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Do Not Resuscitate: A Story of Medical Discrimination and Dehumanised Aged Health Care
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Introduction |
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| This is the story of the final 6 weeks of my
father's life. It is a story of modern health care, as constructed by our
politicians and bureaucrats, and their desire to reduce costs by refusing
to treat the elderly and chronically ill. It is a story of Do Not
Resuscitate orders (DNR orders) and medical rationing. It is a story of
callous coercive tactics employed by medical staff to impose financially
based health care decisions upon patients and their carers. But most of
all it is a story of human suffering and helplessness and dehumanised
modern health care for the elderly. It is a story of the dramatically different aims of a
family who wish to minimise the suffering of a father and husband, as
compared to the aims of medical staff who seek to utilise the quickest and
cheapest option.
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Dad's Story - His Final Six Weeks |
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The Beginning of the EndOn Friday the 23rd of June 2006 I visited my 91 year old dad in the nursing home where he had been for the past couple of years. He was frail, and had been unable to walk for some time, but his mind was alert and we enjoyed much time together during his stay in the nursing home. On that Friday he enjoyed very much some food that I took in for him, and also enjoyed very much looking at some old family photos which I showed him. Even though some of these photos were more than 70 years old he remembered the faces and reflected on days gone by. He was happy. He always enjoyed reminiscing about old times. As we parted company that day I felt happy about the time we shared together. I did not know what was in store for us both over the next 6 weeks. The next day, early in the morning on Saturday the 24th of June, I received a phone call from the nursing home informing me that dad had some kind of sudden attack and could not talk or swallow and was having trouble breathing. I rushed to the nursing home to meet the ambulance which was arranging to transfer dad to St George Hospital where he would spend the remaining weeks of his life. Upon arrival at the hospital dad was quickly admitted to the emergency ward where his breathing problems were quickly attended to. The care level was quite prompt and efficient and as dad's acute distress was relieved they began to assess his condition and its cause. It was not long before they advised me they thought dad had suffered what they termed a "mini stroke" which had effected his throat and his ability to talk and swallow. They also said they suspected he had aspiration pneumonia caused by food and drink going into his lung because his throat was not working correctly. Nil By Mouth and Do Not Resuscitate Orders - Modern Aged Health Care?Subsequent tests confirmed the diagnosis and a strict NIL BY MOUTH order was placed on dad. I was advised that if dad had anything at all by mouth, even a glass of water, the results may be fatal either because it would choke him, or if this did not occur, he would get aspiration pneumonia. These facts were emphasised to me. Stopping all oral intake and treatment for the pneumonia were successful in relieving dad's acute distress and I was soon advised dad would be admitted to a hospital ward where he could be further evaluated and his throat function and prognosis further assessed. Before leaving the emergency ward I spoke with the attending doctor who asked me if I was aware that a Do Not Resuscitate Order (DNR Order) would be placed on dad so if there was some emergency like heart failure he would not be revived. This was the first time this term was applied to dad although I was familiar with the term from previous research I had done (see Medical Rationing). Upon admission to the ward dad's treatment continued. Since the nil by mouth rule was strictly adhered to he was maintained with an intravenous drip to supply him with fluid, glucose, electrolytes, and antibiotics if necessary. Although this drip contained no protein or vitamins it was his sole source of nourishment. I expressed my concern to doctors about dad's nutritional status but they advised me that it does no harm to go a few weeks without food. This surprised me since everyone knows about the so called "RDA's" or minimum daily requirements for essential nutrients. Scientists and nutritionists tell us that if we do not have adequate levels of these vital nutrients everyday then we become ill but in spite of this I am now told by doctors that no nutrition at all (except for fluid and electrolytes) is quite acceptable for a few weeks. Up until this point I had never heard of a minimum weekly requirement (MRW or RWA) for vital nutrients - perhaps this is part of modern health care!! My point here, and one that should be remembered throughout this story, is that the treating doctors adopted a very casual attitude to dads nutritional status. There was no urgency about his lack of nutritional intake. After a few days of hospitalisation an attempt was made to feed dad with a nasogastric tube inserted in his nose and going into his stomach. This