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Unwanted Medical Treatment: A Painful Nightmare We Cannot Afford

By Mickey MacIntyre and Sean Crowley

Imagine your 90-year-old mother has Alzheimer’s disease and is near death. But before she became mentally incompetent, she gave you power of attorney to sign a Do Not Resuscitate (DNR) order so medical personnel would honor her wishes to die peacefully, without aggressive medical interventions in her final days.

Then your worst nightmare unfolds: your mother goes into cardiac arrest, and is subjected to the very treatment she had been determined to avoid: aggressive, traumatic Cardio Pulmonary Resuscitation, and other extreme measures, including having a hole cut in her throat, being injected with paralyzing drugs, having tubes forced down her throat and into her stomach, and having air forced into her lungs.

Two days after this aggressive, traumatic resuscitation, you are in the indescribably horrifying situation of having to direct that your mother’s ventilator be removed so she can finally die and her suffering end. But she lingers on in a slow decline for another five days while you maintain a heartbreaking, bedside vigil each day and night until she finally passes away. Then to add insult to injury, the hospital hands you a bill for this unwanted medical treatment totaling thousands of dollars.

Sound preposterous? Unfortunately, it’s not. It is Sharon Hallada’s real life, front page news nightmare.  It prompted the leading national organization dedicated to ensuring that medical professionals honor patients’ end-of-life choices, Compassion & Choices, to help Sharon file a lawsuit against a hospital and a nursing home in Lakeland, Florida, for failing to honor her mother’s wishes, despite the fact that they had been clearly and legally specified in the DNR. Sharon sued on behalf of her deceased mother, Marjorie Mangiaruca, to ensure no else’s parent has to endure this kind of traumatic experience.

In fact, medical professionals override or ignore many patients’ decisions in the weeks and months before their deaths. It happens for a variety of reasons and can lead to invasive and fruitless testing, needless suffering, unrelenting pain and a prolonging of the period before death. Patients are tethered to monitors and machines despite their determination to reject treatment and desire to die at home in the embrace of loved ones.

A recent study published in Journal of the American Medical Association found that between 2000 and 2009 treatment in intensive care units in the last month of life increased from 24 percent to 29 percent. The accompanying editorial concluded, “The focus appears to be on providing curative care in the acute hospital regardless of likelihood of benefit or preferences of patients. If programs aimed at reducing unnecessary care are to be successful, patients’ goals of care must be elicited and treatment options such as palliative and hospice care offered earlier in the process than is the current norm.”

To stop this disturbing trend, policy makers can and should provide both the carrot and the stick to ensure that patients’ wishes are honored: financial incentives for honoring advance directives and financial disincentives for disregarding patients’ expressed wishes.

The Centers for Medicare and Medicaid Services (CMS) should deny payment to providers when there is clear evidence that patients were subjected to  treatments they didn’t want — just as current policies deny payment when patients receive unnecessary treatment.

The Justice Department is investigating hospitals and doctors’ groups for unnecessary treatment and taking legal action against the perpetrators when they find evidence of such treatment. The same diligence should be trained on unwanted medical treatment. It is always unnecessary and should never be considered acceptable.

Compassion & Choices recently recommended CMS initiate several steps to improve the quality of conversations among health care professionals, patients and families about end-of-life decisions, including:

1.      Reimbursing medical providers for participation in advanced care planning with patients and their families well in advance of illness or before facing end of life;

2.      Providing financial incentives and training to encourage medical providers to offer all the information and counseling necessary for a patient’s decision making when they secure informed consent;

3.      Ensuring that the full range of medical care and treatment decisions, including curative care, palliative care and medical assistance in dying, are freely available to patients without institutional or reimbursement barriers.

The explosion of the aging population coupled with the nation’s financial and moral commitment to providing health care to an ever-increasing number of Americans reveals that the scourge of unwanted medical treatment must be an urgent priority for our nation.

Mickey MacIntyre is the Chief Program Officer for the nation’s leading end-of-life choice advocacy group, Compassion & Choices. He recently testified before the Institute of Medicine’s Committee on Transforming End-of-Life Care.

Sean Crowley is Media Relations Manager for Compassion & Choices and a former press secretary for U.S. Rep. Sander Levin, the ranking member of the House Appropriations Committee, which has jurisdiction over federal health care programs.

San Bernardino County Extreme Heat Alert Issued

Residents are advised to stay cool, stay hydrated, and stay informed

 

San Bernardino: County Health Officer, Maxwell Ohikhuare, M.D. has issued an extreme heat alert for San Bernardino County, due to high temperature forecasts for the inland and desert regions. Residents are urged to take precautions that will prevent heat-related illness.

Extremely high or unusually hot temperatures can affect your health. Most vulnerable are the elderly, those who work or exercise outdoors, infants and children, the homeless or poor, and people with a chronic medical condition.

