Category: Politics and Law

Covering news of legal cases, reform, entitlement programs and political issues surrounding the end of life.

May 21, 2013

Illinois Senate approves nation’s strictest medical marijuana law

In what is being called the strictest medical marijuana law in the nation, Illinois lawmakers have agreed to legalize the drug for some terminally ill patients.

Only physicians with existing relationships with certain patients could prescribe the drug, and patient background checks are mandatory. Patients would not be allowed to grow their own marijuana or use the drug around minors or in public. “What this would set up is a four-year trial program for patients who have an established relationship with a doctor and who can demonstrate that they need this to ease symptoms and take them out of pain,” WGN-TV reports.

The bill also sets a 2.5 ounce limit per patient per purchase from 60 state regulated dispensaries. Illinois will license about 20 growers.

“This bill is filled with walls to keep this limited,” said Democratic Sen. Bill Haine, The Chicago Tribune reports.

The bill now heads to Gov. Pat Quinn, who has remained tight- lipped about whether he will sign the bill into law, saying only that he is “open minded” about the issue. Lt. Gov. Sheila Simon, a former prosecutor, said that after meeting with patients, she favored the plan, The Associated Press reports.

“We are embarking here on a way to achieve relief, compassionate relief, consistent with the law (with) a system which avoids abuse,” Haine said. “It’s the tightest, most controlled legislative initiative in the United State related to medical cannabis.” The Senate vote was 35-21, with five more than needed for passage.

“At the end of the day, we’re talking about a plant,” said Sen. William Delgado, a Democrat from Chicago.

But not all lawmakers are pleased with the legislation. ”For every touching story that we have heard about the benefits of those in pain, I remind you today that there are a thousand times more parents who will never be relieved from the pain of losing a child due to addiction, which in many cases has started with the very illegal, FDA-unapproved, addiction-forming drug you are asking us to make a normal part of our communities,” said Republican Sen. Kyle McCarter before the vote. His daughter died in 2006 from a drug overdose.

According to the bill, “Modern medical research has confirmed the beneficial uses of cannabis in treating or alleviating the pain, nausea, and other symptoms associated with a variety of debilitating medical conditions, including cancer, multiple sclerosis, and HIV/AIDS,” citing a 1999 study published by the National Academy of Sciences’ Institute of Medicine.

“Medical marijuana works really well for hospice patients,” said Dr. Matthew R. Sorenson, an associate professor at DePaul University’s School of Nursing. “Based off my research, I think this type of bill has a lot of potential. Marijuana has a lot of benefits for other patients, especially for those suffering from MS or chronic nausea.”

Vermont votes to allow “Death with Dignity”

The Vermont House approved a measure allowing physicians the ability to prescribe life-ending medications to some terminally ill patients seeking to end their lives. Vermont is set to become the fourth state allowing the legislation known as ”Death with Dignity,” following Oregon, Washington and Montana.

The Patient Choice and Control at End of Life Act awaits approval from Gov. Peter Shumlin, a Democrat and supporter of the bill.

“By a 75-65 roll call vote, the House approved a bill largely that copies a law passed by Oregon voters in 1997 for three years and then shifts to a system with less government monitoring,” The Associated Press reports.

This marks the first time this type of legislation has been moved to passage by a legislature. With safeguards similar to the Oregon bill, patients seeking the prescription barbiturates must first state their intentions three times- once in writing. A second opinion from a physician indicating a patient has less than six months to live and proof of sanity, are mandatory. Patients must wait 48 hours before filling the prescriptions.

“It’s an important step for terminally ill Vermont patients,” Dick Walters, president of Patient Choices-Vermont, said after the vote. “It’s a big step forward for the region and for the country as a whole,” the AP reports.

Come 2016, changes advocated by some of the state senators seeking less government involvement during the process will go into effect, including less monitoring from physicians.

“It’s huge,” said lobbyist Michael Sirotkin, who for years has been involved with the issue in Vermont. “I think it’s going to have a major effect on other states’ willingness to vote on this,” he told USA Today.