type of tube is very uncomfortable and as a result dad removed this tube himself. Apparently this is very common with this type of tube because of the discomfort it causes. I was advised that there was no urgency because dad was being maintained adequately with his intravenous drip and there was a chance his throat would improve so that he could swallow again. Although further attempts were made to insert the nasogastric tube, dad subsequently removed it each time. The First Two Weeks of Starvation - Food for ThoughtSo this continued through the first 2 weeks of dad's hospital admission. Medically there was no urgency about dad's condition because they considered he was adequately maintained on the intravenous drip. Additionally, so I was advised, people who suffer this type of mini stroke effecting the throat commonly regain sufficient throat function within 2 weeks to be able to swallow and eat again. The only other feeding option for dad was a so called PEG tube inserted directly in the stomach but I was advised they would not consider this option for at least 2 weeks after the stroke because statistics show some people recover normal throat function in this 2 week period therefore making this operation unnecessary. So in this first two weeks there was no urgency. Nutrition was not important. It was a waiting game. Wait and see if the statistics are correct. Wait and see how he endures the malnutrition. Wait and see if his throat recovers. During this first two weeks dad was in a four bed ward with three other patients. As these other patients enjoyed their breakfast, lunch, dinner, and tea and coffee, dad would watch. Patients were discharged. New patients came, but dad was still there. Some of them spoke to me about the meals, telling me that hospital food had improved. The patients discussed the meals amongst themselves. Dad just watched and listened. Every time I visited him dad would ask me for food. "Can't you bring me in a sandwich?" he would plead. And he would ask me for a drink also, just a glass of water for his dry mouth. But I would have to say no. His sole purpose was to eat and drink, to obtain nourishment, but the experts said going without food for a few weeks was not a problem. We must wait - wait to see if the statistics are correct in dad's case and his throat recovers. But dad pleaded with me: "Isn't there something you can do to help?" As it turned out the statistics had no relevance to dad's case and so arrangements were made to insert a PEG tube into the stomach on the 10th of July. However, before this operation went ahead dad recovered some swallowing ability which enabled him to consume small quantities of semi liquid foods for a couple of days. As a result of this the operation was cancelled. But this minor improvement in throat function was very temporary and his condition deteriorated so that once again a strict nil by mouth order was placed on him. I was there the last time they tried to feed him orally. He choked as the food went into his lung and blocked his airway. It was a very distressing sight. The attending nurse pressed the emergency button and help swiftly came to restore dad's breathing. The Turning Point - From Nil By Mouth to Let's Feed Him.....Even if He ChokesSo once again dad was in the same predicament although now he also had aspiration pneumonia again from the food he had ingested. That week, the week of 10th July, was a very important and pivotal week in dad's hospital stay because by that Friday the hospital's treatment strategy had totally reversed. As I have stated, in the middle of that week I witnessed the final disastrous attempt to feed dad orally, an attempt which was followed by immediate reinstatement of the rigid nil by mouth regime. Yet, only a few days later, on Friday the 15th July, doctors requested a family meeting to discuss a complete reversal of dad's treatment regime. Three of us attended this meeting, me and my brother and the doctor. From the outset the doctor adopted a totally negative approach and proceeded to outline various reasons why any treatment option for dad was totally futile and useless. He even contradicted other doctors who stated that the stomach PEG tube was the best option. He claimed that the stomach tube was not an option because he would still get aspiration pneumonia and he would also pull the tube out with dire consequences. The specialist gastroenterologist had previously taken the opposite viewpoint and told us that pulling the stomach tube out is not a problem as it is for the nasogastric tube. This doctor contradicted the specialist's viewpoint though he was not a specialist. Since this doctor was adopting a totally negative approach whereby all treatment was futile I wanted to discover his point. What is his preferred option I thought? What is his purpose here with this extremely negative prognosis? We pointed out to him that even if all treatments were useless we still needed to choose an option for dad that would allow him to pass away with the least amount of suffering and for this reason we considered continued starvation was not the best option. However the doctor was undeterred and continued to suggest the stomach tube was not an option and all treatments would be useless. This doctor, like all the others, continued to point out that if dad was fed orally it would