Hospice patients are being quietly killed as Medicare incentivizes ‘stealth euthanasia’

(LifeSiteNews) — A bombshell report was released this year evidencing a scandal that ranks among the worst in its evil: the euthanization of patients for the sake of profit. It made enough of a splash to spur new industry protocols but apparently not enough to stop the entrenched practice of hastening the death of hospice patients. 

The November 2022 report, written by Ava Kofman for ProPublica, shows how hospice conditions create what seems to be an irresistible — and ultimately lethal — opportunity for corruption: The industry rakes in massive funds from Medicare, which delivers a flat daily cash benefit, but hospice groups must repay those funds if the average length of stay of all patients exceeds six months.

An investigation cited by Kofman’s article found that half of hospice patients in a random sample were ineligible for some or all of the care they received, a problem consistent with the testimony of hospice whistleblower Marsha Farmer. She told Kofman how her supervisor set “ungodly” quotas for hospice enrollment, and then threatened to fire employees if they didn’t meet those quotas.

Such hospice patients were “ineligible” because they weren’t near death, as Farmer testified from her own experience. This begs the question: If such patients who are not near death are being brought in for Medicare funds, and these funds must be repaid if patient stays run too long, how do these profit-driven hospices keep their cash flow going?

“One tactic was to ‘dump,’ or discharge, patients with overly long stays,” Kofman reported. But some hospices used more sinister methods.

One hospice group in Frisco, Texas was caught by the FBI trying to avoid repayment to Medicare by killing its hospice patients. The hospice owner reportedly instructed staff to overdose patients who were living “too long.” One of his disclosed texts to a nurse read, “He better not make it tomorrow. Or I will blame u.”

Even when patients aren’t “actively” killed, ineligible ones can easily be led to their death, because one of the conditions of hospice is forgoing curative care — care that non-dying patients need to treat illness.

Anecdotal reports indicate that even since congressional hearings this past March that aimed to address problems with hospice profiteering, suspiciously sudden deaths of hospice patients remain a problem.

An Indiana resident known to LifeSiteNews who would like to remain anonymous (referred to here as Sarah) recently shared her concern that a hospice group was responsible for the sudden decline and hastened death of a dear friend of hers who suffered from brain cancer.

While the cancer was terminal, the pace of his decline and its accompanying heavy sedation raised red flags for Sarah. Not long before his death, she said, he was singing in ICU. A few days later, on a Thursday, she said he was alert, talking a little, and eating pureed food. The next day, Sarah found him heavily sedated, and six days later, with continuing sedation and no food or water (it is typical of hospice groups not to provide IV hydration), he was dead.

She said she had a friend warn her that this particular organization, which is one of the growing for-profit hospice groups, “overmedicates” and “hastens end of life,” and she shared that a few locals have also seen the “rapid demise” of relatives with the organization, while others had a better experience when they could monitor their relative at home.

“The staff people were actually nice and I think they feel they are easing pain and helping to end the life kindly,” Sarah said. 

Sarah’s friend just so happened to be in the care of a hospice organization that as of 2016 was undergoing investigation by the FBI. The investigation is sealed, and it is not clear whether it is still ongoing.  

“In our society, we use hospice once or twice, with no preparation, and nobody is educating the public how to choose a hospice. There seems to be no rating system.  Word of mouth seems the only way to learn,” Sarah told LifeSiteNews.

Ron Panzer, president of Hospice Patients Alliance, has worked for decades for hospice reform in the face of what he calls “stealth euthanasia,” a practice that now appears to be often culturally acceptable in the hospice movement.

In fact, according to Panzer, much of the modern American hospice movement is essentially an outgrowth of the euthanasia movement. Panzer has pointed out to LifeSiteNews that the National Hospice & Palliative Care Organization is a successor of Choice in Dying, which was in turn an outgrowth of the Euthanasia Society of America. Choice in Dying was merged by Dr. Ira Byock into a group called Partnership for Caring, which later became the Last Acts Partnership.

According to Panzer, Byock is one of the most influential hospice and palliative care physicians in the country. Among other contributions to the industry, Byock helped launch the American Academy of Hospice and Palliative Medicine, serving on its ethics committee as well as on the board of directors from 1990 to 1996, and serving as its president in 1997.

Panzer told LifeSiteNews that Byock “is the guy who took the wonderful, life-affirming pro-life mission of hospice and brought the euthanasia people directly into the hospice movement. And he has personally tainted the industry.”

In fact, Byock’s writings give an example of how a pro-euthanasia outlook has quietly seeped into the hospice movement. Interestingly, while Byock formally opposes “physician-assisted suicide,” he in fact endorses euthanasia by another name, by promoting terminal sedation to death in hospice, as well as the voluntary refusal of food and fluids to commit suicide in hospice.

Byock and fellow researcher T.E. Quill wrote in a paper on the subject, “These two practices allow clinicians to address a much wider range of intractable end-of-life suffering than physician-assisted suicide (even if it were legal) and can also provide alternatives for patients, families, and clinicians who are morally opposed to physician-assisted suicide. 

