Financial Elder Abuse Victimizes Elder's Grandson

April 7, 2009. By Heidi Turner

San Jose, CA: J.B. says that he and his grandmother have been victimized by financial abuse. Specifically, his grandmother is a victim of financial elder abuse and this abuse has had a severe impact on J's life, leaving him broke and homeless—living in an extended-stay hotel with the help of a non-profit organization and relying on doctors to provide him with pro bono medical care.

"I can't access my own money [which is in an insurance policy], but having that money in my name is blocking me from getting benefits and help with an attorney," J says. "Would you believe that a forgery by one person would land someone else homeless on the street?"

J says the situation started when his grandmother decided to buy him and his brother an insurance policy on her life.

"The intent was to give us some of her estate," J says. "But, she was taken advantage of by her insurance agent. She bought a quarter of a million dollar policy death benefit on her life. But here's the thing, my brother and I are owners of this policy—even though we never signed anything to say we would be the owners of the policy. The owner has to sign a piece of paper to acknowledge ownership because there are tax benefits. To simply be a beneficiary, nothing has to be signed. Nothing was sent to me, I was told at the time that I was a beneficiary on the policy. It is common to think that you are the beneficiary and not the owner. That was in 1997 and I was a medical resident at the time.

"In order to get the most commission, the agent had to sell the policy as an estate-planning tool, but Grandma didn't have a big enough estate to need the benefits he was selling. She needed to gift out the maximum amount of the premium every year. She gifted us each $10,000 a year for seven years. We got the money and sent it back to her via the insurance money. We were told that the policy was bought and that was how we would save death taxes. We didn't know that wasn't true. When your grandma does that for you, you say thank you, you don't look into it.

"The insurance agent and Grandma handled all the work. This product, at face value, was not worthless, but Grandma was 73 when she purchased it and she wanted my brother and I to have her money when she died. She is now 86; if she survives 6 years there is no money left and it is worth zero because the premiums go up. But that is not how the policy was sold. She was not told that the death benefit would go down without more premiums put in. We put that $10,000 each in for 7 years, thought that was it and the policy would grow. There was $140,000 put in by the end of that seventh year.

"The owners of a policy are the ones with the contract but the contract was never given to us. None of us knew about this because the contract was sent to Grandma's house. The insurance agent collected the premiums and got first check personally. Grandma paid the first premium and we paid remaining 7 years. There is a lot of intention here for him to cover up so that we would not see the contract until she died. We paid in full, thinking that when she died we would get $250,000. But we really were getting the death benefit, [which may not be equal to $250,000]."

"The insurance agent duped her, took advantage of her and manipulated her, but he didn't take her money, he took ours because she gifted it to us. The insurance agent was scamming an elder. His commission was $22,000 out of $144,000 that was put in.

"I took the papers that I supposedly signed [to become the owner of the policy] to a forgery expert, so I have proof that I didn't sign them.

In 2005, J became sick. He was unable to manage his own affairs and turned control of his assets over to his family, who paid for his health insurance through his assets. His grandmother wanted to help him out financially, so she tried to borrow money from her insurance policy.

"The agent said that she could not borrow the money off the account," J says. "I got suspicious because I knew that if you put $140,000 in the policy and have a cash value account, you should be able to borrow money off the account. I asked about seeing a copy of the policy but the agent wanted nothing to do with that. It took months and then I finally went around him and then went to his company. They finally got back to me that my brother and I needed to sign some papers to release the money.

"We wrote a joint letter [giving their grandmother permission to borrow the money] and we get a letter back saying that the signatures on the letter don't match the signatures on file. How could it not match when we didn't sign anything? I looked at my grandmother's contract and our signatures aren't on the contract. The company said that my brother and I are owners and are in complete control of the policy.

"I didn't know the policy was fraudulent, I was just suspicious."

In the meantime, J continued to struggle with his illness and ran out of money. His employment until he was sick consisted of being trained as a surgeon, which does not count towards SSI benefits, so J applied for disability and multiple doctors stated how severe his illness was. Unfortunately, the life insurance policy J's grandmother took out for him and his brother counted against him. Because J is listed as an owner of the policy, he does not qualify for disability benefits.

"I have nothing. I have been living in my car and my doctor continues to treat me pro bono, even to this day, and helps me get compassionate fills from the pharmacy. I was first denied SSDI in March 2007. A year went by with me fighting the insurance company and they are still ignoring the forgeries. Then, I find out that the policy is dwindling in assets and that the benefits are nothing if she [J's grandmother] survives past a certain age. She bought this as a whole life policy.

"There is $25,000 still in the policy and half is mine, but I have no access because it is jointly owned with my brother. The company knows that the signature was forged because they admit that whoever signed my name also signed my brother's. I was in Thailand when I supposedly signed those papers. So, I have no access to the money, the cash value in the policy is dwindling, and, because I own that life insurance policy—rather than being the beneficiary—I don't qualify for benefits.

"This all started with an insurance agent who wanted a big, fat commission. The insurance company assures my grandmother that when she dies we will get the death benefit—but they don't say we will get $250,000, just that we will get the death benefit. It's tricky wording so you don't know what is going on."


[READ MORE FINANCIAL FRAUD & ABUSE ARTICLES]

Medical Bill Errors: Fighting Mistakes

Advocates Can Help Find Typical Medical Billing Errors
By ELISABETH LEAMY and LIZ SINTAY
April 7, 2009

Expensive mistakes on medical bills are hard for most of us to detect, because the bills are written in a mysterious language that we don't speak.
But eight out of 10 medical bills have mistakes on them, according to Medical Billing Advocates of America.

What if you could hire somebody to translate your bills and then do battle for you?

Turns out, you can. And it might not even cost you anything.

Finding the Mistakes and Fighting Back

Artist Cynthia Kulp thought being diagnosed with breast cancer was the worst thing that could happen to her. But, then, the hospital where she received her breast cancer treatment overcharged her.

"To have to fight a hospital going through cancer treatment, overcharging me, they have to be the lowest of the low," Kulp said.

Before her lumpectomy, she said, the hospital told her the operation would cost $5,000. Instead, she got a bill for $12,700, right in the middle of her course of chemotherapy.

"You can barely function, you can barely get out of bed," she said. "How can you fight hospitals?"

So she hired Holly Wallack, a medical billing advocate, to help. Wallack found all kinds of errors on Kulp's bill, such as:

Mismatches. These are drugs that appeared on the medical bill, even though they weren't listed in the medical records.

Double charges. The hospital charged Kulp for two "first" hours in the recovery room. So Wallack asked, "How many 'first' hours do you get? Last I heard, there was only one, then he was very happy to take that charge off."

Inflated charges. The hospital billed $192 for a postoperative support bra that Wallack found on the Internet for $19 -- a tenth of the cost.

"That was one morning in one operating room in one hospital in one little town in the country," she said. "If you extrapolate that out to what's going on every day, it's mind boggling."

Other Common Medical Bill Mistakes
Here are a few other billing mistakes to watch out for:


Artist Cynthia Kulp thought being diagnosed with breast cancer was the worst thing that could happen to her. But, then, the hospital where she received her breast cancer treatment overcharged her.

Billing for things that ought to be included. That's like paying for the value meal and also being charged separately for the sides.

Misplaced decimals. ABC News saw one bill that read $874 for an $87.40 medication, for example.

Fat fingers. These are extra line items caused by clerical clumsiness. A medication might be listed seven times in a row, even though it's only supposed to be given four times a day.

"Our medical situation in the U.S. is seriously broken, and it needs to be fixed," Wallack said. "And I don't know how to fix it. I'm fixing it one bill at a time."

Wallack negotiated Kulp's bill from $12,700 down to $5,800, a $7,000 savings. "It was like a miracle that we found her," Kulp said.

There was another miracle, too. Despite having one of the most aggressive, devastating forms of the disease, Kulp fought off the breast cancer and won.

Hiring a Medical Billing Advocate

Medical billing advocates like Wallack either charge an hourly fee, ranging from $60 to $175, or they work on a contingency basis, earning a commission of 15 percent to 35 percent of the amount they save you. If you do it that way, you don't pay a dime unless they lower your bill, which makes them highly motivated to do just that.

It's a little tricky to find a medical billing advocate, because they go by many names such as claims assistance professional, medical claims professional or health care claims advocate.

And, keep in mind, it's mostly phone work, so they don't have to be in your same city. Here are a couple sources for finding somebody to assist you.


Medical Billing Resources
Medical Billing Advocates of America

National Health Care Anti-Fraud Association


http://abcnews.go.com/GMA/Story?id=7241383&page=1

My Brother Died from Fentanyl Overdose

March 27, 2009. By Jane Mundy


Richmond, RI: "My brother was prescribed fentanyl patches for severe back pain and throat cancer," says Michael. "He was on conventional opiates for a long time but he was prescribed the fentanyl patches on July 10, 2007. The next day my mother found him dead."

Michael says Patrick, his brother, had a tracheotomy and his prognosis was good. After the surgery Patrick went to rehab in the hospital for a few weeks and was released from rehab around 10am—he filled the fentanyl prescription at the pharmacy the same day. "Patrick must have put his patch on shortly afterward," says Michael. "My mother went into his room to wake him up the next morning because he had a follow-up appointment with the doctor—she found him dead.

