Life Imitates Monty Python

[JayB]

[video:youtube]grbSQ6O6kbs

 

 

"Dying patients

A group of experts who care for the terminally ill claim that some patients are being wrongly judged as close to death.

 

 

Published: 4:08PM BST 03 Sep 2009

 

SIR – The Patients Association has done well to expose the poor treatment of elderly patients in some parts of the NHS (report, August 27). We would like to draw attention to the new “gold standard” treatment of those categorised as “dying”. Forecasting death is an inexact science.

 

Just as, in the financial world, so-called algorithmic banking has caused problems by blindly following a computer model, so a similar tick-box approach to the management of death is causing a national crisis in care.

 

The Government is rolling out a new treatment pattern of palliative care into hospitals, nursing and residential homes. It is based on experience in a Liverpool hospice. If you tick all the right boxes in the Liverpool Care Pathway, the inevitable outcome of the consequent treatment is death.

 

As a result, a nationwide wave of discontent is building up, as family and friends witness the denial of fluids and food to patients. Syringe drivers are being used to give continuous terminal sedation, without regard to the fact that the diagnosis could be wrong.

 

It is disturbing that in the year 2007-2008, 16.5 per cent of deaths came aboutafter terminal sedation. Experienced doctors know that sometimes, when all but essential drugs are stopped, “dying” patients get better.

 

P. H. Millard

Emeritus Professor of Geriatrics University of London

Dr Anthony Cole

Chairman, Medical Ethics Alliance

Dr Peter Hargreaves

Consultant in Palliative Medicine

Dr David Hill

Fellow of the Faculty of Anaesthetists of the Royal College of Surgeons

Dr Elizabeth Negus

Lecturer, Barking University

Dowager Lady Salisbury

Chairman, Choose Life "

 

http://www.telegraph.co.uk/comment/letters/6133157/Dying-patients.html

 

In a letter to The Daily Telegraph, a group of experts who care for the terminally ill claim that some patients are being wrongly judged as close to death.

 

Under NHS guidance introduced across England to help doctors and medical staff deal with dying patients, they can then have fluid and drugs withdrawn and many are put on continuous sedation until they pass away. But this approach can also mask the signs that their condition is improving, the experts warn.

 

As a result the scheme is causing a “national crisis” in patient care, the letter states. It has been signed palliative care experts including Professor Peter Millard, Emeritus Professor of Geriatrics, University of London, Dr Peter Hargreaves, a consultant in Palliative Medicine at St Luke’s cancer centre in Guildford, and four others.

 

“Forecasting death is an inexact science,”they say. Patients are being diagnosed as being close to death “without regard to the fact that the diagnosis could be wrong.

 

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

 

The warning comes just a week after a report by the Patients Association estimated that up to one million patients had received poor or cruel care on the NHS.

 

The scheme, called the Liverpool Care Pathway (LCP), was designed to reduce patient suffering in their final hours.

 

Developed by Marie Curie, the cancer charity, in a Liverpool hospice it was initially developed for cancer patients but now includes other life threatening conditions.

 

It was recommended as a model by the National Institute for Health and Clinical Excellence (Nice), the Government’s health scrutiny body, in 2004.

 

It has been gradually adopted nationwide and more than 300 hospitals, 130 hospices and 560 care homes in England currently use the system.

 

Under the guidelines the decision to diagnose that a patient is close to death is made by the entire medical team treating them, including a senior doctor.

 

They look for signs that a patient is approaching their final hours, which can include if patients have lost consciousness or whether they are having difficulty swallowing medication.

 

However, doctors warn that these signs can point to other medical problems.

 

Patients can become semi-conscious and confused as a side effect of pain-killing drugs such as morphine if they are also dehydrated, for instance.

 

When a decision has been made to place a patient on the pathway doctors are then recommended to consider removing medication or invasive procedures, such as intravenous drips, which are no longer of benefit.

 

If a patient is judged to still be able to eat or drink food and water will still be offered to them, as this is considered nursing care rather than medical intervention.

 

Dr Hargreaves said that this depended, however, on constant assessment of a patient’s condition.

 

He added that some patients were being “wrongly” put on the pathway, which created a “self-fulfilling prophecy” that they would die.

 

He said: “I have been practising palliative medicine for more than 20 years and I am getting more concerned about this “death pathway” that is coming in.

 

“It is supposed to let people die with dignity but it can become a self-fulfilling prophecy.

 

“Patients who are allowed to become dehydrated and then become confused can be wrongly put on this pathway.”

 

He added: “What they are trying to do is stop people being overtreated as they are dying.

 

“It is a very laudable idea. But the concern is that it is tick box medicine that stops people thinking.”

 

He said that he had personally taken patients off the pathway who went on to live for “significant” amounts of time and warned that many doctors were not checking the progress of patients enough to notice improvement in their condition.