But not all lawmakers approved of the bill’s passage. ”There can never be a dignified death using a handful of pills or a lethal cocktail,” said Rep. Carolyn Branagan, a Republican from Georgia, VT.

Other opponents were concerned about the radical changes the bill underwent while in the Senate. ”We are passing a bill that has not been vetted,” said Rep. Paul Poirier, an Independent from Barre. “Do we want to pass a bill … just accepting 100 percent what the Senate did overnight?”

Death with Dignity: Vermont House to vote amended end of life bill

The Vermont House will soon vote on a more stringent version of the Senate legislation known as “Death with Dignity.” The House legislation would grant physicians the ability to prescribe life-ending drugs to some terminally ill patients; however, the bill has more caveats, such as mandatory hospice enrollment.

Several weeks ago, the Senate whittled down its 22-page bill to just two pages, simply granting doctors immunity from prosecution for supplying life-ending drugs to any terminally ill patient with less than six months to live.

But with a 7 to 4 vote, the House Human Services committee backed a new bill restoring much of the process the Senate version eliminated, such as the requirements for both oral and written requests, and a 48-hour waiting period before filling a prescription. Furthermore, it requires every prospective patient to have an advanced directive and be enrolled in hospice, VPR’s Bob Kinzel reports.

“We have all of the safeguards that they have in Oregon. We have a 15-year track record in Oregon with this law,” said Rochester Rep. Sandy Haas, a Democrat who helped overhaul the Senate’s bill.

Oregon mandates patients verbally request life-ending drugs to their physicians, followed by a 15-day waiting period and then another verbal request. Patients also must submit written requests. Then, they wait 48-hours before picking up the barbiturates.

“That bill was about doctors. The bill we passed this morning is about patients,” Haas said. “The Senate bill purports to be immunity for doctors for malpractice, basically for misprescribing, for confusing patients about what happens.”

Republican Rep. Anne Donahue from Northfield, said she worries the new version will make it easier for families to coerce loved ones into committing suicide. “A person can then wait a month or two or three or more before actually taking (the drugs),” Donahue said. “And at that point there’s absolutely no protection about coercion, family pressures, financial pressures and even whether a person still has the capacity to make that decision.”

Donahue said she favors how the Senate version limited the ability of the state to intervene once an individual committed to end his or her life. “I think that the direction that the Senate went made a huge amount of sense and didn’t have the intrusion on rights and the intrusion of the state actually sanctioning suicide,” Donahue said.

A possible vote is set for Tuesday. If passed, the bill would be kicked back to the Senate for a vote. This is the farthest this Oregon-style legislation has advanced in Vermont. Last year, a bill came before the full Senate, but it failed.

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Google “Death Manager”: A will for your digital data

Being a friend to someone sick: Advice from author Letty Cottin Pogrebin

Keeping the dead among us

April 8, 2013

Community cancer clinics turning thousands of patients away

Image: Flickr, TipsTimes via Creative Commons,

Many U.S. cancer clinics have started to turn away thousands of patients due to the sequester’s cuts to Medicare.

As The Washington Post’s Sarah Kliff reports, some oncologists say the reduced federal funding makes it impossible for community clinics to administer expensive chemotherapy to seniors and remain financially stable. These patients must now seek treatment elsewhere, even as hospitals accepting Medicare beneficiaries grow more overcrowded.

Jeff Vacirca, chief executive of North Shore Hematology Oncology Associates in New York, told Kliff, “If we treated the patients receiving the most expensive drugs, we’d be out of business in six months to a year.” Vacirca said his clinics have stopped administering drugs on which they lose money. His clinics have also ceased to treat one-third of their 16,000 Medicare patients.

Pancreatic cancer patient Harold Rosen, 81, has been receiving chemotherapy at one of Vacirca’s cancer centers, but sequester cuts will soon change that.