If only we knew about the dangers of this Duragesic patch at that time…

That morning I received a frantic call from my niece, Barbara. 'Uncle Pat has something wrong with him,' she said. 'The paramedics are here and they are trying to revive him,' she told me, frantically. He had no pulse and no heartbeat. Just a few days earlier I had talked to him. Patrick's hopes of recovery were high and he was in a good space of mind. I got him to pray with me and it was like he was given a second chance. His prognosis was good and the cancer was in remission—they had removed it all.

That morning, after I received the call, I went over to my mother's house; I was in shock. By the time I got there, the paramedics had taken Patrick to the hospital: He was dead on arrival.

When I got to their house, I don't know what made me do this, but I went through his room-- I was looking for answers. I was having a conversation with my mother who was very upset of course: We couldn't figure out what happened and guessed that maybe he choked on something. But what really happened was this: I found the fentanyl patches; I found one in his bed that was used and the rest in the Duragesic patch box on his dresser. I don't know if it fell off when they were trying to revive him or before that, but I took this one used patch and put it in a plastic baggie along with the rest of the patches and I took them home with me.

I put the patches in my lock box and they remained there until about five months ago. I was sitting at home watching TV and saw an ad about fentanyl patches. An attorney in Texas was explaining how they had killed people and it hit me like a ton of bricks—my stomach just dropped.

We were trying to get an autopsy report on my brother for a period of 16 months. We always got the same answers at the coroner's office: they were backed up and months behind on getting the final report on his death. Patrick's death certificate didn't have a cause of death; it was blank. The autopsy report couldn't concur with the death certificate because it took so long. They kept saying the reports were not done so we didn’t have any closure. The doctor at the hospital wouldn't talk to us either.

Then I saw the ad on TV. I researched the Internet and found an attorney at LawyersandSettlements. I explained to him that my brother had died, we didn't know why he died and we needed some closure. He got the autopsy report, after 16 months. It said 'acute opiate poisoning, respiratory failure resulting in an accidental death'.
I was able to preserve the patch and I sent it to my attorney; the dates on the package fall within the dates of the recall. This fentanyl patch leaked and that's what I believe killed him. And that is what my lawyer believes.

Patrick was only 47 years old when he died and his daughter is only 13. I am so angry about it. Something that was supposed to help ended up killing my brother."


http://www.lawyersandsettlements.com/articles/12037/fentanyl-patch-duragesic.html?ref=newsletter_bca_fentanyl-patch-duragesic

See also: Leaky patches recalled:
http://involuntarybackdooreuthansia.blogspot.com/2009/01/duragesic-patches-recalled-due-to-risk.html

"My Mother Died from a Fentanyl Overdose"

January 26, 2009. By Jane Mundy

Olathe, KS: Melissa says that now she understands the effects of fentanyl, she believes her mother died from an overdose of this powerful opoid which was administered by way of the Duragesic patch.

"My mother was first prescribed the fentanyl patch in 2005 because her hip needed to be replaced," says Melissa. But her mother had an infection so surgery was postponed. And postponed. As well, her mother was allergic to regular pain medications—they caused her severe itching and nausea—so fentanyl seemed to be a tolerable way for her to deal with pain.

"However, in retrospect my mother should never have been given this drug at her age: she was 73 years old and had COTD—various kinds of lung ailments," says Melissa. "We found out after the fact that fentanyl is a very dangerous drug to take with respiratory problems." And that wasn't all that was wrong with fentanyl.

"Mother was given a large dose of fentanyl of and on by way of the Duragesic patch for about 10 months," Melissa explains. "She was given it 'off and on' because she was in and out of hospital and we also found out some of the hospital staff was stealing it (they were later fired.) After a time, my mum began to lose her mind---she couldn't remember anything; she would eat breakfast and two hours later would ask for her breakfast. She had hallucinations, she couldn't work her TV set in the nursing home where she was moved to (her hip got worse as she was waiting for surgery). She deteriorated rapidly and was put on anti-depressants--that you aren't supposed to combine with fentanyl.

The first time the nursing home staff found her in her room barely breathing, they resuscitated her and rushed her to the hospital. It happened 3 or 4 times after that. During the last month of her life, we found out that they overdosed her. The doctor said no more fentanyl because it stops her heart. But she needed something for pain so he prescribed half-doses. Then they put her in a rehab center because they had to get her stabilized; she continued on the patch and the rehab doctor put her on Effexor—which turned out to be a deadly combination with fentanyl.

I found her one morning in her room with two aides, barely breathing and incoherent. They called 911 yet again and determined that she was overdosed on fentanyl and gave her Narcan—a drug used to rapidly detoxify someone from a serious or lethal narcotic overdose. But the bad thing is that Narcan is not tested on seniors. As well it is apparently a very painful and emotional process; you are in physical and psychological withdrawal.

Although she was screaming her head off, it was the first time in 10 months that I finally saw my mother again—she was lucid and coherent. She also told me she couldn't take it anymore. The doctor said she had to come off fentanyl and he suggested prednisone—a treatment he said was successful.

By that evening she had terrible hallucinations—I think the Narcan fried her brain. For the next few weeks she didn’t know where she was, why she was there. She called me by my nickname she used when I was a little girl. A few days later I thought she was becoming more coherent and it seemed like she was starting to recover when she was off the patch, but it only lasted a few days: I needed to talk to the doctor because she was worse. He phoned and told me they had accidentally put her back on the fentanyl patch!

I was furious. As far as I know, this killed her. She went to another nursing home and was all messed up again. She existed in a weird altered state until the day she died.

My mum's death certificate states heart failure and hardening of the arteries—stuff they would write about any elderly person who dies in their sleep. But I know her breathing was so shallow because of fentanyl. She was mentally together and had a few ailments before this hip problem but that drug doped her up so much she couldn't do anything.

They shouldn't take people on and off fentanyl like they did and combine fentanyl with other drugs. I read online that if you cannot take opiates, do not take fentanyl. It took me 5 minutes of research online to find this fentanyl warning—why doesn't the medical community take notice? It is so maddening—this drug stole her life. We didn’t even get to say goodbye."


http://www.lawyersandsettlements.com/articles/11822/duragesic-patch-fentanyl-recall.html?ref=newsletter_bca_duragesic-patch-fentanyl-r

See also; Leaky patches recalled;
http://involuntarybackdooreuthansia.blogspot.com/2009/01/duragesic-patches-recalled-due-to-risk.html

Seniors Duped in Financial Elder Abuse Scams

January 17, 2009. By Gordon Gibb

San Diego, CA: Next to child abuse, elder abuse is right up there with behaviors that turn the stomach—whether that abuse is physical, emotional of financial elder abuse. Financial abuse, especially against seniors who are in the twilight of their lives and long beyond their capacity to earn a living, leaves a bitter taste. Thankfully, financial elder abuse law is there to help protect then from crooks that attempt to rob them of the little money they have.

The problem with seniors and elders, as most will attest, is that they are often confused. Fraudsters pray on this limitation, all the way to the bank.

Consider the case of four seniors who were defrauded out of money via a bogus lottery scheme perpetrated by a California man. Kim Moy Hioe, himself a senior at 65, is alleged to have strung his victims along by informing them they had won a lottery, but would have to advance funds to pay for related fees, attorney's fees and taxes.

At least four seniors across the US fell for the scam, according to reports.

"In fact, there were no lottery winnings and Hioe and others were intentionally defrauding the elderly victims," alleged Special Agent Gregory Fine of the Federal Bureau of Investigation (FBI). "Hioe received funds from various victims and forwarded a portion of the money to Canada, keeping the remaining proceeds for himself."

The fake lottery scam came to light after an 81-year old pensioner in Lacer County, California tipped off the authorities. Hioe was arrested and put on trial in San Jose, with regard to the alleged fraud scheme.

Sometimes it's a fraud scheme like a lottery win. Other times it's the sensational emails that come from far-off lands, claiming the existence of large sums of money and offerring the recipient of the email a chance to have a stake in the treasure provided funds are advanced to cover everything from taxes, to legal fees. These are not fees at all, but an attempt to secure money for personal gain. There is no wealthy person who has died and has left the money to no one in partcular.

Sometimes it’s a friendly face knocking on a door, selling some kind of service that requires a payment of cash up front. Sometimes it's a phone call.

And sometimes it's an unscrupulous life insurance agent who finds a way to dupe an elderly client out of thousands, in an elder financial abuse fraud scheme.

In this case a San Diego insurance agent by the name of Edward Michael Ybarra is alleged to have collected $110,000 from a 78-year-old client for insurance investment purposes. It was later determined however, by way of an investigation by the Investigation Division of the California Department of Insurance, that $70,000 of that fund was diverted to Ybarra's own personal use.

"There are few crimes more heinous than taking advantage of a senior to cheat them out of their life savings,” said Insurance Commissioner John Garamendi, who announced the arraignment of Ybarra on 3 felony counts of financial elder abuse, grand theft and using false statements in the sale of a security. “My Department is steadfast in its commitment to root out senior fraud and make sure that those who are convicted receive the toughest penalties possible.”