According to Panzer, Byock also promotes euthanasia in his book 1997 Dying Well, which Byock touts as a “standard in the field of hospice and palliative care.”

In the book, Panzer said, Byock talked about terminally sedating patients. Byock describes in his book a conversation in which he told the patient, ‘if things get too bad, I can sedate you and you just die.’” He discussed sedating people with morphine and ativan as they die of dehydration and respiratory failure. 

“This is stealth euthanasia,” Panzer said, “it is undeclared, it’s evil. It’s the antithesis of the Christian, pro-life hospice mission that [Dame] Dr. Cicely Saunders created in the 1960s.” 

Saunders strongly opposed euthanasia on the basis of her Christian faith, instead arguing for effective pain control. According to Panzer, some of the hospice movement maintains Saunders’ pro-life principles, but the industry has effectively split into two parts: one reflecting the secular humanism of Byock, and one reflecting the Christian outlook of Saunders.

Panzer has pointed out that the lessening influence of Christianity and increasing prevalence of secular humanism in the Western world has allowed stealth euthanasia to take hold in hospice. Without a firm belief that only God has the right to take away life, the belief that euthanasia is needed to put an end to severe suffering is easily adopted. 

For hospice managers without a personal relationship to the ill or dying, secular humanism also enables an unscrupulous business mindset that puts a price on a person’s worth — especially if that person is literally bringing their hospice money via Medicare.

In his book on the stealth euthanasia, available online through an archive, Panzer explains how Medicare funds incentivize stealth euthanasia in a subsection entitled “Medicare/Medicaid Hospice Reimbursement Cap & Hastening Death.”

He explains that because Medicare funds are capped after a patient is in hospice for six months, “rogue hospices” — like the above-mentioned one in Frisco — that “see the reimbursement cap as an obstacle to their profit … often will not discharge” the patient.

Instead, “they often will end the life of the patient once their usefulness as a reason to bill for reimbursement ends (the cap is reached). When no more money is coming in for a particular patient, the rogue hospice sees the patient as a net-negative and acts accordingly. New patients, who are readily available, start the flow of money again, often the same day.”

In another subsection entitled Hospice Reimbursement: Is It a Problem?, Panzer lists different methods “rogue” hospices use to kill patients:

“When they make sure that some innocent patients will be medically killed (by using staff training to misinform them about the effects of medications), encouraging the casual administration of morphine to COPD patients, not allowing oxygen for patients who need it, encouraging staff to remove needed medications from the patients they admit or to terminally sedate the patients, or actually sending “closers” to end their lives, they never let the public know what really is going on.”

While the bombshell ProPublica report inspired an attempt at Medicare reform in January, the protocol changes don’t target the main incentive to stealth euthanasia: the Medicare funding of hospice together with the time-limited caps on those payments.

In fact, a report on the newly revised Medicare rules indicates there may now be an increased incentive to stealth euthanasia. 

“An unusually high rate of live discharges could indicate that a hospice provider is not meeting the needs of patients and families or is admitting patients who do not meet the eligibility criteria,” the revised rules note, according to ProPublica. 

Extra attention to high discharge rates without properly checking inappropriate patient intake from the beginning will only motivate unethical hospice providers to continue to take on ineligible patients and make extra sure they’re dead before the six-month mark.

Reform starts with a well-informed, vigilant populace, and to further this end, Panzer recommends the patient Advocacy group HALO, which works to inform and equip patients and/or their loved ones in the face of stealth euthanasia. The group urges patients, for example, to “interview” to doctors and ask them two critical questions:

• Do you view nutrition and hydration as basic care to which every patient is entitled for as long as it will sustain life and/or is beneficial to the patient?
• Do you reject the intentional causing of the deaths of patients, even if they request assisted suicide or euthanasia, and believe that no class of human beings (e.g., the sick, disabled, elderly, poor, preborn) ought ever to be deprived of life for the benefit of other individuals or society?

Panzer writes regarding “true reform” in hospice in his book on stealth euthanasia:

“As we have seen before, efforts to increase revenue (undertaken by HMOs, for-profit corporations and even non-profit health care corporations) or reduce government expenditures, twist the provision of health care into something that uses patients as a means to a financial end, something completely contrary to what is beneficial to the patient. Paying for a lethal agent to end a patient’s life is much cheaper than providing a full range of hospice or palliative care services until the patient dies a natural death.”

While the Medicare funding and cap is not conducive to ethical hospice practice, Panzer recognizes that a cultural shift is also important for reform:

“Big government is part of the problem, as are many big corporations that have forgotten the customers (patients) they serve … But the answer rests in all of us. The people in government, the people in the corporations and the people wherever they live. The choices we make, wherever we are, matter. The people are the answer.”

“We need to establish strong families, extended families and ‘blessed communities’ that can support and care for each other especially in the tough times that many are going through, in the tough times that may come in the future. And out of such strong families, extended families and communities will arise strong individuals, leaders who can create true reform of health care or government, whatever shape they assume as time moves forward.”