 

Prof Millard said that it was “worrying” that patients were being “terminally” sedated, using syringe drivers, which continually empty their contents into a patient over the course of 24 hours.

 

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

 

“If they are sedated it is much harder to see that a patient is getting better,” Prof Millard said.

 

Katherine Murphy, director of the Patients Association, said: “Even the tiniest things that happen towards the end of a patient’s life can have a huge and lasting affect on patients and their families feelings about their care.

 

“Guidelines like the LCP can be very helpful but healthcare professionals always need to keep in mind the individual needs of patients.

 

“There is no one size fits all approach.”

 

A spokesman for Marie Curie said: “The letter highlights some complex issues related to care of the dying.

 

“The Liverpool Care Pathway for the Dying Patient was developed in response to a societal need to transfer best practice of care of the dying from the hospice to other care settings.

 

“The LCP is not the answer to all the complex elements of this area of health care but we believe it is a step in the right direction.”

 

The pathway also includes advice on the spiritual care of the patient and their family both before and after the death.

 

It has also been used in 800 instances outside care homes, hospices and hospitals, including for people who have died in their own homes.

 

The letter has also been signed by Dr Anthony Cole, the chairman of the Medical Ethics Alliance, Dr David Hill, an anaesthetist, Dowager Lady Salisbury, chairman of the Choose Life campaign and Dr Elizabeth Negus a lecturer in English at Barking University.

 

A spokesman for the Department of Health said: “People coming to the end of their lives should have a right to high quality, compassionate and dignified care.

 

"The Liverpool Care Pathway (LCP) is an established and recommended tool that provides clinicians with an evidence-based framework to help delivery of high quality care for people at the end of their lives.

 

"Many people receive excellent care at the end of their lives. We are investing £286 million over the two years to 2011 to support implementation of the End of Life Care Strategy to help improve end of life care for all adults, regardless of where they live.”

 

 

[ivan]

i thought this was gonna be an organ donor thing?

[Jim]

Having just gone through the death of my best friend and climbing buddy for 20 years (brain cancer), I'd have to say that the Hospice folks were among the best health professionals I've ever come across. And they were a godsend to his folks, where he spent the last 6 months of his life.

[tvashtarkatena]

Yeah, the folks I've known who have died under hospice care couldn't speak more highly, er, when they were alive, that is, of the folks working there.

 

Well, it's a country of 300 million. If you want fringe bullshit of any stripe and you look hard enough, I'm sure you'll find it. For some, such as this poster, it's an avocation.

 

Now that there are about 1000 blogs per capita, this has become even easier.

Edited September 4, 2009 by tvashtarkatena

[olyclimber]

this is the worst Monty Python thread yet! where is dru? he knows EVERY line!

 

 

[video:youtube]2eMkth8FWno

[olyclimber]

YOU YELLOW BASTARDS! COME BACK HERE AND GET WHATS COMING TO YA!

[j_b]

Insurance claim denial death panels?

 

September 03, 2009

Brown Launches Independent Inquiry into HMOs' Handling of Health Insurance Claims

Los Angeles - Attorney General Edmund G. Brown Jr. today announced that deputies in his office are launching an independent inquiry into how Health Maintenance Organizations review and pay insurance claims submitted by doctors, hospitals and other medical providers.

 

This investigation is prompted by reports that California's five largest health-insurance providers are denying insurance claims at rates of up to 39.6 percent.

 

"These high denial rates suggest a system that is dysfunctional, and the public is entitled to know whether wrongful business practices are involved," Brown said.

http://ag.ca.gov/newsalerts/release.php?id=1797

[G-spotter]

this is the worst Monty Python thread yet! where is dru? he knows EVERY line!

 

 

[video:youtube]2eMkth8FWno

 

You got it wrong. it's repo man i know every line of.

 

Only one way to know of your girl really loves you... if she'll have your dog.

[olyclimber]

wow you two are more adventuresome than i thought!

[JayB]

Yes. The panel of physicians who have spent careers working in the NHS, and specialize in end of life care wrote that letter because they're vehemently opposed to...hospice care.

 

If we use the conventional meaning of each of the words contained in this passage below at face value:

 

"In a letter to The Daily Telegraph, a group of experts who care for the terminally ill claim that some patients are being wrongly judged as close to death.

 

Under NHS guidance introduced across England to help doctors and medical staff deal with dying patients, they can then have fluid and drugs withdrawn and many are put on continuous sedation until they pass away. But this approach can also mask the signs that their condition is improving, the experts warn.

 

As a result the scheme is causing a “national crisis” in patient care, the letter states. It has been signed palliative care experts including Professor Peter Millard, Emeritus Professor of Geriatrics, University of London, Dr Peter Hargreaves, a consultant in Palliative Medicine at St Luke’s cancer centre in Guildford, and four others.

 

“Forecasting death is an inexact science,”they say. Patients are being diagnosed as being close to death “without regard to the fact that the diagnosis could be wrong."