cause his death, either because of choking or aspiration pneumonia. Doctor Resorts To Name Calling and Insults as Dad Starves - More Aged Care?Since the doctor was giving us no options I asked him directly: "Well, if he was your father what would you do?" He responded: "I would feed him orally." We were astounded at him saying this, just after having told us this would kill him. Amazed, I replied to him: "So you want permission to kill him?" He responded immediately and very angrily: "You're just a smart arse" (I apologise for the language, but it is important that this account is totally truthful). He continued: "That's it, I will not deal with you any more." Little did my poor dying father know what was taking place in the name of "health care" in the corridor near his room. As he lay there starving to death doctors seemed more interested in personal abuse and insults and forcing patients and their families to accept the options chosen by the hospital. I should point out that I also asked this doctor if the option to feed dad orally was part of the DNR order. "Yes", he replied. So a few days after dad choked from being fed orally, feeding him orally became the preferred treatment option of the hospital. We were being given 3 options:
From this point on, by various means, the hospital would continue to try and get their own way by pursuing option 2, regardless of what dad or his family wanted. Although for 2 1/2 weeks there was a rigid nil by mouth policy for dad (excepting the 2 days I mentioned), this was suddenly abandoned on that Friday so that the preferred option then was to feed him by mouth, a treatment option which everyone agreed would have fatal results. Clearly this represented a total abandonment of the practice of determining medical treatments on clinical grounds. There was no clinical reason to feed him orally. They had just tried that a few days earlier with disastrous results. Since this change in treatment strategy was part of the DNR order it was clearly motivated more by financial considerations rather than the principles of sound medical management. Of course we continued to oppose this option of letting dad choke and our opposition apparently led the hospital to resort to even more desperate and underhanded tactics in an attempt to get their way. Let Nature Take Its Course - Feed Him but Do Not Resuscitate if He ChokesThe following week, on Wednesday the 19th of July, I received a phone call from a different doctor who continued with the same type of coercive tactics. Once again the same strategy was being persuasively thrust at me. I was told this time that we should consider feeding dad orally and "let nature take its course". Once again I asked the question: "Is this part of the DNR order?" Once again the answer was "yes". I had seen dad choke a week earlier from oral feeding, now I was being asked to accept that this was the best treatment option. Apparently we should feed him orally then watch him choke and let nature take its course (ie. DNR). This apparently, was the most compassionate and clinically appropriate approach which could be managed by our modern scientific health care system. Coincidentally, it was also the cheapest approach. During the abovementioned call from the doctor on the 19th July I was advised that, due to the surgical waiting list, it would not be possible to do the operation for the stomach tube for at least one week, possibly two weeks. The question was then put to me as to whether I would be happy to visit dad for another week and watch him unable to eat. I responded that any such delay was the responsibility of the doctors and the hospital and my view was clearly known about the delays to that point. In view of this conversation I was amazed to learn the next day, Thursday the 20th, that the operation for the stomach tube was arranged for the following day, Friday the 21st of July. On Thursday afternoon of the 20th July we attended the hospital and at about 5.00pm that afternoon we spoke with the doctor to check that the operation was still going ahead the following day. The doctor rang theatre and the surgeons involved and confirmed that the operation was definitely going ahead on the following day. The following morning however, I was notified that the operation had been cancelled. Social Worker and Patient Advocate Combine to Make Dad Starve LongerSince the hospital could not get their way they apparently decided to call in a social worker to try and interfere in dad's treatment. The social worker saw dad after we left around 5.00pm on the 20th and apparently asked dad if he wanted an operation for a tube in the stomach. According to the social worker dad said "no". I should point out here that dad was traumatised by the nasogastric tube and if you asked him about having more tubes you were likely to get a negative answer unless you explained it to him carefully. I had already been through this issue with the doctors who had asked me to obtain dad's approval for the operation. When I carefully explained to dad about the stomach tube he said he preferred not to have it but he realised he had to have it and wished to go ahead with it. However this did not satisfy the hospital who called in a complete stranger and non medical person (social worker) to apparently try and get the answer they wanted. When dad said no