In the end, fraudsters who take advantage of seniors and commit financial elder abuse are cruel, and taking individuals who can least defend themselves for a financial abuse ride. Financial elder abuse law is there to protect seniors from these kinds of heinous crimes. If you are a senior who feels duped, or someone you love has fallen a victim to financial abuse, contact a financial elder abuse lawyer to explore your options

http://www.lawyersandsettlements.com/features/financial-elder-abuse-8.html?ref=newsletter_bca_financial-elder-abuse-8

Understanding Financial Elder Abuse

Understanding Financial Elder Abuse

January 13, 2009. By Heidi Turner

Beverly Hills, CA: If you think you or a family member has been the victim of financial elder abuse, you might be right. Financial abuse of seniors is far more widespread than many people realize, affecting many seniors and their families. However, before you accuse someone of violating financial elder abuse laws, there are a few things you should know.

First is that financial elder abuse laws are not designed to protect seniors who have simply made a poor decision. According to Philip Brown, founder and partner at Egerman & Brown, LLP, there is a difference between a senior being financially abused and simply making a bad decision.

"A poor or unwise decision is not elder abuse unless it was prompted by someone taking advantage of an elderly person's particular need," Brown says. "For example, an elderly person who is convinced to invest in a risky venture, such as a wildcat oil drilling venture, is not elder abuse if there really is a drilling venture." So, the investment may be unwise—especially if the money for the investment is money that was needed for the senior's care—but that does not mean that the elder is the victim of financial elder abuse. What might make it financial elder abuse is if the senior was told she would not receive proper care unless she invested in the drilling venture.

"Financial elder abuse law is not designed to undo unwise investments—it is designed to make it easier to go after people who cheat and steal from elderly people, or who use undue influence to get the senior do something he or she would not do without that undue influence," Brown says. "Undue influence is the use of a confidential relationship or a real or apparent authority for the purpose of gaining unfair advantage."

Furthermore, it is not financial elder abuse simply because the senior changes his or her mind about a decision. Again, there has to be some form of improper influence or cheating on the part of the person who convinces the senior to do something that is not in his best interest.

It is also important to remember that just because someone else does not like the senior's financial decisions does not mean that the senior has been victimized. For example, in some cases one child might be upset about money or property given to another child—but that alone is not proof that elder abuse has occurred.

"Elderly people, if they are being cared for by one child, tend to want to reward that child for the care," Brown says. "There is nothing wrong with that unless it comes with the demand, 'I won't care for you as much if you do not give something to me.' It is proper to want to give property to one child who cared for the senior. You have to find undue influence—it is not just elder abuse because of favoritism.

"There has to be wrongdoing. Usually, the idea is that someone ends up with an elderly person's money by one of several means, either by cheating or, assuming that there is no dementia on the part of the senior, prevailing upon the senior for one reason or another to give up something that they would not have given up."

When financial elder abuse does occur—where the senior has been prevailed upon to give up money or property that she would not have given up in response to improper pressure or undue influence—the law can step in and help the senior to recover his or her losses. The law also provides for attorney's fees in cases of financial elder abuse, so that the senior does not lose money fighting a court battle. However, before a lawsuit can begin, it is important to contact a lawyer to discuss the senior's legal options.



[READ MORE FINANCIAL ELDER ABUSE ARTICLES]

Search 10,000 recent
cases and settlements

Home

Lawyers wanting to advertise for Financial Elder Abuse In Southern California cases sign up here.

Lawsuits:
In the News

Services:
Free Newsletters
Email this Page to a Friend

Determining the Mental capacity of a Decedant

January 7, 2009.

Forensic psychologists and neuropsychologists regularly give expert opinions about a person’s mental capacity in the criminal, family law and civil courts. The evaluative process involves clinical interviews, psychological/neuropsychological testing, review of the records and interviews with individuals who have personal knowledge of the defendant’s behavior and cognition.

However, when the case calls for an opinion regarding the mental capacity of a deceased person, the forensic psychologist/neuropsychologist cannot administer psychological tests or conduct a clinical interview. Consequently, the expert retained on a contested Will or Trust matter has to assemble information that yields a true picture of the pre-morbid personality and cognitive function of the decedent.

In this case, the forensic psychologist must take on an investigative role with individuals and family members. Information is gathered about the decedent’s cognitive, behavioral and decision-making behavior just prior to death, in the recent and distant past. Materials reviewed can include depositions as well as clinical, financial and medical records. Not surprisingly, nurse’s note can often contain very valuable information relating to a person’s emotional and mental states.

These sources may reveal whether a caretaker or significant other was involved in the daily decision making, health management or general care of the decedent. This information assists the expert in determining whether the caretaker or significant other unduly influenced the decedent when writing the Will and/or Trust, signing signature cards at a financial institution or requesting specific medical care such as Advanced Directives.

Comparing historical information with recent findings can yield a detailed picture of similarities and discrepancies in the decedent’s mental capacity over time. It can illuminate changes in habits, psychological and physical well-being, friendships, belief systems, self care and financial management. Noting the variation in these factors on a time line gives the forensic psychologist/neuropsychologist a method to determine if and when changes occurred in the decedent’s lifestyle and if any specific factors or people unduly influenced the decedent. These findings assist the attorney and/or the court in determining whether the decedent had sufficient understanding of the contents and consequences of the will, trust, contract or other signed document.

By Dr. Joyce Vesper Ph.D.

For any questions concerning competency or to enlist the services of experts in any field, please contact Atrium Psychological Group at (866) 446-0991 or on the web at www.atriumpsych.com.

Atrium Psychological Group
11500 Olympic Blvd, Suite 580
Los Angeles, CA 99064
(866) 446-0991
(310) 464-1165

You Never Suspect Your Siblings of Financial Elder Abuse

January 4, 2009. By Heidi Turner , PT. 1

Oceanside, CA: Paula believes her parents were the victims of financial elder abuse at the hands of her 2 sisters. Although she suspected financial abuse a couple of years ago, it wasn't until her parents moved in with her that Paula learned how deep the financial abuse ran. As a result of her parents' situation, Paula now knows more about financial elder abuse law than she ever thought possible—all thanks to the actions of her sisters.

Paula's father turned 96 on December 31, 2008 and her mother turned 85. The situation actually began about 5 years ago, when Paula's younger sister became pregnant with her second child. The sister and her parents came to an agreement that they would lend her $64,000 as a down payment on a house but the father would be listed on the deed and share equity in the house. Furthermore, both parents would live with Paula's sister in Virginia.

That happened for while, but in 2005, Paula's father became ill and Paula, who lives in California, started flying out regularly to see her parents. At one point, Paula, her parents and her sister had a meeting with an attorney to discuss legal and financial matters. Paula says she had an uneasy feeling from that meeting and alerted the attorney to her concerns, however there was little he could do about it.

Paula says she was worried because it seemed that her sisters (there are 2 sisters, one older than Paula and the other younger) were too eager to get their hands on their parents' money. Paula's father asked Paula about having Power of Attorney, but Paula said at the time that she was uncomfortable doing so because she lived so far away and did not want to be doling out money when she didn't know what the money was for. So, Paula's father went to Paula's sisters for Power of Attorney.

Paula became more concerned about things when she noticed that her younger sister, with whom her parents were living, was not taking care of their parents. Their bathroom was never cleaned, they were not receiving important medical attention (including a cancerous growth on Paula's father's head) and the parents were frequently left home alone, sometimes to care for their young grandchildren.

"On one of my visits, my older sister [who lived in Connecticut but made sure she was in Virginia whenever Paula was] was heading out," Paula says. "I asked her to pick up a newspaper for my father and she said he could read an old one. I told her that he shouldn't have to read an old paper and I would pay the quarter for today's paper but she wouldn't get him one. I thought she was cheap, but later, when I told a social worker about it, the social worker told me it was because my sister didn't want him to know what day it was. She even made it so that it was never convenient for him to watch television—any time he wanted to, she came up with something else for him to do."

PT. 2
----------------
Oceanside, CA: Paula explains further about financial elder abuse as a continuation from part 1. She says the last straw was when she phoned her parents and learned that her younger sister had not been around for a week. Paula learned that she had gone on vacation and left her parents home alone, without telling them where she had gone or when she would be back. Paula's mother said they were ready to move in with Paula, so Paula set about bringing them to California to live with her.

"My father kept asking for a financial accounting of his money but my older sister refused to give it to him," Paula says. "He asked me about the $64,000 he had in the house, but my sister wouldn't produce the records for the house. When she did, my father's name wasn't on it. She said he signed the house over to her but couldn't produce the papers to prove it. I contacted the lawyer, but found out that my sister had fired the attorney without ever telling my father.

"My father expected to be paid back that $64,000 and I found out that he loaned my older sister $30,000 that he expected to be paid back. I put in change of address forms for my fathers accounts and finally was able to receive some information [Paula's sister wouldn't let her take any paperwork from the home]."

