Sentenced to death on the NHS

[south]

Kinda scary

http://www.telegraph.co.uk/health/he...n-the-NHS.html

[draggar]

If you only knew what US insurance companies did.....

[Doc Com]

This is nothing new and commonly practiced in the US - per patient and family request!

It is commonly termed "Comfort Care" or "Comfort Care Measures". That is why it is so important to have advanced directives and a will. Having family members aware of your exact wishes is also important.

How many of you have made your family member aware of your wishes should an event or accident leave you in a vegatative state? Do you want to remain on a ventilator forever?

Dying is not a pretty thing and most people can not accept seeing their love ones expire. That is why the common instructions given by family members to health care workers is, "Make them comfortable".

Folks, we can make the patient comfortable and pass with dignity. But what can we do to make the family comfortable? That is what I always ask people - what can I do to make you comfortable and accepting of your decision.

These Death Squads and Death Panels are a myth but dying is a reality and a part of life.

I am bound by law to not reveal details. I once took care of a man who was mid 90's and one of the scientist behind nuclear fusion and Los Alamos. He was a really cool person to talk to. He expressed to everyone around him (including his family) that he wanted no "heroic measures" to keep him alive - that would be resuscitation, CPR, and shocking. When the point came that he was near death and unresponsive, the daughter insisted that everything be done DESPITE what the patient wanted.

Her ****ing rationale for doing this was she always wanted him to live to be 100. It is not what THE patient wanted but what SHE wanted. She had become his Power of Attorney. I would not make this up if those words had not come directly out of her and her husbands mouth.

Here is what happened - we did CPR, we cracked several ribs and his sternum when performing chest compressions. This happens all the time to elderly people thanks to lose of bone mass and osteoporosis. We shocked him several times to get a rhythm back. We intubated him (put a breathing tube down his airway) and put him on a vent. We gave him drugs to keep the heartrate in a semi-normal pattern and rate.

The patient for all practical purposes had died and was gone. But we kept him alive by artificial means. To make a long story short, the family continued to insist every thing be done that he was gone and would have no quality of life and was in a vegatative state. We ended up traching him (slicing his neck and inserting an artificial airway) and surgically placing a feeding tube to the belly. He swelled up and ballooned up to the point he did not even look like the same person. His glasses would not even fit on his face. We kept him for weeks until he was accepted to a long-term vent facility.

Yes, I wanted to smack this *****. She did not let her father pass in a dignified maner and violated his wishes.

Medicine and science can do wonders. But one thing it can not do is reverse aging. Death is a natural process and should be a peaceful moment.

This is just one of countless examples I can think of.

There are no Death Squads. There is a time for passing. Using artificial means to delay the inevitable is horrible and inhumane. We do not do this to our animals. When all signs of life and brain activity are gone, the person is gone.

What I see more than anything are "Life Squads" which are family members wanting everything done no matter what to their naturally deceased family member. This is what drives the cost of healthcare sky high - unneeded and unwarrented procedures and tests. We are obligated to do what they demand. That is where their lack of acceptance comes in.

Calling it a Death Squad when a physician talks to the family about the final moments and makes recommendations to provide comfort care - calling it a death squad is far from the truth. Why more people in healthcare, pallative care, and hospice are not expressing outrage over this is beyond me.

I call it INHUMANE and SELFISH care when the family insists everything be done when their loved ones have asked for just the opposite. I prefer peacefulness and dignity.

[JMJ]

A doctors letter to his patients.

"Friends:

I have been sitting quietly on the sidelines watching all of this national
debate on healthcare. It is time for me to bring some clarity to the table
as your friend by explaining many of the problems from the aspect of a
doctor.

First off, the government has involved very few of us physicians in the
healthcare debate.. While the American Medical Association has come out in
favor of the plan, it is vital to remember that the AMA only represents 17%
of the American physician workforce.

I have taken care of Medicaid patients for 35 years while representing the
only pediatric ophthalmology group left in Atlanta , Georgia that accepts
Medicaid. Why is this?

For example, in the past 6 months I have cared for three young children on
Medicaid who had corneal ulcers. This is a potentially blinding situation
because if the cornea perforates from the infection, almost surely blindness
will occur. In all three cases the antibiotic needed for the eradication of
the infection was not on the approved Medicaid list. Each time I was told to
fax Medicaid for the approval forms which I did. Within 48 hours, the form
came back to me which was mailed in immediately via fax and I was told that
I would have my answer in 10 days. Of course by then each child would have
been blind in the eye. Each time the request came back denied. All three
times I personally provided the antibiotic for each patient which was not on
the Medicaid approved list. Get the point? Rationing of care.