to the social worker the patient advocate was called in, apparently with the same result, and consequently the operation was cancelled. But the hospital was leaving no stone unturned in their efforts to get their own way. They accused us of trying to force dad to have an operation he did not want and they advised me that they were calling in a psychologist to assess dad's mental capacity and confirm his decision about the operation. They also informed me that if dad could not make his own decision they would call in the Guardianship Board to make the decision on his behalf. The hospital did not care what we wanted, or what dad wanted, they had their own agenda. An agenda which was consistent with the quickest and cheapest option, regardless of suffering, and regardless of clinical justification. This apparently is modern aged care in action. I was at the hospital on Friday the 21st when the psychologist interviewed dad. I explained to him about how traumatised dad was from people pushing tubes down his nose and pointed out that he needed to explain carefully to dad about the stomach tube. When he did this he got exactly the same response as dad gave me. Dad told him he preferred not to have the operation but he realised he had to have it and wished to go ahead with it. The psychologist also questioned dad to determine his capacity to understand and concluded he had sufficient capacity to make his own decision. This assessment conflicted sharply with those of the social worker and the patient advocate, and also contradicted staff accusations that we were forcing dad to have an operation against his will. Needless to say, the hospital was most unhappy about the psychological assessment because they did not get their own way and were not permitted to pursue their chosen option of feeding dad orally and letting nature take its course. However they did succeed, thanks to the efforts of the social worker and the patient advocate, in forcing dad to starve another 6 days until the following Wednesday when the operation was finally performed. It is an absolute disgrace that neither the patient advocate or the social worker, or indeed the hospital staff showed any concern whatsoever about what dad wanted or what we wanted. They had their own agenda. It is history now that their allegations about us going against the wishes of dad were totally false and fabricated. If dad was questioned carefully about the stomach tube he consistently gave the same answer, but the hospital nevertheless persisted with their arguments and allegations. But of course if the distinction between the stomach tube and the nasogastric tube was not made clear to him he would tend to give a negative answer. Of course the hospital realised this, even before I told them. Hospital Abandons Proper Medical Care and Opposes Dad's WillThe facts are clear. The hospital adopted a course of action that was directly opposed to the will of dad and his family. They tried every possible way of abandoning normal medical practice and enforcing their will upon us and sought the assistance of the social worker and patient advocate to justify their actions. It is amazing that they continued to try and justify their actions on the basis that they must respect dad's will and do as he wished. Interestingly, during most of dad's stay in hospital they totally ignored his requests for food and drink. His will was blatantly ignored. And the repeated attempts to put a tube down his nose. He fought these attempts and protested vigorously. But his will did not matter. Yet, amazingly, after 3-4 weeks of violating dad's will, suddenly we were expected to believe that his will was the paramount consideration. Nutrition Only Important for the Young, Not the Starving - Modern Aged Care?So the hospital, the social worker, and the patient advocate, all conspired, against dad's will, to force him to starve for another six days before the operation. By the time dad finally had the operation on the 26th July he had been lying in bed starving to death for 4 1/2 weeks. With the exception of a couple of days of small quantities of semi liquid food and a few days of food from the nasogastric tube, he had no food during this entire period. Another thing that amazed me was that the doctors refused to give him vitamin injections. Many vitamins are easily injectable and this would have at least prevented him suffering from vitamin deficiencies but the doctors chose to let him suffer from various vitamin deficiencies in addition to the protein calorie malnutrition which contributed to his final death. They claimed vitamins were unimportant and going 4 1/2 weeks without vitamins was not a problem. I had always thought the minimum daily requirements for essential vitamins had been firmly established but now I find that according to medical experts no vitamin intake whatsoever for 4 weeks is quite acceptable. And often I have heard of relatively young people who are eating normally being given vitamin injections by doctors as a "tonic" or to help them recover from a long illness. But in an elderly person who is starving to death, vitamins apparently are not needed at all. The End of the End - Dad Succumbs to 4 Weeks of Starvation - Modern Aged Care?When dad finally had the operation for the stomach tube he was very weak and frail and extremely emaciated. After