“When I first came here, I was afraid to come because everyone’s dying. But everyone here is so pleasant. They smile, they laugh, they care about you. You would never know it’s a place of cancer,” Rosen said to NBC News. Rosen’s physician told him he must start receiving treatment in a hospital.

Vacirca said he is sad to turn away patients like Rosen, but he insists he must.”I have to be financially responsible to be here,” he said. “I owe it to my patients to not go out of business.”

Although Medicare is only facing a 2 percent reduction in funding- much less than other federal programs- oncologists say cancer patients are losing the most.

Seniors’ medications are mostly covered under the optional Medicare Part D. However, cancer drugs must be administered by physicians, and they are paid for by Medicare Part B. Part B covers doctor visits and is facing the sequester’s cuts.

According to Kliff, “The federal government typically pays community oncologists for the average sales price of a chemotherapy drug, plus 6 percent to cover the cost of storing and administering the medication.” But physicians cannot change drug prices, so the 2 percent cut will have to come out of the 6 percent cover charge- “akin to a double-digit pay cut” for clinics.

A recent survey of more than 300 oncology practices by the Community Oncology Alliance determined that 72 percent of them will change how they treat Medicare patients if the cuts continue.

The Alliance has pledged to “fight this unjust and devastating cut to cancer care” with an online petition.

A Milliman report shows that half of all U.S. cancer spending is associated with Medicare beneficiaries. Chemotherapy in hospital settings costs the federal government about $6,500 more than treatment in community clinics does. Some of those costs are then handed to patients, who pay another $650.

Will hospitals be able to absorb these patients? The same study shows almost 70 percent of Medicare patients receiving chemotherapy are treated in community clinics. Clinics in Connecticut, New York and South Carolina have already stopped treating patients.

What is the sequester?

In 2011, Congress passed a law stating that if no legislation was passed to reduce the federal deficit by $4 trillion, some $1 trillion in automatic budget cuts would take effect in 2013.

Learn more from the Life Matters Media Newswire:

Dementia more costly than cancer, will become more common

Connecticut assisted suicide bill finally gets a hearing

April 1, 2013

Connecticut assisted suicide bill finally gets a hearing

For the first time in Connecticut’s history, the General Assembly’s Public Health Committee allowed a legislative hearing about a physician-assisted suicide bill.

H.B. 6645 aims to allow physicians the ability to prescribe life-ending medications at the request of mentally competent, terminally ill patients. Patients would have to self-administer the drug.

Connecticut’s CBS affiliate reports that because Democratic State Sen. Ed Meyer of Guilford received so many phone calls supporting “Death with Dignity,” he chose to author the bill, which he insists is both compassionate and cautious.

“The bill that we’re hearing today, for example, requires two different physicians to certify under oath that the person is terminally ill, likely to die within six months and is mentally competent to make an informed decision about ending his or her life,” Meyer told WCBS 880.

Washington, Oregon and Montana have already approved the legislation known as “Death with Dignity.”

“If the legislators see the bill as providing a choice, an intelligent choice for people making an informed decision to end their life and end the misery and pain they’re going through at the end of life, I think the bill will go forward,” Meyer said.

However, the bill faces strong opposition from religious and social organizations, such as the Family Institute of Connecticut and Second Thoughts Connecticut. Such opposition could hold-up the bill’s passage.

“We will be killing our vulnerable parents and grandparents through public policy,” said Teresa Wells, a nursing home administrator, according to the Hartford Courant.

The Catholic Church has also been a vocal critic. The Church cites the lack of wait time between the necessary oral and written requests for drugs. Other states require a 15 day wait.

Meyer said he remains open to suggestions.

Proponents of the bill argue it would ensure individual freedoms at the end of life. “The deep yearning for increasing autonomy for patients themselves to have a voice, I think now it’s reaching a tipping point all across the world,” Compassion and Choices’ Barbara Coombs Lee told CBS. “I think the Baby Boomer generation has something to do with that.”

