it. They said they consulted with Archbishop George Niederauer of San Francisco and he determined the governance change was consistent with the church’s teachings and that it could proceed.

Jean Dunn of Santa Cruz was stunned by the news. Her husband was chief of staff at Dominican Hospital and she volunteered for chaplain services for 35 years and served six years on the hospital’s ethics committee.

“I am a Catholic,” she said. “It’s a monumental disappointment to see Dominican Hospital part of a secular organization.”

Dr. Jerome Deck, who served as president of Dominican’s medical staff 30 years ago, voiced regret.

“I’m sorry to see the Catholic system is going to knuckle under to business,” he said.

Deck, who retired from medicine in 2000, considers the change part of the “leaner and meaner” trend in the business world, in which large banks buy up smaller community banks and doctors who practice independently are pressured to join larger groups.

“I’m not so sure becoming leaner and meaner is better for the American economy or consumers in general,” he said.

Local resident Dale Owen offered a different perspective.

“I think separation of church and administration of health care is a good idea,” Owen said. “Religious dogma should not stand in the way of medical decisions made between a patient and his or her doctor, especially if the patient is not a member of the church in question.”

As yet, there are no obvious signs of a secular affiliation.

Dominican Hospital spokesman Mike Lee said none of the Catholic Healthcare West signs have been changed but that process is in the works.

Dignity Health is the fifth largest health system in the nation, operating 25 Catholic hospitals and 15 non-Catholic hospitals. It was founded in 1986 when nuns in Burlingame and Auburn merged their health care ministries.

Lloyd Dean, Dignity’s president and chief executive officer, said the name change reflects a commitment to being a national leader in health care, supporting the company’s “long-term plan to grow and coordinate care.”

Dignity is investing $1.8 million in electronic medical records for the next five years as a way of using data to drive innovation and improve care while cutting costs.

In mid-December, the privately-run company was designated by Medicare as one of 26 “hospital engagement centers,” accepting a mission to change practices to reduce injuries and complications 40 percent and hospital readmissions 20 percent over three years. That initiative is funded by the federal health care reform legislation.

Catholic Healthcare West had three layers of management. Nuns from six religious orders served as corporate board members who appointed the 18-member board of directors; together they selected the executive management.

Dignity has a single board that retains nine members from Catholic Healthcare West. They include Sister Julie Hyer, a member of the Adrian Sisters who preceded Mickiewicz as Dominican Hospital president. She did not return a call seeking comment Monday.

The Diocese of Monterey had little comment on Catholic Healthcare West’s decision.

“Dignity is an independent organization that operates within the boundaries of the Diocese, but is not a part of the Diocese,” said Dean Warren Hoy, spokesman for the bishop. “Therefore, we can’t appropriately comment on their actions.”

Dignity operates three hospitals in the Diocese, Dominican in Santa Cruz, Arroyo Grande in Arroyo Grande, and French Hospital in San Luis Obispo, he said, adding, “We do not anticipate any significant changes in these three hospitals’ operations as a result of the change to Dignity Health.”

Deck pointed out Dominican’s Catholic affiliation prevents doctors there from doing a tubal ligation, a procedure to prevent future pregnancies, at the time of a Caesarean section, or an abortion.

Those who want a tubal ligation must go to Sutter Maternity & Surgery Center or Watsonville Community Hospital, he said noting abortions usually are performed at a freestanding outpatient center rather than at a hospital.

“I don’t think Dominican Hospital will start doing abortions right away,” Deck said, but he expects there will be pressure to perform that service, perhaps by setting up a separate unit.

The crucifixes were missing from the patient rooms last year when he visited a friend at the hospital, he said, but they were back in place when his wife was a patient this month.

“We asked the head nurse about it,” he said. “Enough Catholics objected to them being removed.”

By Kristian Foden-Vencil
OPB News
January 23, 2012

A study of Oregon’s POLST system shows that when it comes to death, patients want a lot of choices.

POLST stands for ‘Physician Orders for Life Sustaining Treatment.” It’s a form that helps sick and elderly people decide what therapeutic options they want as they die.

Helen Hobbs is 93 and lives in a nursing home in Lake Oswego.

Age has bent Hobbs low and she uses a walker. She’s well aware of what’s around the corner and she’s happy to talk about it.

“You know, death is part of your life. You know you’re going to get there someday so let’s make it as pleasant as possible. There’s no point in prolonging what’s…I mean would you like to stay in an unconscious condition for years while people kept you alive with feeding and hydration tubes? No,” says Hobbs.