the operation he lasted another 8 days before he passed away on Friday the 4th of August, six weeks after that day we shared in the nursing home when he enjoyed the last food he would ever eat. The death certificate listed "sepsis" as the primary cause of death, but the contributory caused was listed as "protein energy malnutrition". In that final 6 weeks most of my father's discomfort came from starvation as pain was not a significant issue. As the hospital argued and one doctor stood in the corridor name calling and abusing me, dad lay in his bed starving. As the hospital plotted to bring in the guardianship board so they could have their way, dad lay there, still starving. And not satisfied with this, the hospital engaged the services of the social worker and the patient advocate to ensure dad starved for even longer. Very strange that neither the social worker nor the patient advocate offered any support for dad in his desire to be fed and end his starvation. They frustrated his wishes and worked against him. But they pretended they were doing it because it was his will, something which has been proven untrue. And when dad pleaded to be fed orally, and protested vigorously about the nasogastric tube, where were the social worker and patient advocate? Strange that they only became interested in dad's will AFTER we resisted hospital pressure to let nature take its course by letting dad choke to death (ie by feeding him). These final six weeks have created many sad and indelible images and memories for me. The sight of my severely emaciated 91 year old dad lying in hospital starving to death while doctors argued and patient advocates pretended they were prolonging his starvation because this was his wish, is not easily forgettable, or forgivable. But this is our modern health care system. It is a system where treatments are dictated by cost, not human caring and compassion. It is a system where economists, social workers and patient advocates make medical decisions about peoples lives. Medical treatments are determined not by sound medical judgement and clinical indications but rather by the financial dictates of politicians and bureaucrats. This is especially true for the elderly and chronically ill who are just too difficult to treat for our emergency acute care patch up non caused based symptomatic medical system I would like to turn my attention now to some of the issues arising from dad's story.
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The Politics of Modern Medicine and Health Care |
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| Modern medicine surrounds itself with a huge
political and economical hierarchical self serving juggernaut. Although
this juggernaut is remote from patient care it often serves to influence
patient care in insidious and frequently negative ways (see Medical
Bias,
Medical Rationing). Because this structure has been established primarily
to protect and preserve the system itself rather than serve the interests
of patients, there is a very significant conflict of interests when
patient care challenges the system in some way, whether financial or
otherwise. In other words, when such a challenge exists health care
decisions may be based upon the requirements of the system rather than
seeking the best outcome for the patient. This is the bottom line for
modern health care and these forces are clearly seen at work in dad's
story. It should be noted that this "huge
political and economical hierarchical self serving juggernaut" is
absent from alternative forms of health care which are more patient
oriented and patient friendly.
I will outline some of the issues arising from dad's case and hopefully contribute in some way to preventing these problems in future. Issues Arising from Dad's HospitalisationThe following issues are worthy of further discussion.
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1. Interference in patient care because of non-clinically based health care decisions based upon economics, 'social worth', and age - special scientific medical care for the elderly? |
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| Since I have already discussed elsewhere the
reality and pervasiveness of economically motivated medical discrimination
and ageism in modern health care (see Medical
Rationing), I will endeavour here to update that information and
demonstrate its relevance to the circumstances involved in dad's hospital
treatment. It is important that the hospital decisions made regarding his
care are seen within the context of the current environment of politically
and bureaucratically promoted cutback of medical services and rationing of
medical resources.
Because modern medical treatments for most chronic diseases are not curative they have failed to arrest the current epidemic of chronic diseases and they are therefore needed in ever increasing doses as these diseases proliferate. This is the fundamental cause of the exorbitant global cost of modern health care. Rather than seek cheaper and more effective therapies however, the preferred current option of politicians and health administrators is to ration medical resources by making arbitrary value of life decisions about patients. Doctors, hospital ethics committees, and other health care providers, decide how much each patient's life is worth and then allocate resources preferentially to the most "worthy" patients. This is how modern health care works. Economically based health care decisions are a fact of life with our modern health care system (1,). Economists and accountants are making health care decisions which are implemented by doctors (1,) and therefore "marketplace solutions are being imposed on healthcare throughout the globe" (2). Since such decisions are based upon economics and the "worth" of patients it is the elderly who are often effected most by this type of financially motivated medical discrimination (3,4). According to Professor Nair (3):