Through a series of phone calls and dealings with banks, Paula learned that her sister had written checks to herself from her father's account and even moved his stocks from one company to another so that she could write more checks to herself. Paula also learned that her sister canceled their father's trust and will and had a letter sent to their father's financial institution having him declared financially incompetent—leading the financial institution to freeze his accounts. By the time Paula got the account unfrozen, thanks to a lot of letters and the intervention of a lawyer, the account had lost $40,000 in value.

Paula's parents decided to set up a new trust, in which all 4 children received equal amounts after both parents had died. Paula's sister phoned the lawyer, threatening to have her disbarred, harassed Paula and showed up unannounced at Paula's house.

It wasn't until Paula spoke with a social worker that she learned that what was going on was considered financial elder abuse. She learned that, in total, close to $300,000 had been taken from her parents, including charges for food in Connecticut when her parents were never in that state, charges for presents for her parents and other needless charges. Paula says there may even be other accounts her sisters are stealing from but she does not have the account numbers so she can't find out for sure.

Paula knows for sure that her older sister sold their parents' car, worth $9,700, even though her name was not on the car and it was illegal for her to do so, and her sister liquidated $21,500 from one of their father's stocks but did not report it on his income tax. Now, the IRS wants $3,000 for that transaction, and although they have agreed to put the account on hold for now, Paula knows they will want the money eventually. She also knows that thousands of dollars from her mother's Wachovia account were written to cash, but that money was not used to help her parents at all.

"Just this week, a social worker came out because my sister keeps calling them and sending them out," Paula says. "The social worker said, 'This isn't going to end. She won't let go. She is threatening to sue you and take your house. You need to get an attorney.'

"You never expect your siblings to do this. I'm kind of in shock, a little bit angry, that she can't let it go. The whole thing is, she was neglecting my father. She left him alone for 2 weeks, I know what she wanted to happen."

Obama Appoints "Pro-Death - Right-to-Die" Attorney

Obama Makes Lawyer for Terri Schiavo's Husband Third-Ranking
Justice Official

Washington, DC -- Barack Obama has named the lawyer who
represented Terri Schiavos husband Michael in his efforts to kill
his disabled wife as the third highest attorney in the Justice
Department. Thomas Perrelli, who won an award for representing
Schiavo's former husband, had severed on Obama's transition team.

Click on title above for Full story or go here;
http://www.LifeNews .com/bio2685. html

Art Imitating Life or "How to Live While Dying"

Art Buchenwald shows us how to live while dying;

http://fora.tv/2006/12/12/Too_Soon_to_Say_Goodbye

Duragesic Patches Recalled due to Risk of Overdose

Who on hospice dont use these?

Possible Tears in the Patches Pose Serious Health Threat
Johnson & Johnson's subsidiary PriCara, in conjunction with the FDA, has issued an immediate recall of 2 lots of Duragesic pain patches, because of possible tears in drug reservoir in the patch.

Direct exposure to fentanyl gel, the opioid pain medication in the patch, may lead to serious adverse events, including respiratory depression and possible overdose, which may be fatal.

The Duragesic patches, also called the Fentanyl Transdermal System, involved in the recall are the PriCara 50 mcg/hr patches under the lot number 0817239, and the Sandoz Inc 50 mcg/hr patches under the lot number 0816851.

This is the 5th recall of the duragesic transdermal pain patches since 1994. As was the case with an earlier recall in February 2008, Alza Corp is the company that manufactured these latest defective fentanyl pain patches.

JAN-02-09: Johnson & Johnson's Subsidiary Recalls Pain Patch Duragesic [RTT NEWS: DURAGESIC PAIN PATCH RECALL]

Woman Found Guilty of Financial Elder Abuse

December 16, 2008. By Heidi Turner

Lakeport, CA: In a move that shows how horrified the public is about financial elder abuse, a jury convicted a woman of one count of felony financial abuse and one count of felony elder abuse and neglect. The victim's story shows how far some people are willing to go to make money off those who cannot care for themselves. The senior was the victim of financial abuse, but was also not given the medical and physical care he required. Thankfully, the courts do not look kindly on people who violate financial elder abuse laws.

The story itself is appalling. A 53-year-old woman, Shauna Michelle Brewster, took advantage of a 75-year-old man for a year-and-a-half, according to the Lake County News. Brewster was named private conservator for the man, Lawrence Russell, in 2003. Russell was completely unable to care for himself physically and financially, and therefore required someone to help take care of him. Unfortunately, the person who came forward to help Russell was really only interested in helping herself.

Brewster helped herself so much that Russell's medical bills and mortgage were not paid, nor were his other bills. In fact, his debt was left for so long that Russell's home went into foreclosure. By that time, of course, there was next to nothing left in Russell's bank account. Brewster's job, as Russell's conservator, was to ensure that his bills were paid and his finances were looked after, but Brewster instead wrote checks from Russell's account to her boyfriend, her manicurist or her grocery story.

How much money was taken? In just 3 months while Russell was at a nursing facility, Brewster received $4,000 in cash back from Russell's account. According to prosecutors, there is no reason to believe that the $4,000 was used to help Russell. Russell wound up in the nursing home because of the serious neglect he was subjected to. It was so bad that Russell's health was endangered, including second and third degree burns on parts of his upper body that were not treated and became infected. Luckily, protective services and concerned neighbors got involved in the situation and Russell received important medical intervention.

Brewster now faces up to 5 years in prison for her actions, but whether or not Russell will get any of his money back remains to be seen.

Unfortunately, there are many people like Brewster out there: people who are more interested in making a quick, illegal buck than in actually helping a senior out. Russell trusted the woman who was named his conservator, but she victimized him and subjected him to serious medical problems.

What sets Russell's case apart from others is that action was taken on his behalf and justice was served. In many cases, the senior does not realize what is happening or is too afraid or ashamed to take any action. All too often, the victimizer gets away with the abuse and the victim is left to pick up the pieces alone, if he or she survives the abuse at all.

Sometimes, the abuse even comes at the hands of a family member or trusted relative. A woman was recently arrested for using her 90-year-old stepfather's money for unauthorized purchases. In all, the woman used almost $5,000, according to the Victorville Daily Press. The woman was arrested after the victim noticed 30 unauthorized transactions on his account. He then called the police, suspecting that his stepdaughter was the guilty party. Evidence, including surveillance footage, allegedly shows that the woman used her stepfather's ATM card illegally. She was arrested for theft by access card and elder abuse.

As awareness about financial elder abuse grows, so will the number of people willing to take action against those who abuse them. There are laws to protect seniors from financial elder abuse and the courts, and the general public, do not look kindly on those who would abuse members of such a vulnerable population.


Financial Elder Abuse Legal Help
If you have suffered losses in this case, please send your complaint to a lawyer who will review your possible [Financial Elder Abuse Lawsuit] at no cost or obligation

A Killer Arguement Against Assisted Suicide

Hot News frum Big-Mouth Broad Casting;
Dec. 9, 2008

A killer argument against assisted suicide

In exposing the euthanasia lobby’s disregard for equality before the law, and for free will itself, Neil M Gorsuch has written the most important book yet on the ‘right to die’.
by Kevin Yuill

Given the currency of the issue of assisted suicide, it is surprising how few well-written books arguing against changing the law to allow euthanasia have been published.

There are a few lucid arguments in favour of changing the law. The best texts to appear so far address the issue from a philosophical perspective. The books produced by Margaret Battin, Ronald Dworkin and Peter Singer present direct philosophical arguments in favour of changing the law to allow assisted suicide, though they do not deal with specifics. In Europe, Raymond Tallis, John Harris, John Griffiths and others have argued in favour of legalisation from a medical-legal perspective.

However, there have been far fewer book-length treatises from the ‘against assisted suicide’ camp. Ian Dowbiggin, though opposed to legalisation, has produced the best history of euthanasia and assisted suicide to date, but, as good histories should be, it is objective. Physician Ezekiel Emmanuel has produced several excellent articles containing secular arguments against assisted suicide.

Now, with his book The Future of Assisted Suicide and Euthanasia, Neil M Gorsuch is clearly filling a gap in the debate about assisted suicide.

Gorsuch comes at the question from a legal perspective and is well qualified in legal philosophy. A former clerk to US Supreme Court Justices Byron White and Anthony Kennedy, he was nominated by President George W Bush and confirmed by Congress last year as a federal judge on the United States Court of Appeals for the Tenth Circuit. The remit of this book is, as Gorsuch tells us, ‘to introduce and critically examine the primary legal and ethical arguments deployed by those who favour legalisation, and to set forth an argument for retaining existing law that few have stopped to consider’. Readers (like myself) who might not warm to the task of following the circuitous logic of American law courts would do well to persevere, for Gorsuch lucidly lays out key ethical and philosophical arguments on both sides.

“For Plato, suicide was an ‘unjust judgement of death’ that sprung from ‘a spirit of slothful and abject cowardice’”

Gorsuch begins by showing how the debate remains unfinished within the context of American law. He then provides an excellent chapter on the history of assisted suicide and suicide. Punching holes in the classical pretensions of some advocates, he notes Plato’s condemnation of suicide as akin to a soldier leaving his post. In Laws, Plato condemned suicide on the grounds that it ‘imposes [an] unjust judgment [of death] on [oneself] in a spirit of slothful and abject cowardice’.