Hobbs filled-in her own POLST form a couple of years ago — after a serious surgery. It’s signed by a medical professional, so it’s legally enforceable. And, says Hobbs, running over her choices, it’s pretty detailed.

“Yeah, I did want antibiotics in case of infection. I don’t want CPR if I’m in cardiac arrest. I don’t want to be tied down with tubes. You know there’s no point in prolonging it. I mean death can be natural and it’s not that bad,” says Hobbs.

Hobbs likes the fact that she has a lot of choices for medical care when the end comes. But it hasn’t always been that way.

Terri Schmidt is an emergency room doctor at Oregon Health and Science University. She remembers one elderly man with congestive heart failure.

“I intebated the man, I did very aggressive things. It didn’t feel right at the time. There was just this sense in my mind that this is a 92 year-old very elderly person with bad heart failure. And about 15 minutes later, when I was able to get a hold of the family.  They said, ‘You did what?  We talked about this. He didn’t want it. We had a big conversation in his room about a week ago.’”

But the man did not have a POLST form and by law, if no medical preference has been made, doctors have to provide all the medical care possible,” says Schmidt.

And that, as you can imagine, is very expensive.

By Rhonda Swan
The Palm Beach Post
January 22, 2012

In 2006, when the Legislature and then-Gov. Jeb Bush allowed for-profit hospices to operate in Florida, this paper predicted that the move would undermine the successful hospice model. Six years later, it has done exactly that.

Chief Financial Officer Jeff Atwater sponsored the bill as a state senator, claiming that competition would put nonprofits “on notice that the best in the business” are coming to Florida. What Florida and taxpayers got was the most expensive in the business.

The number of for-profit hospices in the state has doubled. A study by Florida Trend found that while most nonprofit hospices lose money and use fund-raisers to make up the difference, for-profit hospices earn a 12 percent to 16 percent return. Medicare picks up a huge portion of the costs that generate those profits.

“I supported this bill to ensure that Florida wouldn’t have one monopoly player,” Mr. Atwater said in an email, “and that Floridians had options available for the highest quality of end of life care.” That monopoly, however, still exists in Palm Beach County, where VITAS Healthcare is the only licensed for-profit. It also was the only licensed for-profit hospice in the state in 2006, operating under an exemption.

As The Post’s Charles Elmore reported, area Medicare patients at VITAS Healthcare stay 40 percent longer on average than patients at nonprofit hospices. The longer patients stay, the more money a hospice makes. Studies show that for-profit hospices shop for the most profitable patients - those who live the longest. That means patients with dementia, who are less expensive to treat and live longer, as opposed to those with cancer who are more expensive to treat and die sooner.

Ron Fried, VITAS’ senior vice president for public affairs, said in an interview that the company does not select only those patients from whom it can make more money. “Our length of stay varies from community to community and depends on several factors such as disease, ethnicity, site of care and acuity,” he said. “To make comparisons of length of stay without a detailed analysis of these variables is inaccurate and misleading.” VITAS’ overall length of stay is 80 days, near the overall average of hospices nationwide. Its median length of stay is 14 days, well below the overall average.

That doesn’t change the fact that VITAS and other for-profit hospices admit more patients who require less skilled care and longer stays than nonprofits. Mr. Fried said VITAS does outreach in underserved communities, some of which happen to include a larger population of non-cancer patients than others.

One person’s outreach is another person’s cherry-picking.

Hospice used to be the province of nonprofits. For-profits now account for 52 percent. VITAS’ parent company is a $1.3 billion corporation whose top executive earned nearly $6 million last year. Congress created the Medicare hospice benefit in 1982 to provide more humane and less expensive care to people with terminal illnesses, not to start a for-profit industry that creates millionaires. Congress should turn back the clock.

By Keith Huffman
JournalGazette.net
January 22, 2012

By Joseph Nowinski, Ph. D.
Huffington Post
January 18, 2012

Today, thanks to several decades of remarkable medical advances, stories like the above have become the rule rather than the exception they once were. The realities of death and dying have changed profoundly in a relatively short period of time. Life expectancy in countries like ours continues to grow as modern medicine, in its war on deaths, is getting better and better at converting diagnoses such as cancer, that once were associated with a relatively quick death, into something akin to chronic illnesses. And because of this the nature of grief has changed.

For better or worse, this change represents a situation that virtually every one of us will find ourselves in sooner or later. The crisis begins when we learn that a loved one has been diagnosed with an illness that is terminal or life-threatening. But this only marks the beginning of a journey — one that may last months or years, and which has the potential to affect just about every aspect of our lives and our relationships.