As has been asserted by Grimley Evans (4):
As is noted by Grimley Evans (4), the main reason for this discrimination against the elderly is the lower "social worth" of such patients. As long ago as 1993 the National Health and Medical Research Council (NH & MRC) of Australia endorsed the use of (5) “social worth criteria” such as “the patients lifestyle and personal morality and his or her value to the community” as grounds for assessing the allocation of medical resources. Although health care treatments have been traditionally based upon the needs of the patient and have been motivated by compassion on the part of the practitioner, now for the first time in history this is being abandoned. Now there is a determination to ensure neither need nor compassion play any role but rather the fundamental question is: 'is this patient worth treating?' Now we are being asked to accept that doctors assess a patient's 'social worth', perhaps by some kind of arbitrary 1-10 ranking system, before medical treatment is administered. Health care it seems, is at the crossroads. Should health care abandon its fundamental basis of compassion and caring which, according to the experts, is now too expensive? Of course once we proceed to go down this road and devalue life there will be many tragedies ahead in the years to come. As has been noted by Olver (18), "society's handling of health resource allocation will say a lot about its attitude to the importance of life." Do we really wish to progressively devalue life because of pressure from economists? In this economic environment of modern health care ageism or discrimination against the elderly is so prevalent that special derogatory terms are used to describe elderly patients (3a). Elderly patients may be referred to as GOMER or "Get Out Of My Emergency Room" (3a). Other disparaging names for the elderly include 'geris' or 'crumble' (3a), or perhaps simply "bed blockers" , a term commonly used by both private and public hospitals in Australia (16), as I have also discussed elsewhere (see Medical Rationing). Medical discrimination against the elderly is simply a fact of life (6). In view of this environment of ageism in modern medical care it is hardly surprising that the hospital sought to pursue the cheapest option in dad's case. The sudden change in the preferred treatment of the hospital and their determination to "let nature take its course" are typical results of economically determined medical "treatments". The desire of the hospital to pursue a "treatment" strategy which was highly likely to cause choking could certainly not be justified clinically or be described as part of good medical management. On the other hand of course, such a treatment strategy would have definite financial advantages, a fact which would please economists and hospital administrators. In dad's case, the abusive and intimidatory attitude of doctors, the use of DNR orders, and the use of non-medical personnel to attempt to override the will of the patient and his family (social worker, patient advocate, government authorities), can all be seen to be working in the one direction, namely, towards the most economical option, regardless of the interests of the patient. In dad's case the hospital was pursuing a treatment strategy which was totally consistent with the requirements of medical discrimination and therefore medical staff were required to apply the dictates of the economists. Perhaps the hospital was following the guidelines (5) of the NH & MRC and had evaluated the relative "worth" of dad and reached a negative conclusion. We should heed the warning of Grimley Evans however (4):
According to Smith (17):
When aged care proceeds down that road where treatments are determined by the needs of economists rather than the suffering of patients it will be a sorry day indeed. Most conspicuously, those who endorse such an approach have defined no limits and therefore according to them life will become cheaper and cheaper as economical pressure increases. Having abandoned the fundamental values of caring, compassion, and sanctity of life, there is no limit to the financial savings that could be achieved. Is it too late to turn back and put human suffering and compassion first?
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| 2. Modern medicine's continuing bias against nutrition, even in the case of total starvation. | ||||||||||||||||||||
| It is difficult to imagine a more deserving use
of vitamin injections than complete starvation, but yet the prevailing
medical opinion in dad's case was that it was better to let him starve to
death than give him vitamin injections. Even on a cost basis this
is difficult to explain since vitamins are so
cheap.