A similar bill was proposed in 2009, but it failed to garner a hearing. Connecticut has banned assisted suicide since the late 1960s.

Read the bill at Connecticut’s General Assembly Web site

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LMM co-founder Randi Belisomo interviewed by the Association of Health Care Journalists

More male caregivers emerge as demographics shift

As Americans live longer, organ donations suffer

March 19, 2013

GSN’s David Goldhill: “American health care killed my father”

Game Show Network President David Goldhill says it was the American health care system that killed his father, not the pneumonia for which he sought treatment at a New York City hospital. He addressed the need for health care overhaul at last weekend’s Association of Health Care Journalists conference in Boston.

Goldhill’s newly released book, Catastrophic Care: How American Health Care Killed My Father- and How We Can Fix It, outlines his helplessness in watching his father acquire a hospital-borne infection and subsequent five-week stay in the ICU. Goldhill argues his death, at 83, was entirely preventable and all too painful for both his father and family.

“If you’ve had a loved one die in the hospital, you’ve likely seen someone tortured to death,” Goldhill said to room filled with journalists. His argument is based in his belief that the health care industry fails to adopt cost-saving, life-saving ideas because the incentives in the business are “fundamentally broken.”

Americans, Goldhill argued, have learned to accept medical mistakes as inevitable, whereas in the restaurant industry, eateries can be shut down after one meal served tainted with something suspicious- often of dubious origin.

“In hospitals, we took the most personal, heterogeneous, important service and we have made it impossible- impossibly expensive, impossibly complex and completely lacking in accountability,” Goldhill said.

His father’s death was one of more than 200,000 each year due to medical error, and his gargantuan medical bill was covered by Medicare. One of Goldhill’s many sources of anger is how a failing product- the health care delivered to his father- could be compensated in full. He writes that high costs, over treatment, bad service and error are the inevitable consequences of an insurance-based system.

Americans typically have more coverage than they need at any one point, and Goldhill cited one of his 23-year-old full-time employees. If she marries, has two children, and her income grows annually at 3 percent, that woman will pour $1.8 million into the health care system- more than her family will likely ever use.

“It’s time to hold this industry accountable to standards of service, quality, consistency and value, and then it will start to change.”

Goldhill said the average healthy senior spends $5,500 each year on health care. “The amount of health care (seniors) are getting is genuinely frightening,” he said.

It is estimated that ten percent of the American population assumes 70 percent of the care, and Goldhill used this statistic to bolster his claim that “we define the whole system on the basis of the most extreme cases.”

How can the health care system change?

Goldhill argued that the Affordable Care Act will not fix the problem. National insurance does have a role, but for catastrophic events only. In other cases, individuals should use health care savings accounts to pay for other things, like routine exams or management of chronic conditions. Goldhill acknowledged such a change will take some time, likely two generations, and will only come about if prices come down.

Prices would drop, he said, if the industry would reorganize itself to serve consumer needs. This reorganization would happen if resources that currently pay for non-catastrophic events transfer to health savings accounts.

As an example, Goldhill cited the development of the personal computer. In its advent, the computer was one of the most expensive products for sale. It’s initial $18,000 cost translates today to roughly $200,000. “If someone had said to you back then that within a few decades, we would have one in every pocket, it would have been an argument for greater spending in mental health,” an amused Goldhill said.

But it happened. Why? “We created billionaires out of people that have figured out how to make them simple, accessible and cheap,” Goldhill answered.

The same, he said, could be true for health care.

“It’s time to hold this industry accountable to standards of service, quality, consistency and value, and then it will start to change.”

-Randi Belisomo

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Don Berwick on the ‘rhetorical nonsense’ of ‘death panels’: an interview with LMM

Geriatrician shortage unlikely to be remedied

What is your ‘Medical Mindset?’: Dr. Groopman suggests you define it

March 18, 2013

Don Berwick on the ‘rhetorical nonsense’ of ‘death panels’: An interview with LMM

Don Berwick, former administrator of the Centers for Medicare and Medicaid Services, addressed the need to better control health care costs in a panel at the Association of Health Care Journalists’ conference in Boston. Afterwards, he spoke with LMM about the political firestorm that erupted as a result of his proposals for end of life counseling.