Here are a few statistics that illustrate just how much things have changed:

• Roughly two-thirds of those who are diagnosed with cancer currently have a five-year survival rate.
• Today, a diagnosis of cancer (or coronary artery disease) no longer means that death is imminent.
• The same is true for hypertension: the number of deaths attributable to hypertension has decreased significantly, and continues to do so.

One profound result of all of this is that death has become less and less a sudden and unexpected event and more and more a prolonged process that begins with a diagnosis, proceeds through a period of treatment (or treatments), and may end eventually in death. This process means that both the terminally-ill individual and the family are increasingly confronted with the need to “live with death” for a prolonged period of time.

Challenges in the 21st Century
The changing nature of terminal illness has created some unique challenges for both patients and their loved ones. These typically did not arise when death came quickly, and when “terminal” meant “imminent.” Patients and their loved ones alike are often not prepared for these. In our book, Saying Goodbye: A Guide to Coping with a Loved One’s Terminal Illness, we offer them some specific suggestions, as follows:

Meet the Payers
Most individuals do not read the fine print in their health insurance plans and are unaware of the definitive list of covered services. Rather, what most people focus on when deciding what insurance plan to sign up with are the overall cost of the plan and the out-of-pocket cost of co-pays for office visits and prescription medications. Many people falsely believe that all health insurance plans cover the same range of services.

Health insurers do publish the list of services and procedures each of their plans cover, as well as how much they will pay (vs. how much the patient is expected to pay) for each. They also provide the list of health care providers who participate in their various plans, plus the ground rules for utilizing specialists, for contesting denied benefits and so on. This information is available in most cases through the Internet, by visiting the health insurer’s web site.

It is very important and helpful if one (and preferably more than one) family members take responsibility for gathering information such as the following:

• Understand limits of medical coverage.
• Understand the process for specialist consultation.
• Understand the appeals process.

This team of family members need to become expert in this material. As time goes on this information will play an increasingly significant role in the decision-making process.

Facilitate and Coordinate Communication
Today, when a person is diagnosed with a terminal illness there will not be just one but many medical personnel involved in the treatment. How many and what kind of medical specialists will be involved depends in part on the complexity of the diagnosis and how the disease progresses. Typically, several specialists will be involved.

We recommend that the family consciously think in terms of a chain-of-command for decision-making purposes. Ultimately it is the patient — in this case, the terminally-ill family member — who sits at the head of this chain. He or she, however, will also have one of more confidantes (a spouse, an adult child, a parent, etc.) whose opinions will weigh heavily in any decisions that are made. All families develop their own chains of command. This organization can be altered, for example if it is the head of the family who is the one who receives a terminal diagnosis. There is no reason why all those family members who are truly invested can’t be included somewhere in this organizational scheme, for example by being asked to become expert in the patient’s health insurance plan, researching alternative treatments or identifying specialists who can be consulted.

Another important consideration is managing the interactions of the various specialists: oncologist, surgeon, radiologist and other health care providers. Which of these individuals is in charge — the person who the patient trusts the most and who will have the final word when it comes to determining medical treatment? On what, if any, issues do the doctors disagree when it comes to the best course of action? If more than one specialist is consulted and interviewed for a specific procedure, who will go with the patient to these meetings and what questions will be asked? Write these questions down and bring them with you. Most importantly, do NOT assume that specialists will communicate with one another. Therefore, the family needs to be prepared to facilitate this communication.

A Long and Winding Road
The challenges that families must face when confronted with a terminal diagnosis of a loved one are complex. They include evolving new structures and dynamics as the person they love slowly slips away. It means learning how to cope with setbacks and deterioration, as well as periods of seeming remission. It means dealing with the complexities of extended grief, which can wear individuals down and lead at times to ambivalence about the wisdom of extending life. It means talking with a dying loved one about mortality and other issues that do not arise when death strikes suddenly and unexpectedly. It means learning to make space for extended grief in lifestyles that are busier than those of earlier generations.

If there is a lesson to be learned from these changes in the nature of dying and grief, it is that patients and their families alike typically feel more (not less) empowered, and less (not more) stressed if they can escape the profound and lingering sense of loss of control that comes with a terminal diagnosis. Rather than feeling depressed after reading about what to expect, and what steps to take, our readers have said they feel more at ease, and more prepared for whatever might lie ahead.

By Robin Marty
www.Care2.com
January 18, 2012

With a crisis in our health care system, more hospitals are shuttering or merging in an attempt to remain viable, especially those who take on the poor and uninsured.  Unfortunately, many of the strongest and most enduring hospitals are Catholic-based and often do not offer the full range of health care options available at other medical institutions.