Over the past 35 years, I have cared for over 1000 children born with
congenital cataracts. In older children, the vision is rehabilitated with an
intra ocular lens. In newborns we use contact lenses which are very
expensive. It takes Medicaid over one year to approve a contact lens post
cataract surgery. By that time a successful anatomical operation is wasted
as the child will be close to blind from a lack of focusing for so long a
period of time. Again, extreme rationing. Solution--I have a foundation here
in Atlanta , supported 100% by private funds, which supplies all of these
contact lenses for my Medicaid and illegal immigrants children for free.
Again, waiting for the government would be disastrous.

Last week I had a lady bring her child to me. They are Americans but live
in Sweden as the father has a job with a big corporation. The child had the
onset of double vision 3 months ago and has been unable to function
normally because of this. They are people of means but are waiting 8
months to see the ophthalmologist in Sweden . Then if the child needed
surgery, they would be put on a 6 month waiting list. She called me and I

saw her that day. It turned out that the child had accommodative esotropia
(crossing of the eyes treated with glasses that correct for
farsightedness) and responded to glasses within 4 days - no surgery was
needed. Again, rationing of care.

Last month, I operated on a 70 year old lady with double vision present
for 3 years. She responded quite nicely to her surgery and now is symptom
free. I also operated on a 69 year old judge with vertical double vision.
His surgery went very well and now he is happy as a lark. I have been
told--but of course there is no healthcare bill that has been passed yet--
that these 2 people, because of their age, would have been denied surgery
and just told to wear a patch over one eye to alleviate the symptoms of
double vision. Obviously cheaper than surgery.

I spent two year in the US Navy during the Vietnam war and was well
treated by the military. There was tremendous rationing of care and we were
told specifically what things the military personnel and their dependents
could have and which things they could not have. While in Vietnam , my wife
Nancy got sick and got essentially no care at the Naval Hospital in
Oakland , California . She went home and went to her family's private
internist in Beverly Hills . While it was expensive, she received an
immediate work up. Again, rationing of care.

For those of you who are over 65, this bill in its present form might be
lethal for you. People in England over 59 cannot receive stents for their
coronary arteries. The government wants to mimic the British plan. For
those of you younger, it will still mean restriction of the care that you
and your children receive.

While 99% of physicians went into medicine because of the love of
medicine, and the challenge of helping our fellow man, economics are still
important. My rent goes up 2% each year and the salaries of my employees
goes up 2% each year. Twenty years ago, ophthalmologists were paid $1800
for a cataract surgery and today $500. This is a 73% decrease in our
fees. I do not know of many jobs in America that have seen this lowering
of fees.

But there is more to the story that just the lower fees. When I came to
Atlanta , there was a well known ophthalmologist that charged $2500 for a
cataract surgery, as he felt the was the best. He had a terrific reputation
and in fact, I had my mother's bilateral cataracts operated on by him with
a wonderful result. She is now 94 and has 20/20 vision in both eyes.
People would pay him $2500 fee. However then the government came in and
said that any doctor that does Medicare work cannot accept more than the
going rate (now $500) or he or she would be severely fined. This put
an end to his charging $2500. The government said it was illegal to
accept more than the government allowed rate. What I am driving at is
that those of you well off will not be able to go to the head of the line
under this new healthcare plan just because you have money as no physician
will be willing to go against the law to treat you.

I am a pediatric ophthalmologist and trained for 10 years post college
to become a pediatric ophthalmologist (add two years of my service in the
Navy and that comes to 12 years).A neurosurgeon spends 14 years post
college and if he or she has to do the military that would be 16 years. I
am not entitled to make what a neurosurgeon makes, but the new plan calls
for all physicians to make the same amount of payment. I assure you that
medical students will not go into neurosurgery and we will have a tremendous
shortage of neurosurgeons. Already the top neurosurgeon at my hospital who
is in good health, and only 52 years old, has just quit because he can't
stand working with the government anymore.. Forty-nine percent of children
under the age of 16 in the state of Georgia are on Medicaid so he felt he
just could not stand working with the bureaucracy anymore.

We are being lied to about the uninsured. They are getting care. I operate
on at least 2 illegal immigrants each month who pay me nothing and the
children's hospital at which I operate charges them nothing also. This is
true not only on Atlanta , but of every community in America .

The bottom line is that I urge all of you to contact your congresswomen and
congressmen and senators to defeat this bill. I promise you that you will
not like rationing of your own health.

Furthermore, how can you trust a physician that works under these
conditions knowing that he is controlled by the state? I certainly could not
trust any doctor that would work under these draconian conditions.

One last thing, with this new healthcare plan there will be a tremendous
shortage of physicians. It has been estimated that approximately 5% of
the current physician work force will quit under this S new system. Also
it is estimated that another 5% shortage will occur because of decreased
men and women wanting to go into medicine.

Zane Pollard , MD"

[draggar]

Originally Posted by Doc Com

There are no Death Squads. There is a time for passing. Using artificial means to delay the inevitable is horrible and inhumane. We do not do this to our animals. When all signs of life and brain activity are gone, the person is gone.