As I have discussed elsewhere (see Medical Bias, Nutrition is for the Birds, Nutrition or Malnutrition?), anti-nutrition bias has long been a fundamental part of modern scientific medicine irrespective of extensive scientific evidence in support of the importance of nutrition (see B Vitamins, Nutrition and Megavitamins, Nutrition is for the Birds, Nutrition or Malnutrition?). In the case of the elderly in particular, the need for and advantages of nutritional supplementation are very well established (see The New Paradigm). Nutritional deficiencies abound in elderly communities and trials of nutritional supplementation in this age group consistently reveal many health benefits as well as cost reductions because of reduced need for other forms of medical intervention (see The New Paradigm). As I have stated previously (see The New Paradigm):
According to Chen and co-workers (7): "Today there is no doubt that malnutrition contributes significantly to morbidity and mortality in the elderly." These workers continue: "In the elderly, malnutrition is an ominous sign. Without intervention, it presents as a downward trajectory leading to poor health and decreased quality of life." This is clearly what happened in dad's case as the severe but preventable malnutrition from which he suffered was a contributory factor in his death. To a large degree, he was permitted to starve to death. An American survey reported by Mike Snider (8) found that 1 in 4 elderly people suffer from malnutrition. The survey found that (8) "About half the elderly patients in hospitals and 2 of every 5 in a nursing home suffer from malnutrition" and "malnourished patients are more likely to have major complications and more expensive hospitalizations than healthy older patients are." So in our modern scientific health care system half of the elderly patients in hospital are suffering from malnutrition. Dad was one of them. An Australian study by Walker and colleagues made the following startling findings (10):
In Australia, 40% of people admitted to hospital have malnutrition (11) and according to Ellingsen (9), "many of Victoria's estimated 400,000 elderly are so malnourished they are falling ill and dying in what has been described as an unspoken national scandal." In an attempt to explain the disgraceful prevalence of malnutrition in America Snider makes a very telling observation (8): "The doctors of today don't talk much about foods. They don't talk much about prevention of illness or bolstering the immune system with solid balanced nutrition. They mention vitamins and minerals so seldom, it's almost as if they don't want us to hear about them." In keeping with this observation is the fact that malnutrition today frequently is partly "iatrogenic", that is, it is doctor caused (12,14), resulting in 108, 000 deaths from iatrogenic malnutrition in America alone (15). It is indeed interesting to note that according to the recent Victorian inquiry into naturopathy (nutrition and dietary supplements are a traditional part of naturopathy) and herbal medicine (13), increasing support for these healing modalities amongst practitioners and consumers has resulted in "increased scientific and regulatory interest in complementary and alternative medicine around the world." In other words it seems, interest in such therapies is consumer led. Politicians and scientists are only interested because of consumer interest. Given this official medical disinterest in nutrition it is indeed sad to realise that dad's starvation is not surprising in the modern aged care environment. This is in spite of the fact that nutrition is so cheap it should be the number one therapy favoured by economists and supporters of medical rationing. But it is not.
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3. Total disinterest in complaint resolution and learning from mistakes |
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| In spite of the claims made by the so called "Clinical
Excellence Commission", the huge self serving bureaucratic and political
structure which surrounds modern medicine has been created largely to
protect the system and those within it (see When
Caring Stops - whistleblowers incorporated This disinterest in medical mistakes has also occurred in Dad's case where there has also been a clear attempt to avoid responsibility and accountability and a complete refusal of authorities to make any meaningful attempt to resolve, or even acknowledge, a medical complaint. As a result of the events which occurred during dad's hospitalisation I lodged a complaint with the Health Care Complaints Commission. The main points of my complaint were as follows.
The Health Care Complaints Commission informed me that they had passed my complaints on to St George Hospital and I would receive a written response in due course. Subsequently I received a letter, dated 7th August, from Sue Katz, manager of St George Hospital. To see a complete copy of this letter click this image. The first paragraph of this letter stated as follows:
Although Ms Katz claims "I am writing in response to the issues you have raised with the Health Care Complaints Commission", nowhere in the letter does she consider the substance of any of my complaints. In fact she carefully avoids all the issues which I complained about. For instance, she completely avoided any mention of the hospitals attempts to "let nature take its course", feed dad orally, and use DNR orders to justify letting him die. These matters were strictly avoided by Ms Katz yet they were fundamental to my complaint. The same is true of my concern about the abusive language used by one doctor and the coercive intimidatory tactics employed by the hospital in an an attempt to get their own way. Ms Katz apparently decided to completely avoid these issues also. The seriousness with which Ms Katz considered these matters is clear from the fact that even the date of admission she lists for dad is incorrect. I quote: "Mr Williamson was admitted to The St George Hospital on 24 July, 2006". But Ms Katz continues: "The first PEG tube insertion was booked for 10 July, 2006." In other words, according to Ms Katz the first operation for a PEG tube was scheduled for 14 days before he was even admitted to hospital!!! Of course dad was admitted on 24th June, not 24th July as claimed by Ms Katz. The third major issue I complained of was the disgraceful intervention of the social worker and patient advocate who opposed dads will and forced him to starve even longer. While Ms Katz acknowledges the intervention of the social worker and patient advocate she avoids any mention of the concerns expressed by me that they directly opposed the will of dad and his family and forced him to starve even longer. This entire matter was strictly avoided by Ms Katz. In connection with dad's consent, or lack thereof, Ms Katz makes the following statements.