An outstanding historical point – again, a useful counterpoint to the claim by supporters of assisted suicide that they are carrying on an Enlightenment tradition – is that the more lenient attitude towards suicide, away from the medieval tradition of burying the suicide at a crossroads with a stake through them, reflected the view that suicides were often the result of madness, rather than malfeasance. As Gorsuch rightly declares, ‘it is a large leap from that merciful fact to the conclusion that suicide had become normalised in law, let alone a matter of legal right’ (2).

Most of the other chapters deal with the ethical and logical problems with arguments in favour of assisted suicide. Gorsuch reconstructs the arguments of advocates before effectively knocking them down. Willing participation of the victim does not render the act harmless or victimless. As Gorsuch shows, repeating arguments by John Stuart Mill, it takes nothing away from our ‘freedom’ to be prevented from duelling, selling one’s organs, or selling oneself into slavery. There are some activities prevented by a liberal or even libertarian society for the good of all. It would be perverse to say that the prevention of any of theses activities – or suicide – destroys the basis to our freedom.

Gorsuch spends altogether too much time on the canard of autonomy. It needs to be said that all are free to commit suicide, a reflection upon the impracticality of making suicide illegal. What is being requested today, however, is the right to kill those we judge (and who agree with our judgement) to be living worthless lives.

As Gorsuch notes, few argue that all must have the right to be killed if they cannot kill themselves. This leads pro-assisted suicide commentators to draw lines between those with terminal illnesses and others. One of Gorsuch’s stronger and more original arguments shows that delineation between the terminally-ill and everyone else (the basis for Oregon’s definition between those who qualify for assisted suicide and those who do not) erodes equality. To be treated as equals before the law can bear no demarcations between subjects; we cannot set down simple criteria for which lives are worth living and which are not. The arbitrariness of a line based on physical health matches the arbitrariness of lines between, say, Jews and Gentiles. How can one judge the worth of an individual’s life in such random and simple terms?

There is, as Gorsuch makes clear in a laugh-out-loud section (how many books on law or, indeed, assisted suicide can boast of this?) on Peter Singer, a real question of what constitutes a ‘person’ or ‘personhood’ running throughout the debate. Gorsuch demonstrates how Singer’s grotesque argument that a newborn infant can be killed because it is not an autonomous, self-aware being ‘is but a modest extension of the argument advanced by Ronald Dworkin or Margaret Battin’ that we should ignore the demented pleas of an Alzheimer’s patient because they had given a prior request to be killed when dementia sets in (please don’t laugh yet!). Using Singer’s somewhat simple-minded thesis based on a being’s autonomic qualities, Gorsuch concludes that a diet of spring lamb rather than mutton, veal rather than steak and poussin rather than chicken would be appropriate. We cannot establish who deserves to live and who does not on the basis of whether they are self-aware.

“Gorsuch’s concept of the inviolability and the inherent value of human life is somewhat mystical”

Yet Gorsuch also stumbles on the question of personhood. His concept of the inviolability and the inherent value of human life as it is now constituted is somewhat mystical. Humanity is defined socially and historically rather than suspended through time and space, like the monolith in 2001: A Space Odyssey. We define humanity through our relations with others and recognise even the profoundly disabled as human, no matter what Peter Singer argues. Gorsuch would doubtlessly agree that if the profoundly and hopelessly disabled were killed, the importance would be the diminished humanity of those who did the act. Though Gorsuch is correct to note the erosion of the concept of human equality, and thus of humanity itself, the idealist hinge to his arguments must be questioned. It is possible to make a secular case against assisted suicide without the shadow of God looming behind.

Apropos of this, abortion is barely mentioned by Gorsuch but is germane, especially because proponents use the association with anti-abortion to gain support amongst liberals. It would be difficult to justify abortion using Gorsuch’s inherent value of human life without justifying why this should exist from birth and not before. However, it is perfectly possible to argue that placing real value on human life as it is lived between us allows us to prioritise the existing humanity of a woman over the potential humanity of a fetus.

Gorsuch might also be open to the criticism that he does not adequately track the changing justifications for and against assisted suicide. In response to the charge that doctors regularly despatch patients by giving them enough morphine both to kill the pain and the patient, assisted-suicide advocates call for the process to be regulated; though the argument will not appeal to libertarians, it may build on common fears and negate the occasionally hysterical ‘slippery slope’ argument. The issue of disabled rights has also been used to justify legalising assisted suicide; if the able-bodied can do it, why shouldn’t disabled people?

Gorsuch’s book has been criticised for being too abstract, for not dealing with practical issues (3). But if anything, it is not abstract enough. The problem exists almost wholly within the minds of those for whom death is still a distant prospect. It is worth remembering that in Oregon less than one per cent of those who qualify for assisted suicide actually take that option. Despite Gorsuch’s somewhat flimsy supply-and-demand argument (legalisation will create a market for assisted suicide), the evidence from Oregon shows there is no real increase in the numbers annually who opt for assisted suicides.

With these qualifications in mind, Gorsuch’s best contribution – one that is profoundly important – is his insistence that intention be the gauge of actions taken regarding assisted suicide. If a patient requests to be withdrawn from life-saving equipment with the intention of destroying herself, the doctor must refuse the request. If the doctor kills a patient with an overdose of morphine but with the intention of relieving pain, the doctor’s action is justified.

The intention argument directs the issue away from the purported needs of the ‘patient’ towards the rightness or wrongness of an action, towards the actor himself. Gorsuch elaborates on Justice Oliver Wendell Holmes’ discussion of intent: ‘[E]ven a dog distinguishes between being stumbled over and being kicked.’ As Gorsuch notes, ‘[t]o kick a dog intentionally – to choose to hurt an animal – says something about the kicker, his or her way of interacting with animals, and, perhaps, it tells us about the kicker’s character and beliefs, about who the kicker is.’(4)

“In Oregon, less than one per cent of those who qualify for assisted suicide actually take that option”

This intent idea is important, for it places actions in relation to assisted suicide back within a moral sphere. The emphasis on intention also militates against the corrosive idea that there is little to delineate between conscious human actions and unconscious human actions, something that those who would condemn ‘climate criminals’ or equate drunk-driving with murder seek to deny. As Gorsuch comments: ‘To disregard whether or not an act is intended would be…in a very real way to disregard the role of the free will in the world – leaving, for example, those who fail to assist charities that feed the hungry open to the same censure and penalties as those who would starve such persons.’ (5) To put it another way, the driver who speeds with reckless disregard for the lives of others but who has no intent to harm the child is different to the depraved killer who deliberately aims for the child.

Gorsuch’s emphasis on doing rather than on being done to, on intent rather than effect, begins to put the argument about assisted suicide back on track. If trust is to be rebuilt between doctor and patient we must believe that doctors really do have our best interests at heart rather than treating them as all potential Mengeles or Shipmans and demanding regulations.

To conclude, Gorsuch’s is the most important book published so far in consideration of ethical and legal issues. As any good book should, it raises as many questions as it provides answers, advancing a continuing dialogue.

Kevin Yuill is lecturer in American studies at the University of Sunderland. He is the author of Richard Nixon and the Rise of Affirmative Action, published by Rowman & Littlefield. Buy this book from Amazon(UK) or Amazon(USA).

The Future of Assisted Suicide and Euthanasia by Neil M Gorsuch is published by Princeton University Press. (Buy this book from Amazon(UK).)

(1) See Physician-Assisted Suicide: Expanding the Debate, Margaret Battin (ed.), 1998; The Least Worst Death: Essays in the Bioethics at the End of Life, Margaret Battin, 1994; Life’s Dominion: An Argument about Abortion and Euthanasia, Ronald Dworkin, 1993; Rethinking Life & Death: The Collapse of Our Traditional Ethics, Peter Singer, 1994; Euthanasia and the Law in the Netherlands, John Griffiths, et al., 1998.

(2) The Future of Assisted Suicide and Euthanasia, Neil M Gorsuch, Princeton University Press, 2006, p31

(3) Legal scholar Stephen Arons complains: ‘But the primary weakness of the book is that its approach, while not insensitive at all, is nonetheless too detached from the realities to which its ideas are meant to apply.’ See Law and Politics Book Review Vol. 17 No. 1 (January, 2007) pp.5-10.

(4) The Future of Assisted Suicide and Euthanasia, Neil M Gorsuch, Princeton University Press, 2006, p55

(5) The Future of Assisted Suicide and Euthanasia, Neil M Gorsuch, Princeton University Press, 2006, p56

http://images.google.com/imgres?imgurl=http://www.spiked-online.com/images/reviewofbooks/october2007/suicide.jpg&imgrefurl=http://www.spiked-online.com/index.php%3F/site/reviewofbooks_article/4007/&usg=__6D7faxceDLTxa8zujzxsKMFLlDo=&h=152&w=100&sz=37&hl=en&start=41&tbnid=lyHiQR-qZQcOzM:&tbnh=96&tbnw=63&prev=/images%3Fq%3Dagainst%2Beuthansia%26start%3D40%26gbv%3D2%26ndsp%3D20%26hl%3Den%26sa%3DN

Nurse/Mom in UK Mercy-Kills Bedridden Daughter after 16 Years of Caregiving

Hot News frum Big Mouth Broad Casting;
December 9, 2008

Mother arrested as 'yuppie-flu' daughter is found dead after 16 years in bed
By Vanessa Allen, Colin Fernandez and Tamara Cohen

Last updated at 7:25 AM on 09th December 2008

A mother who nursed her daughter for 17 years with the disease ME has been arrested on suspicion of her murder following what is believed to have been a 'mercy killing'.