Emphasis on the animals is mine.

The reason why we don't do it to animals because most people don't have pet insurance (and most of it is a rip off anyway, but that's besides the point). Right now it doesn't cost most of us to keep someone "alive" using tubes and machines, it all gets billed to the insurance company. It allows hospitals and doctors to bill insurance companies huge amounts of money on some of the lowest cost patients in the hospital. This, of course, helps offset the rise in their insurance (malpractice etc..) as well as other costs - uninsured patients, bookkeeping, and plain old keeping their "investors" happy (yes people, hospitals are now for profit, like any other business). It also helps doctors keep up with their rising costs while also facing lower and lower payouts from insurance companies.

[Doc Com]

Originally Posted by draggar

Emphasis on the animals is mine.

The reason why we don't do it to animals because most people don't have pet insurance (and most of it is a rip off anyway, but that's besides the point). Right now it doesn't cost most of us to keep someone "alive" using tubes and machines, it all gets billed to the insurance company. It allows hospitals and doctors to bill insurance companies huge amounts of money on some of the lowest cost patients in the hospital. This, of course, helps offset the rise in their insurance (malpractice etc..) as well as other costs - uninsured patients, bookkeeping, and plain old keeping their "investors" happy (yes people, hospitals are now for profit, like any other business). It also helps doctors keep up with their rising costs while also facing lower and lower payouts from insurance companies.

Regardless of what gets billed and what is done, what people do not see is the is the astronomical millions of dollars that are NOT PAID by medicare, medicaid and private insurance as they deem these procedures and billable as un-necessary. Some is fraud. We know that. But a vast majority is the 3rd party payor refusing to pay. There is so much that people do not see or know what is going on behind the scene. If you are ever told NO to a request to have a procedure done, there is a great chance that it is the insurance carrier saying no!

That is why this whole healthcare debate and spats going on is between two massively uninformed groups who are following their party leaders while remaining ignorant to what exactly the issues are.

And not once in my career have I ever given a rat's ass to someone's ability to pay.

There is much waste, that is a given. IF there is any rationing going on it is the insurance companies doing the rationing.

As for the uninsured or underinsured, don't worry - we are all already paying for it and have for decades. Look at your pay stubs.

You have been taxed already for the care of illegal immigrants, crack heads, junkies, murderers, rapists etc. You already paid and paid and paid and did not even know it.

[south]

Originally Posted by Doc Com

This is nothing new and commonly practiced in the US - per patient and family request!

It is commonly termed "Comfort Care" or "Comfort Care Measures". That is why it is so important to have advanced directives and a will. Having family members aware of your exact wishes is also important.

Dude, I have no problem with a peaceful death, and no-one wants to be a burden on their kids when they get sick. I certainly don't want to be kept alive if I'm in a vegitative state with no chance for recovery.

The points of the article that most got my attention:

“As a result a national wave of discontent is building up, as family and friends witness the denial of fluids and food to patients."

Starving a person is definitely not "comfort care".

And this:

In 2007-08 16.5 per cent of deaths in Britain came about after continuous deep sedation, according to researchers at the Barts and the London School of Medicine and Dentistry, twice as many as in Belgium and the Netherlands.

That in particular was the especially scary part....

[Doc Com]

Originally Posted by south

That in particular was the especially scary part....

I call this a clever piece of journalism, whether it is true or not, and a timely release to fuel the flames of a debate here.

The UK system has been getting positive reviews.

I just described to you the problems we encounter and what I have seen on a daily basis. People need to be educated and told the truth about conditions.

As for your scary part, I would have to know under what conditions these numbers were extrapolated from. Comfort Care and End of Life Decisions usually include morphine to alleviate pain and suffering, again, at the request of or with the knowledge of the family.

This country is in the midst of a unity meltdown as everyone has to suddenly choose sides on every damn issue. I have never in my life seen such discourse. And today I am hearing outrage over the president addressing schoolkids? What kind of bullshit is this????????

There are people claiming that he is going to brainwash people? I am at my wits end trying to figure out where these people come from. Every child in america takes civic lessons, history lessons, and so on and studies the presidents. Suddenly, the president is going to address children and this is wrong? Rather than spend the money to send kids to DC for a personal sit down with the president the president is using technology to reach the kids - go to the kids?

Every president and every first lady I have ever known has initiated a classroom visit.

Where was Bush when the planes hit the towers?

Where is the No Child Left Behind protesters?

[Adatise]

All terminal illnesses are curable via natural cures unless you let the mainstream medicine cut, burn, and poison you first.

[randomo]

Originally Posted by Adatise

All terminal illnesses are curable via natural cures unless you let the mainstream medicine cut, burn, and poison you first.

Let me guess ... the cures that "They" Don't Want You to Know About?