As more struggling hospitals begin to merge into this Catholic care system, they are being forced to adhere to the Catholic health care standards — no abortions, no emergency contraception, no sterilization and no removal from life support, even if the family requests otherwise.

Such is the case in Tennessee, where a recent merger between Jewish Hospital & St. Mary’s HealthCare, now both being run under Catholic Health Initiatives.  The hospitals are about to undergo their first examination by the Archbishop of Louisville to ensure “our health care institutions are faithful to the call of the Church to make health care accessible to as many as possible, especially the poor and vulnerable.”

For St. Mary’s HealthCare, there should be no issue.  But for Jewish Hospital, they have been asked to stop doing procedures that the church finds “intrinsically immoral,” such as “elective abortions, sterilizations and fertility treatments, and from dispensing contraceptives solely to prevent pregnancy.”

Right now, the Jewish Hospital seems unconcerned with the directives, as they do very few of any of the procedures the Catholic church is upset by.  However, the archbishop is also allowed “the right to ‘develop his own ethical and religious directives if he chooses,’” meaning new directives could be added at any moment.

For women, this can be especially dangerous, as more news comes out regarding hospitals that refuse to allow abortions for health reasons, telling the patients they must find a different provider even if they are already too sick to travel.  Or, as more hospitals merge into Catholic systems, access to emergency contraceptives after a rape could all but disappear.

Even disallowing a family the right to decide if a member should no longer be kept on life support could become a growing problem, as loved ones, who come to hospitals sick and have no ability to recover would also have no ability to be moved to a facility that does allow end of life decisions.  The inability to take a family off life support wouldn’t just violate the patient and family’s rights, but could potentially bankrupt them with sustained medical costs.

By Robb Miller
Executive Director
Compassion & Choices of Washington

An amazing thing happened in Olympia, Washington last month. In a legislative hearing room, representatives of Compassion & Choices of Washington and the Washington State Catholic Conference sat down before a budget committee. Together they successfully advocated the restoration of funding to produce the Death With Dignity Act’s (DWDA) annual report.

On what issue do the Catholic Conference and Compassion & Choices of Washington agree? We both want the accountability that reports by the Department of Health provide. On an annual basis, these reports show the DWDA is working as voters intended, and vulnerable people are protected from abuse.

Watch (testimony by the Catholic Conference starts at 43:41, by Compassion & Choices of Washington immediately after).

We learned that the DWDA reporting funds were targeted for elimination at 11am on Monday, December 12th. Kate White Tudor testified on behalf of Compassion & Choices of Washington in favor of restored funding that afternoon. Thanks to an amendment offered by Representative Reuven Carlyle (with support of Eileen Cody and the Ways & Means chair Ross Hunter), the House Ways & Means Committee amended the budget bill to restore funds for DWDA reporting, The amendment was retained as part of the bill when it passed the House floor Tuesday evening and a similar amendment process restored funding on the Senate side.

We consider ourselves the steward of the DWDA and continually advocate its impeccable implementation. State reports repeatedly confirm the safety of physician aid in dying. The accumulated knowledge from Oregon and Washington is an invaluable resource to other states and nations seeking to expand end-of-life choice for their citizens.

Aid in dying must become an open, accepted end-of-life care option, integrated into standard medical practice. When we shine a light on its practice we help reach that end. The state’s annual report is an important tool to ensure the practice has no unintended consequences – and on that, we and the Catholic Conference can agree.

By Shannon Brownlee
Time.com
January 16, 2012

Last month, an essay posted by retired physician Ken Murray called “How Doctors Die” got a huge amount of attention, some negative but mostly positive. Murray tells the story of an orthopedic surgeon who, after being diagnosed with pancreatic cancer, chose not to undergo treatment. The surgeon died some months later at home, never having set foot inside a hospital again.

Critics said that the essay was a biased opinion of how one should die, not an actual analysis of how doctors actually do die. And indeed, much of Murray’s essay was anecdotal. Murray writes that his physician friends wear medallions with DNR, or Do Not Resuscitate, orders. They instruct their colleagues to not take any heroic measures and to keep them out of the ICU at the end of life. He’s even seen a colleague with a DNR tattoo, something I’ve been threatening to get for a long time.

(MORE: The Real Issues of End-of-Life Care)

And yet, there is good evidence that physicians have thought out end-of-life issues more thoroughly than laypeople and are more likely to decline medical intervention. For example, they sign advance directives far more often than the rest of us do. Less than half of severely or terminally ill patients have an advance directive in their medical records. These are legal documents that indicate the kind of medical care we prefer at the end of life and where we would like to spend our last few days or weeks. Contrast that to a study published a few years back that found 64% of doctors surveyed had signed such documents. Those who had were nearly three and a half times more likely to refuse rescue care, like CPR, compared with doctors who had not signed an advance directive.