 

It's clear that what they are all implacably opposed to the very notion of...hospice care.

[olyclimber]

[video:youtube]4Kwh3R0YjuQ

[olyclimber]

"forcasting death"? i can see this socialist idea rapidly decaying into this:

 

[video:youtube]xSnLU9nyFSA

[j_b]

“Forecasting death is an inexact science"

 

except for the 20,000 americans who die every year for lack of access to healthcare and who don't get to die in hospices.

Edited September 5, 2009 by j_b

[tvashtarkatena]

Yes. The panel of physicians who have spent careers working in the NHS, and specialize in end of life care wrote that letter because they're vehemently opposed to...hospice care.

 

If we use the conventional meaning of each of the words contained in this passage below at face value:

 

"In a letter to The Daily Telegraph, a group of experts who care for the terminally ill claim that some patients are being wrongly judged as close to death.

 

Under NHS guidance introduced across England to help doctors and medical staff deal with dying patients, they can then have fluid and drugs withdrawn and many are put on continuous sedation until they pass away. But this approach can also mask the signs that their condition is improving, the experts warn.

 

As a result the scheme is causing a “national crisis” in patient care, the letter states. It has been signed palliative care experts including Professor Peter Millard, Emeritus Professor of Geriatrics, University of London, Dr Peter Hargreaves, a consultant in Palliative Medicine at St Luke’s cancer centre in Guildford, and four others.

 

“Forecasting death is an inexact science,”they say. Patients are being diagnosed as being close to death “without regard to the fact that the diagnosis could be wrong."

 

It's clear that what they are all implacably opposed to the very notion of...hospice care.

 

THe Daily Telegraph?

 

Heh heh...

 

Anyhoo, the fewer Brits out there the better.

[j_b]

California's Real Death Panels: Insurers Deny 21% of Claims

PacifiCare's Denials 40%, Cigna’s 33% in First Half of 2009

 

More than one of every five requests for medical claims for insured patients, even when recommended by a patient's physician, are rejected by California's largest private insurers, amounting to very real death panels in practice daily in the nation's biggest state, according to data released Wednesday by the California Nurses Association/National Nurses Organizing Committee.

 

CNA/NNOC researchers analyzed data reported by the insurers to the California Department of Managed Care. From 2002 through June 30, 2009, six of the largest insurers operating in California rejected 47.7 million claims for care -- 22 percent of all claims.

 

The data will be presented by Don DeMoro, director of CNA/NNOC's research arm, the Institute for Health and Socio-Economic Policy, at CNA/NNOC's biennial convention next Tuesday, Sept. 8 in San Francisco. The convention will also feature a panel presentation from nurse leaders in Canada, Great Britain, and Australia exploding the myths about their national healthcare systems.

 

"With all the dishonest claims made by some politicians about alleged 'death panels' in proposed national legislation, the reality for patients today is a daily, cold-hearted rejection of desperately needed medical care by the nation's biggest and wealthiest insurance companies simply because they don't want to pay for it," said Deborah Burger, RN, CNA/NNOC co-president.

 

For the first half of 2009, as the national debate over healthcare reform was escalating, the rejection rates are even more striking.

 

Claims denial rates by leading California insurers, first six months of 2009:

 

PacifiCare -- 39.6 percent

Cigna -- 32.7 percent

HealthNet -- 30 percent

Kaiser Permanente -- 28.3 percent

Blue Cross -- 27.9 percent

Aetna -- 6.4 percent

"Every claim that is denied represents a real patient enduring pain and suffering. Every denial has real, sometimes fatal consequences," said Burger.

 

PacifiCare, for example, denied a special procedure for treatment of bone cancer for Nick Colombo, a 17-year-old teen from Placentia, Calif. Again, after protests organized by Nick's family and friends, CNA/NNOC, and netroots activists, PacifiCare reversed its decision. But like Nataline Sarkisyan, the delay resulted in critical time lost, and Nick ultimately died. "This was his last effort and the procedure had worked before with people in Nick's situation," said his older brother Ricky.

 

Cigna gained notoriety two years ago for denying a liver transplant to 17-year-old Nataline Sarkisyan of Northridge, Calif. and then reversing itself, tragically too late to save her life.

[...]

 

 

California's Real Death Panels: Insurers Deny 21% of Claims

[Bug]

I just helped my mother through her last five weeks of life with the help of Hospice. Hospice prevented what otherwise would have been intense and protracted agony of the worst kind.

Get them involved if you have someone close to you who wants to die at home. It is very unlikely that you can do it without them.

 

Now please resume spray.

[tvashtarkatena]

JayB: All poignant analysis, no personal experience.

 

Remember, always trust an expert.

[ivan]

YOU YELLOW BASTARDS! COME BACK HERE AND GET WHATS COMING TO YA!

bet you're gay!

[olyclimber]

i am quite happy!

[G-spotter]

Are your moms gay?

Oh no, they hate each other.