Dude, you have just got to stop believing (and spreading) every bit of nonsense that comes over your transom.

[jberryhill]

Starving a person is definitely not "comfort care".

Many persons in a persistent vegetative state retain enough autonomic nerve system function to maintain respiration without a ventilator. When we are talking about nutrition of such persons, it's not as if anyone is feeding them hamburgers. They cannot chew, taste or swallow. Instead, a tube is inserted down the esophagus, and a liquid formula is pumped into the stomach. They can be maintained for years this way, provided that pressure ulcers (bedsores) are managed well. However, the usual course is that pressure ulcers are unavoidable, and if you are really good, you can stretch it out to as long as ten or twenty years before eventually you are going to get multiple sites of infected pustulating external ulcers and the patient is going to succumb to infection.

Where the patient's desire, preferably in the form of an advance directive, or by judicial determination based on competent evidence, is not to be maintained in a PVS for a prolonged period, the typical course is to use a morphine drip and saline irrigation in order to prevent pain and to maintain hydration connection with withdrawal of the nutritional support.

State laws vary on whether nutritional tubes count as "artificial" life support, hence if this issue is of concern to you, then you should be certain your desires are known in specific relation to nutritional support, in addition to other means that you may personally consider to be "artificial" or not. If you want to die of bedsores instead, you have the right to that choice, within the limits of your insurance coverage (good luck) or whomever it is that is going to be responsible to pay for it. In some states, such as under legislation signed into law by George W. Bush, it's going to be up to a hospital board to determine how long they are going to keep you on the pump.

Here is how it works in Texas:

Tuesday, March 22, 2005 Sun Hudson, a six-month old Texas baby died last week when health care providers at Texas Children's Hospital in Houston, Texas removed his life support system over the objections of his mother. The action was authorized under the 1999 Futile Care Law which was signed into law by then-Gov. George W. Bush.

Under the Texas Futile Care Law, health care workers are allowed to remove expensive life support for terminally ill patients if the patient or family is unable to pay the medical bills.

Hence, you should inquire about projected costs, and establish a fund of some sort with an adequate annuity to maintain your desired support. They are your bedsores, and you have a right to die from them instead.

Go ahead and Google "texas futile care law", and you will find a wealth of information about this particular bit of hypocrisy.

[zurc.net]

Originally Posted by jberryhill

Go ahead and Google "texas futile care law", and you will find a wealth of information about this particular bit of hypocrisy.

Interesting... so anti-abortion, but kill them when they are born and have a chance to live? wtf

[jberryhill]

Interesting... so anti-abortion, but kill them when they are born and have a chance to live? wtf

That's your Republican morality at work, yep.

[aZooZa]

There's no need to suffer decubitus ulceration. An alternating pressure mattress that runs on an aquarium pump and a fluidic gate can be bought for relatively little money. I know 'cos I used to design and manufacture them in the 70's. Today, that's inexcusable suffering.

[jberryhill]

An alternating pressure mattress that runs on an aquarium pump and a fluidic gate can be bought for relatively little money.

"Can be" and "is", being, of course two different things.

What's the record for persistent vegetation anyway?

[aZooZa]

"Can be" and "is", being, of course two different things.

Indeed so. That was probably my point.

[PRED]

Originally Posted by jberryhill

What's the record for persistent vegetation anyway?

you'd have to ask Focus

[Doc Com]

Originally Posted by jberryhill

What's the record for persistent vegetation anyway?

decubiti ulcers is a care giver problem, nothing more.

Most patients in this condition should be on a regular turn schedule.

This is also a huge issue of debate and many fall under that "pre-existing" conditions. Plus, new revisions of Medicare here in the states will stop paying for any hospital acquired ulcerations. Again, this demonstrates "care giver" issues and concerns.

It is very important to note that Medicare WILL still cover these issue but will NOT reimburse the hospital for that care. In other words, the hospital eats the bill. This is all part of the new Pay For Performance (P4P) structure.

Essentially, if you go to the hospital for something the diagnosis, assessment, and charting better be just as flawless as the care. Anything NOT DOCUMENTED upon arrival is subject to NOT get reimbursed to the hospital.

A couple of examples: if someone has decubitis (bed sores) and it is not properly assessed and documented upon admission, if it is documented later and after-the-fact, the hospital is likely not to get reimbursed.

If you go to the hospital for appendicitis, have surgery, and get an infection post op, the hospital will NOT get reimbursed.

The P4P puts added (and needed) pressure on ALL care givers to provide great care.

[JuniperPark]

Originally Posted by draggar

The reason why we don't do it to animals because most people don't have pet insurance

NONSENSE.

People allow suffering animals to die because it's HUMANE. There is no point to torturing an animal with "treatments" that will not improve their condition and only extend their pain.

[aZooZa]

Originally Posted by PRED

you'd have to ask Focus

Guffaw...