It seems, according to Ms Katz, dad's consent was not an issue on the 10th July when the first operation was scheduled but only became an issue 10 days later when the social worker was called in. The social worker and patient advocate apparently both saw dad on the 20th July, the day we were at the hospital till 5.00pm. Strange that they did not come while we were there. Following their claims that dad refused consent this was apparently confirmed by the gastroenterological registrar on the next day, Friday the 21st. But in the afternoon of the 21st, the same day the registrar saw dad, he was also assessed by the psychologist, but this time with a totally different result which I witnessed. The fact is, that both before and after the intervention of the social worker, when I questioned dad he gave the same positive response. Hospital claims that dad refused consent for the operation always seemed to occur when no family member was present. Since dad was very traumatised by the nasogastric tube it was very easy for the hospital to get dad to refuse consent for any further tubes if the situation was not carefully explained. Dad repeatedly gave his consent for the operation when it was carefully explained to him although this was not accepted by the hospital, a fact which was ultimately confirmed by the psychological assessment. The intervention of the social worker and patient advocate forced dad to starve even longer. The question is, why did the hospital consistently try to oppose dad's will, even resorting to use of the social worker and patient advocate to achieve this end? Why did Ms Katz decide to completely avoid this issue in her response? And what action will be taken against the social worker and patient advocate for forcing my father, against his will, to starve even longer? Since Ms Katz avoided any consideration whatsoever of the issues I raised I responded by sending her the following letter.
I have received no further communication from St George Hospital. In spite of claims made by the Clinical Excellence Commission, the above evidence clearly demonstrates the eagerness of health authorities to go to any lengths to conceal and dismiss medical negligence and mistakes and protect health workers. This is no surprise since the system has been deliberately constructed this way. Of course if the Clinical Excellence Commission, politicians, and health authorities, were at all serious the first step they would take would be to protect whistleblowers and encourage whistleblowing by imposing suitable incentives and rewards. Unfortunately however, the traditional rush by politicians, bureaucrats, and health authorities to crucify and persecute whistleblowers demonstrates a cruel callous and totally compassionless indifference to the suffering and welfare of patients (When Caring Stops - whistleblowers incorporated). Strange that this is not on the absolute top of the list on the agenda of the so called Clinical Excellence Commission. Strange that it is not even on the bottom of their list. The Clinical Excellence Commission will display their sincerity and allegiance when a whistleblower exposes a problem in the health system. Will the Commission be on the queue waiting to crucify and persecute? Many serious issues have been raised by my father's hospitalisation. The most serious issues involve ageism, non-medically based aged care decisions and DNR orders, and the use of non-medical staff to override the will of patients. But perhaps even more disturbing is the determination of health authorities to avoid all responsibility and accountability, even refusing to acknowledge the issues involved and oppose any resolution of the problems which occurred. Their actions are consistent with a single minded obsessive determination to protect the reputation of the hospital and its staff at any cost. In this way, even when human life is at stake, they perpetuate the problem and so ensure such problems will occur again and again. Of course they may be severely penalised for publicising the truth. The response of the manager of St George Hospital to these very serious issues is absolutely disgraceful. There was no response and no concern about the issues I raised. There has been a determination to cover up or dismiss the issues I raised. In effect, there has been official indifference to my father's starvation and loss of life. And so, because of our health authorities, and the aged care system constructed for us, dad is merely one more person who died in hospital. The main purpose of health authorities it seems, is to conceal the truth so no one learns from their mistakes and therefore ensure this will happen again and again. While the nurses did their job within the restraints placed upon them, the bureaucrats and health authorities tried diligently to do their jobs - they attempted to pursue the cheapest option - and conceal the truth. It is just a job for them.......but for me it was dad's life.
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| References 1. http://www.ajmc.com/files/articlefiles/AJMC04mayTunisEdtl_301_04.pdf
See: Tunis, R., (editorial), American Journal Managed Care, 10,
301, 2004. |
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