 

Take the necessary precautions to prevent serious health effects such as heat exhaustion or heat stroke.

 

Stay cool

  • Stay in air-conditioned buildings.
  • Find an air-conditioned Cooling Center open to the public by dialing the United Way’s toll-free resource telephone line at 2-1-1, or online at www.coolingsb.org.
  • Do not rely on a fan as your primary cooling device.
  • Limit outdoor activity, especially midday when it is the hottest part of the day, and avoid direct sunlight.
  • Wear loose, lightweight, light-colored clothing.
  • Take cool showers or baths to lower your body temperature.
  • Check on at-risk friends, family and neighbors at least twice a day.

 

Stay hydrated

  • Drink more than usual and don’t wait until you’re thirsty to drink.
  • Drink from two to four cups of water every hour while working or exercising outside
  • Avoid alcohol or liquids containing high amounts of sugar.
  • Make sure your family, friends and neighbors are drinking enough water.

 

Stay informed

  • Check your local news for extreme heat warnings and safety tips.
  • Visit http://emergency.cdc.gov/disasters/extremeheat to find information and tips for preventing heat sickness.
  • Sign up for free weather alerts to your phone or e-mail from websites such as www.weather.com/mobile. .
  • Keep your friends, family and neighbors aware of weather and heat safety information.

    Additionally, the San Bernardino County Department of Public Health encourages all residents to learn the signs and first aid response for heat-related illness. Warning signs and symptoms vary but may include:

     

    What You Should Do  • Move to a cooler location.  • Lie down and loosen your clothing.  • Apply cool, wet clothes to as much of your body as possible.  • Sip water.  • If you have vomited and if it continues, seek medical attention immediately.


    Heat Exhaustion

    Symptoms

    • Heavy sweating
    • Weakness
    • Skin cold, pale, and clammy
    • Weak pulse
    • Fainting and vomiting

     

     

     

  • Heat Stroke

    Symptoms

    • High body temperature (above103°F)
    • Hot, red, dry or moist skin
    • Rapid and strong pulse
    • Possible unconsciousness

Education Department Releases Latest College Cost Data to Help Families Make Informed Decisions

Today, the U.S. Department of Education updated its College Affordability and Transparency Lists as part of the Administration’s ongoing effort to increase transparency around the cost of college. The updated lists highlight institutions with the highest tuition prices, highest net prices, and institutions whose costs are rising at the fastest rates.

“With so much information out there, it’s important that students and their families are equipped with the tools they need to make informed decisions about where to go to college,” said U.S. Secretary of Education Arne Duncan. “Everyone has a role to play in keeping college affordable, and these lists help consumers compare the costs of higher education institutions.”

The lists, available at the College Affordability and Transparency Center, are required by the Higher Education Opportunity Act of 2008 and released by the Department to make the costs of college more transparent for students and their families.

In 2011, the Department published the first set of College Affordability and Transparency Lists. Last year, the Department updated the lists to include newer information. Similar to previous releases, three of this year’s lists focus on tuition and fees, and three others look at the institution’s average net price, which is the average price of attendance that is paid by full-time, first-time students after grants and scholarships are taken into account. Those colleges and universities where prices are rising the fastest will report why costs have gone up and how the institution will address rising prices, and the Department will summarize these reports into a document that it will post online.

Of the approximately 7,500 Title IV participating institutions of higher education, there are 1,498 institutions included on these lists, and schools are allowed to appear on more than one of the lists.

 

In addition to the College Affordability and Transparency Lists, the Administration has also released other tools to help families as they pursue higher education. The College Scorecard and Financial Aid Shopping Sheet are two of the Administration’s latest resources that provide consumers with easy-to-understand information about institutions and affordability. These tools are all part of the Administration’s continued efforts to hold colleges accountable for cost, value, and quality so that students choose a students choose a schools that is well-suited to meet their needs, priced affordable, and is consistent with their education and career goals.

 

In response to several requests from consumers last year for more comparison data, the Department provided tuition and net price information for all institutions, broken out by sector in order to allow students to compare costs at similar types of schools. The comprehensive lists are provided this year as well.

 

Lists
Highest tuition and fees (top 5 percent)
Highest average net price (top 5 percent)
Lowest tuition and fees (bottom 10 percent)
Lowest average net price (bottom 10 percent)
Highest percentage increases in tuition and fees (top 5 percent)
Highest percentage increases in average net price (top 5 percent)
 

Sectors
4-year public
4-year private nonprofit
4-year private for-profit
2-year public
2-year private nonprofit
2-year private for-profit
Less-than-2-year public
Less-than-2-year private nonprofit
Less than-2-year private for-profit

Institutions report data on their tuition and fees and net price annually through the Department’s Integrated Postsecondary Education Data System (IPEDS). Additional updated data on individual schools is available on the Department’s College Navigator site. To view the lists, visit: http://collegecost.ed.gov/catc/Default.aspx.