Police sources revealed that Lynn Gilderdale, 31, died from a massive overdose of morphine after attempting suicide with the same drug at least twice during her battle with the debilitating condition.

Detectives arrested her mother Kay, 54, over suspicions that she helped administer the fatal dose after watching her daughter suffer since she was 14.


Bedridden Victim Lynn Gilderdale, 31, had been confined to her home for 16 years

Mrs Gilderdale, a trained nurse, was the full-time carer for her frail daughter, who had been bedridden for more than 16 years and was taking a cocktail of drugs for her condition.

Police were called to their bungalow in Stonegate, near Heathfield, East Sussex, on Thursday after the alarm was raised by Lynn's father, Mrs Gilderdale's ex-husband Richard, a former police sergeant.

Mrs Gilderdale was arrested on suspicion of murder, interviewed and released on police bail on Friday. The suspected 'mercy killing' will reignite the right-to-die debate over assisted suicide.

Yesterday she and her ex-husband released a statement on behalf of their family.

Pointedly referring to Mrs Gilderdale's 'total dedication' to her daughter, they said: 'Lynn was young, beautiful, loving and caring. At the age of 14 years she was struck down by ME - an illness greatly misunderstood - and as a result, suffered the stigma attached to this dreadful illness.

'She fought long and hard for 17 years with immense bravery, enduring constant pain and sickness.

'Every system of her body was affected. She required 24-hour care that was provided by her totally- dedicated mother, with continuous support from Lynn's father.'

They said Lynn had been active and healthy until she was 14. She had a tuberculosis immunisation in November 1991 and immediately felt unwell.

She was diagnosed with ME in May 1992 and was left bedridden by her severe condition. She had been unable to speak since August that year.

Her family said: 'Prior to her illness, which left her paralysed, unable to speak, eat or drink and until recently, no memory, she was an active healthy teenager full of life's dreams.

'She enjoyed sailing, swimming, cycling and was an accomplished musician. Her family praise and admire Lynn for her courage, which she showed to the end.

'She was a much-loved daughter, sister and granddaughter who despite her illness always gave love and support to others.

More...
GILL SWAIN: I've seen patients paralysed dying Aids victims, starving children... but I've never seen anyone as ill as Lynn

'Lynn's family say her death will leave a massive void in their lives - and the love she gave so unreservedly, will be missed every minute of the day.' Police were called to the £400,000 bungalow at 8.30am on Thursday. Mrs Gilderdale was arrested just after 10am.

A post-mortem examination has been carried out but police refused to reveal the cause of death pending further toxicology tests.

Chief Inspector Heather Keating said: 'This is a very tragic incident. We are not looking for anyone else in connection with it.'

A Sussex police spokesman said Mr Gilderdale, who still works for the force in a civilian role, was not suspected of any involvement in his daughter's death.

He split from his wife in 2002. The couple, who also have a son, Steven, said their divorce had not been caused by their daughter's illness.

Mr Gilderdale still lives nearby and is said to have visited his daughter daily and to have helped with her day-to-day care.

He was with his Irish-born ex-wife at the family home yesterday, where she was being comforted by her sister.

Mrs Gilderdale has been a prominent campaigner over the illness which struck down her daughter.

The family statement added: 'In life, Lynn strove to help the medical profession improve their insight into ME which affects thousands of people, in varying degrees of severity.

'Her dedicated mother, supported by Lynn's family, has pledged to achieve her ultimate goal - for better understanding and recognition of this life-destroying illness.'

THE AGONISING TRUTH ABOUT 'YUPPIE FLU'

ME affects up to 250,000 sufferers in Britain. Although it was first documented in the 1930s, it was not officially recognised by the Government's medical advisers until 2002.

Until then victims of myalgic encephalomyelitis were often dismissed as having 'yuppie flu', as its symptoms were considered particularly common among overworked middle-class professionals.

Common symptoms include severe fatigue, painful muscles and joints, insomnia, gastric disorders and poor memory and concentration. There is currently no test or cure and doctors are able to diagnose it only after ruling out other possible causes, including flu, diabetes and depression.

The condition usually develops during the early twenties to mid-forties although children can also be affected, most probably between the ages of 13 and 15. Women account for up to three-quarters of all cases.

Prior to her illness at the age of 12, Lynn enjoyed a normal childhood before being struck down.

Sufferers include the athlete Dame Kelly Holmes, who was struck down in 2001 but recovered and went on to win double gold at the 2004 Olympics in Athens.

Scientists believe it could be carried in the genes, or be set off by a 'trigger' including bacterial illness, a viral infection such as glandular fever, stress, depression or a reaction to a traumatic event, such as bereavement or redundancy.

Some sufferers recover fully within two years and the majority learn to manage their condition with anti-depressants and painkillers and through avoiding stress, monitoring their energy levels and taking gentle exercise.

But around a quarter go on to develop severe ME lasting for years or even decades, often leaving them completely housebound and totally reliant on carers.

In his 2002 report the Chief Medical Officer, Liam Donaldson, said ME 'should be classified as a chronic condition with long-term effects on health, alongside other illnesses such as multiple sclerosis and motor neurone disease.'

http://www.dailymail.co.uk/news/article-1092865/Devoted-mother-arrested-mercy-killing-yuppie-flu-daughter-died-massive-morphine-overdose.html

UK Leads the Way in Fight Against BDE

Tuesday, July 29, 2008
UK LEADING FIGHT AGAINST BACKDOOR EUTHANSIA
Everything we know or do or have regarding palliative care in the USA, is modeled after UK standards, as is our religion and legal systems; Read about the UKs fight against backdoor euthansia, IF you care to learn;

http://www.timesonline.co.uk/tol/news/uk/article402893.ece

2 Withold & When Not 2 Withold & How 2 tell the Difference

Tuesday, July 29, 2008
When to Withhold & When NOT 2 Wthhold & How 2 Tell the Difference
Backdoor euthanasia

WITHHOLDING FOOD & FLUIDS JUSTIFIABLE ONLY FOR TERMINALLY ILL

James Paul, Specialist registrar in palliative medicine
Kilburn, London NW6 7HH JamesPaul@compuserve.com

Top
Intravenous and enteral fluids may cause rather than alleviate suffering
References

Editor—Recent articles in the general1 and medical press2 on “backdoor euthanasia” illustrate the confusion that surrounds the subject. This is especially true for decisions to withdraw or withhold food and fluids from ill patients. Focusing on the issue of the intention behind such actions may help to achieve some clarity.

Current research, although limited, suggests that the desire for food and drink lessens in terminally ill patients and that artificial hydration neither prolongs survival nor alleviates symptoms.3,4 Furthermore, drips and nasogastric feeding tubes can cause unnecessary distress to patients and their relatives. In such cases the withholding of these treatments is entirely appropriate as the intention is to save the patient from a treatment that has no medical benefit.

But what about those who are not in the terminal stages of an illness—for example, heart patients, COPD patients, or those who have had a recent stroke or with acute infection? In most instances death is not imminent. However, not providing food, fluids & proper nutrients would certainly lead to death. In this case the intention behind the omission is to let the patient die. It fulfils the definition of an act of euthanasia and as such is morally unjustifiable.

This leaves one further question: when is a patient's condition terminal? That is, when is a patient at a stage where recovery is highly improbable and provision of artificial nutrition and hydration is of no benefit? This is not always easy to answer. Clinical signs and biochemical tests act as a good indicator, as does experience in dealing with such cases. But when there is doubt, as there often is, it seems common sense to err on the side of caution and provide all reasonable means to aid recovery, including the basic human needs for food, drink and proper nutrition.
Top
" src="http://www.pubmedcentral.nih.gov/corehtml/pmc/pmcgifs/square.gif" border=0>Intravenous and enteral fluids may cause rather than alleviate suffering
References
Intravenous and enteral fluids may cause rather than alleviate suffering in the terminally ill in their end days....