Berwick, influential in the Affordable Care Act plan that would have allowed for Medicaid coverage of a doctor-patient discussion about end of life care, said he was outraged his ideas would be labeled “death panels” by many on the political right. The Harvard University trained physician resigned in 2011 from his CMS post due to heavy Republican opposition.

“To think about the suffering and the disrespect that nonsense had for people in the terrible stages in their life,” Berwick recounted. “They need compassion, they need the help, they need plans, they need to be together, and this rhetorical nonsense- with no basis in science at all- hurt thousands,” he said.

Berwick said he does not know why that accusation caught on in the political and media dialogue. “I wish in my dreams that the communities in America had risen up and said, ‘Nonsense, no you won’t seize this terrain with rhetoric that makes no sense at all,’” Berwick said.

Despite support from many medical professionals and fellow Democrats, President Obama dropped Medicare funding for end of life counseling from the Act. When it was signed into law in 2009, Democrats wary of being identified with “death panels” dropped all proposals associated with end of life planning.

According to Politifact, a Pulitzer Prize winning fact checker, comparing end of life counseling to “death panels” was 2009′s “Lie of the Year.” Former vice presidential candidate and Alaska governor Sarah Palin was the first to coin the term “death panels” on her Facebook page after the release of an early draft of the Act.

Politifact notes: “This falsehood, our 2009 Lie of the Year, started after an early draft of the bill sought to allow Medicare to pay for doctors’ visits in which patients discussed end-of-life care, such as living wills. The critics labeled it suicide counseling.”

Berwick said he does not envision Republicans embracing the Affordable Care Act anytime soon. “This isn’t about the Affordable Care Act, it’s about a much deeper rift in American public belief in policy,” he said. “It’s the field of battle but not the reason for the war,” he said.

Berwick, who has an exploratory committee looking into a possible run for governor of Massachusetts, did not confirm or deny intentions to enter the race, despite repeated questions from journalists.

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Geriatrician shortage unlikely to be remedied

What is your ‘Medical Mindset?’: Dr. Groopman suggests you define it

March 15, 2013

Illinois POLST form released to public

The POLST Illinois Task Force with the Illinois Department of Public Health announced the release of the new Illinois Department of Health Uniform DNR Advance Directive, known as the POLST form.

POLST was developed in Oregon in the 1990s, and now 14 states have POLST programs. Twenty-eight states are considering the use of POLST forms.

POLSTs are more detailed than conventional living wills or advance directives. They allow patients to indicate preferences regarding resuscitation, intubation, intravenous antibiotics and feeding tubes. Such forms are intended for patients in their last year of life, and they can follow patients across care settings and direct doctors to provide or withhold lifesaving treatment.

Learn more about the Illinois POLST

Would a POLST form have prevented the Bakersfield CPR drama?

POLST Illinois moves forward

POLST coming to Illinois

February 27, 2013

Washington POLST form: A new bill aims to close loophole

Medical orders for terminally ill patients and seniors in Washington state are sometimes ignored, due to a loophole that intimidates caregivers and assisted-living facilities from following the POLST form, Physician Orders for Life Sustaining Treatment. Last week, a Senate health care committee approved a bill that would guarantee protections to caregivers who follow patients’ POLST and remedy this problem.

POLST, first developed during the 1990s in Washington and now used in 14 states, indicates orders for emergency medical providers. Patients with this form may choose to forgo medical treatments, such as CPR and antibiotics, and indicate comfort care preferences. The neon colored form, which must also be signed by a physician, exempts medical providers who follow such orders from liability.

However, last year, the Department of Social and Health Services sent a letter to adult care centers warning they may have no legal protection for following their patients’ POLST.