Why would doctors be so anxious to avoid the very procedures they deliver to their patients every day? For one thing, they know firsthand that these procedures are most often futile when performed on a frail, elderly, chronically ill person. Only about 8% of people who go into cardiac arrest outside of the hospital are revived by CPR. Even when your heart stops in the hospital, you have only a 19% chance of surviving. That’s a far cry from the way these procedures are portrayed on TV, where practically everybody survives having his heart shocked and undergoing CPR.

Doctors also know that undergoing heroic measures is a lousy way to die. They’ve seen what it’s like for an elderly patient to end up in the ICU, hooked up to machines, often semiparalyzed, in pain, lying on what philosopher Sidney Hook called “mattress graves” during his own terminal illness. At a recent meeting I attended, one emergency physician tearfully admitted she didn’t think she could stand to hear the sound of ribs breaking as she perform CPR on yet another elderly patient who almost certainly would not survive.

I know I want to avoid such a death. Not everybody feels the same, however, and whichever you prefer — “do everything” heroic measures or avoiding the hospital in the last few weeks or months of life — one of the first steps you should take to increase the chances you get what you want is ask your doctor about an advance directive or get one from the Web. Some of the most informative forms can be found at Physician Orders for Life Sustaining Treatment Paradigm.

The next step is to look at the Dartmouth Atlas, which has compiled a recent report on how different hospitals tend to treat patients in the last months of life. If I have a choice, I’ll choose to go to a hospital that’s less aggressive.

Finally, one day I hope patients will have access to the work of a brilliant and caring physician named Angelo Volandes. Volandes is developing a series of videos to help patients and families understand exactly what’s involved in many of the procedures that are done on dying patients, including CPR, being put on a ventilator and having a feeding tube inserted. He wants to give patients a chance to understand what their doctors already know.

Trust Doctors, not Government to Guide Aid in Dying

HONOLULU - Compassion & Choices Hawaii, the local affiliate of the nation’s oldest and largest nonprofit organization working to improve care and expand choice at the end of life, and the Hawai’i Death with Dignity Society today responded to an opinion on “assistance with dying” by Hawaii’s attorney general. The organization joined attorneys and physicians in expressing confidence that when the time comes, patients can request, and doctors will provide, aid in dying. Terminally ill, mentally competent Hawaii patients can request a prescription that gives them the peace of mind of knowing they could achieve a peaceful death in their homes, with their families and loved ones.

“Almost everyone in Hawaii agrees that terminally ill individuals, not government, should make end-of-life decisions and control end-of-life options,” said Robert “Nate” Nathanson, M.D., a founder of Hospice Hawaii. “The people of Hawaii overwhelmingly trust doctors to establish guidelines and respond appropriately to requests for medication to bring about a peaceful death if suffering becomes unbearable.” The results of a recent poll bear out Dr. Nathanson’s assertion. In the poll, 90% agreed the decision about aid in dying is a personal one between patient and doctor. Eighty-one percent (81%) said they trust their doctors to respond appropriately to a request for medication to bring about a peaceful death if suffering became unbearable. A complete summary of poll results can be found at CompassionAndChoicesHI.org.

The reasoning of the attorney general’s opinion is flawed. Focusing narrowly on a single 1909 statute, the opinion failed to appreciate how a constellation of Hawaii laws vests its citizens with broad autonomy over end-of-life decision-making. It does not mention findings in other states, including the persuasive authority of Baxter v. Montana or the recognition by Georgia’s attorney general that his state’s law against “assisting a suicide” does not cover aid in dying.

“The palliative benefits of aid in dying are very significant,”said Dr. Nathanson. “It offers relief for terminal pain and anxiety. And it lets some patients live longer and with peace of mind during their last days. This is comfort care at its best. When doctors cannot cure, at best they can provide relief.”

Chaired Professor at NYU Law School, frequent visiting Professor at Richardson and resident of Kailua Sylvia Law said, “Legal opinion differ and change over time. Hawaii has many laws which offer patients autonomy in end-of-life care and pain management. The state does not outlaw aid in dying with the sort of specificity required of a criminal prohibition. So it is reasonable to conclude Hawaii physicians can respond to these requests subject to best practices, without fear of prosecution.”

By Mark H
Scienceblogs.com
January 13, 2012