Bliss, Mary (Bryning Day Hospital, Homerton Hospital, London E9 6SR).
Editor—I am worried by the recent reporting and police investigation of “euthanasia” deaths due to dehydration.1-1 I was distressed by articles in the Times which seemed to exploit bereaved families who had supported the decline and death of their relatives over many years, by suggesting that they may have suffered unnecessary pain and distress because of poor, or even criminal, mismanagement.1-2

Not all doctors and nurses agree that giving intravenous or enteral fluids to dying patients who can no longer swallow or feel thirst eases suffering. Many experts in palliative care believe the contrary. Zerwekh, a clinical coordinator of the Hospice of Seattle, observed that giving fluids and interfering with the natural course of dehydration can cause acute discomfort to the patient near death and emotional distress to the family.1-3 He commented that if the kidneys have not shut down, the fluids can sharply increase the flow of urine. If patients are extremely weak, have lost bladder control, or are in a coma, this increase may necessitate insertion of a catheter. The fluids also significantly increase gastrointestinal fluids, which is a major problem for patients whose vomiting is difficult to control, especially when there is bowel obstruction requiring a nasogastric tube. Intravenous fluids also tend to increase respiratory secretions, making it more difficult for patients to catch their breath or cough, and suction may be required. Fluids can also cause a flare up of oedema and ascites and expand the oedema layer around tumours, aggravating symptoms, particularly pain.1-3

With increasing reliance on technology rather than nursing and family support for dying patients, we seem to be following North American medicine into the hole that it is currently trying to climb out of. A study of long term patients found that tube feeding did not prevent aspiration pneumonia. The authors concluded “for almost all conscious patients we suggest a dedicated attempt at feeding by hand.”1-4 As the nurses at Kingsway Hospital observed,1-2 over zealous nil by mouth orders can also cause unnecessary dehydration and suffering. We need to remember the real meaning of the word euthanasia—a quiet and easy death. This is what we all want for ourselves and need to strive to achieve for patients by individual assessment of their needs, not by adherence to prescriptive protocols.
1-1.
Dyer C. Police investigate “euthanasia” deaths. BMJ. 1999;318:143. . (16 January.). [PubMed]
1-2.
Various articles on euthanasia Times 6 January 1999:1, 2, 9, 17.
1-3.
Zerwekh JV. The dehydration question. Nursing. 1983;13:47–51.
1-4.
Finetune TE, Bynum JPW. Use of tube feeding to prevent aspiration pneumonia. Lancet. 1996;348:1421–1424. [PubMed]
Top
References
1.
Various articles on euthanasia Times 6 January 1999:1, 2, 9, 17.
2.
Dyer C. Police investigate “euthanasia” deaths. BMJ. 1999;318:143. . (16 January.). [PubMed]
3.
Ellershaw JE, Sutcliffe JM, Saunders CM. Dehydration and the dying patient. J Pain Symptom Management. 1995;10:192–197. [PubMed]
4.
Dunlop RJ, Ellershaw JE, Baines MJ, Saunders CM. On withholding nutrition and hydration in the terminally ill: has palliative care gone too far? A reply. J Med Ethics. 1995;21:141–143. [PubMed]
Articles from BMJ : British Medical Journal are provided here courtesy of BMJ Publishing Group
Write to PMC PMC Home PubMed
NCBI U.S. National Library of Medicine
NIH Department of Health and Human Services

A Good Place to Start Your Learning

A GOOD PLACE 2 START YOUR LEARNING

About Hospice Patients Alliance

The Hospice Patients Alliance was formed in August of 1998 as a nonprofit charitable organization and is a 501(c)(3) corporation serving the general public throughout the United States. We were formed by experienced hospice staff and other health care professionals who saw that hospices were not always complying with the standards of care, and in fact, were in some cases, violating the rights of patients and families and exploiting them for financial gain, or not providing adequate care to control pain or other distressing symptoms during the end of life period.HPA promotes quality hospice services whether a patient is enrolled in a licensed hospice or not, whether residing at home or in a facility. HPA protects the rights of patients, their families and caregivers, the bereaved and staff by providing information about the standards of care governing the health care provided, the services required to be provided by law, standard industry practices and how to obtain the very best hospice care available.

http://www.hospicepatients.org/index.html

Why Euthansia? In Hospice, Longer Lives Mean $$ Lost

Friday, August 1, 2008
Why Euthansia?
IN HOSPICE, LONGER LIVES MEAN MONEY LOST

Ozier Muhammad/The New York Times
For Charles Brown Jr., 81, with his wife, Cora, growing old in Wilcox County, Ala., means care from Hometown Hospice. By KEVIN SACK
Published: November 27, 2007

CAMDEN, Ala. — Hundreds of hospice providers across the country are facing the catastrophic financial consequence of what would otherwise seem a positive development: their patients are living longer than expected.

Uncertainty at Hometown Hospice

Over the last eight years, the refusal of patients to die according to actuarial schedules has led the federal government to demand that hospices exceeding reimbursement limits repay hundreds of millions of dollars to Medicare.

The charges are assessed retrospectively, so in most cases the money has long since been spent on salaries, medicine and supplies. After absorbing huge assessments for several years, often by borrowing at high rates, a number of hospice providers are bracing for a new round that they fear may shut their doors.

One is Hometown Hospice, which has been providing care here since 2003 to some of the most destitute residents of Wilcox County, the poorest place in Alabama.
The locally owned, for-profit agency, which serves about 60 patients, mostly in their homes, had to repay the government $900,000, or 27 percent of its revenues, from its first two years of operation, said Tanya O. Walker-Butts, a co-owner. Its profits were wiped out in the time it took to open the demand letters, Ms. Walker-Butts said.

Hometown paid its first assessment with a bank loan. When the bank declined credit for the second year, the hospice structured a five-year payment plan with the Centers for Medicare and Medicaid Services, the federal agency that administers the program, at 12.5 percent interest.
The next bill is expected any day. If they hit us with a number in the several hundred-thousand range, I just don’t see how we can survive,” said Gaines C. McCorquodale, Hometown’s other owner.

In the early days of the Medicare hospice benefit, which was designed for those with less than six months to live, nearly all patients were cancer victims, who tended to die relatively quickly and predictably once curative efforts were abandoned.
But in the last five years, hospice use has skyrocketed among patients with less predictable trajectories, like those with Alzheimer’s disease and dementia. Those patients now form a majority of hospice consumers, and their average stays are far longer — 86 days for Alzheimer’s patients, for instance, compared with 44 for those with lung cancer, according to the Medicare Payment Advisory Commission.

The commission, which analyzes Medicare issues for Congress, recently projected that 220 hospices — about one of every 13 providers — received 2005 repayment demands totaling $166 million. The National Alliance for Hospice Access, a providers’ group that is lobbying for a three-year moratorium on the collections, places the numbers at 250 hospices and $200 million.
Because fewer than a tenth of all hospice providers have faced repayment, Medicare officials suggest that management might have been an issue. But Lois C. Armstrong, president of the hospice access alliance, said that if the cap on Medicare reimbursements was not lifted, the availability of care would tighten at a time when demand for hospice care was exploding and when new research suggests it saves money for the runaway Medicare program.

Many elderly people here in the remotest reaches of the state’s Black Belt would most likely live out their last days alone if not for Hometown Hospice nurses like Meg Appel Youngblood.
One recent autumn morning, Ms. Youngblood forded the Alabama River by ferry and set off on her rounds of the storied quilting enclave of Gees Bend, looking in on old women who had grown too feeble to quilt or to care for themselves.

Inside a clapboard house, she checked the vital signs of Loretta L. Pettway, a former farmhand whose stitchwork has been celebrated in postage stamps and picture books, and found that her blood pressure was a bit high.

“Miss Loretta, have you had your medicine?” she asked, and Ms. Pettway, 65, weary from chronic heart disease, shook her head no. “I didn’t think so,” Ms. Youngblood said, as she started to inventory the 14 pill bottles Ms. Pettway had stowed in a plastic bag.
Medicare’s coverage of hospice, which began in 1983, has become one of the fastest growing components of the government’s fastest growing entitlement. Spending nearly tripled from 2000 to 2005, to $8.2 billion, and nearly 40 percent of Medicare recipients now use the service.

To be eligible, patients must be certified by two doctors as having six months or less to live, assuming their illness runs a normal course. They must agree not to bill Medicare for curative procedures related to their diagnosis.

Medicare, which pays the vast majority of hospice bills, reimburses providers $135 a day for a patient’s routine home care. The hospice is then responsible for providing nurses, social workers, chaplains, doctors, drugs, supplies and equipment, as well as bereavement support to the family.

Studies have reached various conclusions about whether hospice care actually saves money, especially for long-term patients. But a new study by Duke University researchers concluded that it saved Medicare an average of $2,300 per beneficiary, calling hospice “a rare situation whereby something that improves quality of life also appears to reduce costs.”
In 1998, Congress removed limits on the number of days that an individual could receive Medicare hospice coverage, a move that encouraged physicians to refer terminal patients.
But lawmakers did not remove a cap on the aggregate amount that hospice providers could be reimbursed each year, a measure designed to contain the program’s cost. A hospice’s total annual reimbursement cannot exceed the product of the number of patients it serves and a per-patient allowance set by the government each year ($21,410 in 2007).

For reasons that are not fully understood, problems with the cap have been most prevalent at small, for-profit hospices in Southern and Western states like Mississippi, Alabama and Oklahoma.

Those programs typically have had higher proportions of noncancer patients and, thus, longer lengths of stay. But the Medicare advisory commission’s analysis also determined that the average length of stay in the cap-busting programs was significantly higher for all types of patients, including those with cancer.