“Since the POLST is intended for emergency medical personnel, there are issues related to legal immunity for others to follow the POLST directions,” the letter from Joyce Pashley Stockwell, director of residential care services, read.

Since then, some patients in assisted-living facilities have been resuscitated against their wishes by caregivers who fear being held liable.

The Seattle Times reports 12 of the state’s 39 adult care centers told workers they must do CPR, even on residents with POLST forms specifying that they do not want resuscitation.

“Based on my experience, the POLST has been an essential tool for our sickest and oldest patients when they make it clear they want death to occur naturally at home,” Debra Everson of the Adult Family Home Nurses’ Association told the Senate health care committee. “Many of the patients have made it abundantly clear they never want to return to the hospital — but some of the residents’ decisions to refuse CPR and die a natural death are being disregarded,” the Times reports.

If approved by the full Legislature, SB 5562 would extend POLST protections to include assisted-living facilities and nursing homes. But the bill’s fate is unclear, as recent attempts to expand the POLST have been stymied in committee.

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Projects get people talking about end-of-life

An OP-ED for PBS: Inequalities in the health care system

Texas bill would clarify end-of-life treatments

February 21, 2013

Montana HB505: Outlawing assisted suicide

Montana lawmakers are considering a controversial bill to outlaw physician-assisted suicide, a decision that opponents say would punish doctors for honoring their dying patients’ wishes. If the bill passes, physicians who provide life-ending drugs could face 10 years in prison and a $50,000 fine.

Introduced by Rep. Krayton Kerns, a Republican, HB505 seeks to clarify “the offense of assisting in suicide,” after a 2009 Montana Supreme Court decision left many confused about the issue.

Known as the Baxter Decision, the court ruled physicians that prescribe life-ending drugs are safe from prosecution, because “nothing in Montana Supreme Court precedent or Montana statutes [indicates] that physician aid in dying is against public policy.” However, the decision did not address whether assisted suicide is a right guaranteed under the state Constitution.

Kerns insists the ruling needs clarification. ”The Baxter Decision did not establish legal assisted suicide in Montana, and this has remained a gray area,” Kerns told the Great Falls Tribune. ”This bill would be a legislative declaration saying it is illegal based on constitution principles.”

According to the bill, “A person who purposely aids or solicits another person to commit suicide, including physician-assisted suicide, commits the offense of aiding or soliciting suicide.” Consent of the patient would not be a defense. However, withholding life-sustaining treatments from terminally ill patients would remain legal.

Critics argue the bill would curtail patients’ end of life choices. Opponent Bonnie Warne of Billings told the Billings Gazette that doctors who provide life-ending drugs to their patients would be unfairly attacked. “Death is inevitable and private. We do not need the state interfering with aid in dying,” she said.

Dan Lourie, from Bozeman, wrote a letter to the Montana Standard arguing that if the bill passes, he would be forced to forfeit his doctor-patient privacy. “My position is that my end-of life choices should be between me and my doctor, and the Montana Supreme Court agrees with me,” he wrote. “It should be my right, and certainly will be my desire, to discuss all of my choices with my doctor — treatment options, my choice to refuse treatment, pursuit of comfort care and assistance in dying.”

Compassion and Choices, a non-profit that serves to expand end of life options, maintains the bill would “roll-back” end of life legislation.

“HB505 goes beyond just prohibiting aid in dying by putting a physician at risk of prosecution for answering a patient’s questions about any of a variety of death hastening options, such as directing deactivation of a cardiac device, directing withdrawal of a ventilator or feeding tube, or provision of palliative sedation; and a spouse, child or friend could be prosecuted for driving the patient to the doctor’s office for the discussion,” a statement posted on their Web site read.

If the bill were to pass, palliative care would still be allowed for terminally ill patients, because palliative care serves to manage pain and ease suffering.

Hearings about the bill began this week.

Learn more from the Life Matters Media Newswire:

Texas bill would clarify end-of-life treatments

Combating malnutrition: Nine percent of seniors suffer

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