Herb B. Kuhn, the deputy director of the Center for Medicare and Medicaid Services, said that finding was attracting attention at the center, which is eager to keep the hospice care benefit from morphing into a long-term care entitlement. “Well over nine out of 10 hospices seem to be managing well, including the ones in higher-wage areas, so it does raise an issue of management,”

Mr. Kuhn said. Mr. Kuhn said it remained a question whether hospice care saved money, but called it “a wonderful benefit” that “probably needs refinement” after nearly 25 years.
Among the matters meriting review, he said, is whether doctors have been premature in certifying patients as terminal. Medicare has issued disease-specific guidelines for the certifications, which must be made by both a personal physician and the hospice medical director.

The medical director at Hometown Hospice, Dr. Sumpter D. Blackmon, said he relied heavily on the judgment of the hospice’s nurses to determine whether prospective patients were rather likely to live longer than six months. But of the 56 patients on the books on Oct. 31, 17 had been there for at least that period, including two for more than 500 days.
“Doing this for 40-something years,” said Dr. Blackmon, a longtime physician here, “every time I think somebody is going to die tomorrow, damned if they don’t live for a year and a half.”

A number of hospice providers said ethical and legal constraints would prevent them from discharging patients who outlived their profit potential. But some said they sometimes delayed admission for those patients with illnesses that might result in longer stays.
Like other providers, Richard R. Slager, the chairman and chief executive of VistaCare, which is based in Arizona and has programs in 14 states, said his company now aimed its marketing at cancer patients.

“In communities where we have had cap issues, we have to really look hard for shorter-length-of-stay patients to offset it,” Mr. Slager said. “It’s a never-ending nightmare.”
After being hit with $200 million in cap charges over four years — the equivalent of a year’s revenues — Mr. Slager said he chose to close or sell 16 of 58 hospices.

Some providers have survived only by aggressively recruiting new patients, using this year’s Medicare reimbursements to pay off last year’s cap charges, while stalling for Congressional relief. Ms. Youngblood, the Hometown Hospice nurse, said that after she visited her charges — doling out their pills, and turning the sweet potatoes in their ovens — she trolled for new patients at nursing homes and senior centers.

At the small hospital here, she said, the nurses joke about her “marketing” forays: “They’ll say, ‘Here comes Nurse Kevorkian. She has no shame.’ And I’ll say, ‘Look, I have to have a paycheck, too.’”

Art Buchwald Lives While Dying on Hospice

Saturday, August 2, 2008

Art Buchwald LIVES While Dying on Hospice
Art Buchwald's Last Lecuture: A touching video "Too Soon to Say Goodbye,"
but could also be entitled, "How to Live While Dying."

http://fora.tv/2006/12/12/Too_Soon_to_Say_Goodbye

The Washinton, DC Hospice he was in for nearly a year must be a "pro-life" hospice,
as they did not terminally sedate and starve him to death, but let him keep his mind
and his mobility, and he used both to the fullest right up until the end. Good for you Art!
We miss you. (Mom & Dad both liked him)

Art Buchwald Wiki: http://en.wikipedia.org/wiki/Art_Buchwald

Art Buchwald Articles, including, "Good-bye Friends."
http://www.washingtonpost.com/wp-dyn/content/linkset/2005/03/25/LI2005032501829.html

How to Respond to a Request to Hasten Death

Saturday, August 2, 2008
A Request to Hasten Death
And encouragement to live from a loved one. An educational video for professional health care workers and family members when a patient or a loved one requests to hasten death; and a lesson for us all: CHOOSE LIFE! Death is forever.

Click on title to se vid;
http://video.google.com/videoplay?docid=-6236351715989399572&q=hospice+deaths&ei=LH6USPakHo_ArgL--ISyCg&hl=en

....and Now, a "Duty to Die?!"

Fergetabout right to life, now, they are talking a "Duty to Die?!"

Solidifying her reputation as a “philosopher provocateur”, Lady Warnock, a long time advocate of euthanasia, whose previous work has included investigations of fertility treatments, and special education for disabled students, dares to say what has previously been unspeakable. According to an interview earlier this month in the Times Online:

“If you’re demented, you’re wasting people’s lives – your family’s lives – and you’re wasting the resources of the National Health Service,” she said.


See full article at:
http://open.salon.com/content.php?cid=30316
or click on title above

The Danger of Living Wills

From an Article in the North Carolina Journal of Medicine, entitled "Palliative Care," by Phillip A. Sellers, MD (July / Aug 2004, Vol. 65, No. 4, Pg. 247;)

Here is what Dr. Sellers had to say about the dangers of living wills;

“Today some caregivers assume the presence of a living will or a DNR order is is also a “comfort care” order, when it clearly is not. Many health-care providers , including doctors, nurses, patients and families are unclear about the difference. At times, there is a tendency for the care giving medical staff to assume that is ok for the patient to die if there is a living will or a DNR order. The staff may not be as attentive to that patients needs and complaints as they would be to a patient with no living will or DNR order. Indicate3d or beneficial treatment may be delayed or not instituted.”

An International Review of Hastened Death

Wednesday, July 30, 2008

An International Review of Hastened Death

Monday, July 21, 2008(Hopefully not a recurring feature)*Please read disclaimer at the end of post*The New York Times #6 most emailed article today is about the underground practice of hastened death via the procurement of barbiturates in Tijuana, where the medications are intended for euthanizing animals, not humans. It is interesting this practice fits under neither commonly used terms for hastened death by medical means:"euthanasia" - the administration by a medical professional (or other person) of a prescribed medication with the intent of causing a hastened death"physician-assisted suicide" - the self-administration of a medication prescribed by a physician with the intent of causing a hastened deathThis article describes people obtaining the medication without a doctor's prescription, therefore 'physician-assisted' is a disqualified descriptive. They merely need to show a picture of the medication they want at the Mexican veterinary stores. So I guess this is simply 'suicide?' Although I think 'suicide' is too broad to define the particulars about a situation where someone is in the terminal phase of a condition versus someone suffering from a severe depression but no terminal illness. But to label this 'terminal suicide', 'hastened death in the terminal phase' or some other contortion feels clumsy and is bound to cause even more confusion.Regardless of the term used, the issue has been made more relevant with a couple high profile cases of medicine and hastened death.In Australia, Exit International and Philip Nitschke have been making the papers and TV (and are featured in the NYT article) with a public campaign to legalize euthanasia including You Tube Videos, film screenings, book promotions (attempts at banning it are underway in Australia and New Zealand), workshops and political initiatives. More focus has been on Mr. Nitschke and his group since the recent manslaughter conviction of a woman who gave a barbiturate to her partner who had Alzheimer's. Another recent case is also being featured of a woman who was depressed but not terminally ill who supposedly relied on information form Exit International's materials to kill herself.In Germany, a lawyer/politician advised, and videotaped a 79 year old woman who prepared and self-administered a 'lethal cocktail.' The woman was not terminally ill but chose hastened death because she did not want to go to a nursing home. The politician, Roger Kusch, was inspired by Dignitas, a pro-euthanasia organization based in Switzerland who has many people from Germany requesting its services.In Scotland, a Member of Scottish Parliament, Margo MacDonald has filmed a documentary with the BBC and proposed legislation to adopt the euthanasia and assisted suicide laws similar to The Netherlands.In Italy, a case eerily similar to Terri Schiavo and Nancy Cruzan is being discussed publicly and was recently covered in TIME magazine. A 20-year old woman in a car accident (in 1992) now comatose and with a feeding tube that her father wants to have removed (and has fought for since 1999) was allowed by Italian courts to stop her artificial nutrition via feeding tube despite much opposition. The case is now pending appeal despite already having gone to the Italian Supreme Court in 2002.In Canada, Samuel Golubchuk, an 84 year old man whose family fought hard to continue aggressive life-prolonging measures died 9 months after doctors initiated discussions about end-of-life decisions. He died on full life support measures. If his life support was withdrawn it would have been illegal since a court ordered physicians and the hospital to continue partly based on the family's belief of hastening his death would be a sin under Orthodox Jewish law. The case was to be heard by a full court in September. Doctors refused to care for him, likening his medical treatment to 'torture.'In England, a man who was refused Sutent, a prostate cancer drug, by the National Health Service suffocated himself.So why is this all important to palliative care?Because guess who thinks about these things:your patientstheir familiesmedical professionals who consult youthe publicand they may never bring it up with you for a multitude of reasons. Or they may hint at hastened death, but never start an open discussion. Or they may make a sly joke about it, waiting to see how you respond. Or they may assume what is good standard palliative care is really euthanasia.Good hospice and palliative care practices can help people discover hastened death does not have to be the easy way out. If the lines are too blurred between the legal and illegal our field has significant trust to lose with the public and our peers. Being educated and aware of the public debate over hastened death is a responsibility for palliative medicine to ensure the safe, ethical, and legal care of the patients and families entrusted to us.(My Standard Disclaimer: Pallimed, Dr. Sinclair and his current and former employers and states do not endorse or practice euthanasia or physician-assisted suicide, but do encourage the open, non-judgmental discussion of these topics for educational and ethical discourse about this controversial area of medicine. Links do not represent endorsement.)Posted by Christian Sinclair, MD Labels: artificial nutrition, ethics/law, euthanasia/suicide, hospice, international, media, sinclair