Profiteers debasing hospice care, insulting dead with body parts trafficking

Although countless doctors and nurses put in untold blood, sweat, and tears to provide quality care to their patients, health care profiteers can undo these good works in an instant with shameful plundering. Here is a roundup from multiple fronts.

The nonprofit, nonpartisan Kaiser Health News Service deserves credit for its painful reporting on the rising problems in the once much-admired area of hospice care.

Reporters JoNel Aleccia and Melissa Bailey have written, in a story carried by Time Magazine, that they “analyzed 20,000 government inspection records, revealing that missed [hospice worker] visits and neglect are common for patients dying at home. Families or caregivers have filed over 3,200 complaints with state officials in the past five years. Those complaints led government inspectors to find problems in 759 hospices, with more than half cited for missing visits or other services they had promised to provide at the end of life.”

The article goes on to note that the reporters found written complaints—which did not carry names or identifying information—on:

A 31-year-old California woman whose boyfriend tried for 10 hours to reach hospice as she gurgled and turned blue, and a panicked caregiver in New York calling repeatedly for middle-of-the-night assistance from confused hospice workers unaware of who was on duty. In Michigan, a dementia patient moaned and thrashed at home in a broken hospital bed, enduring long waits for pain relief in the last 11 days of life, and prompting the patient’s caregiver to call nurses and ask, ‘What am I gonna do? No one is coming to help me. I was promised help at the end.’

The hospice boom

This investigation points out that hospice has become a booming business, raking in $16 billion from Medicare, private insurers, and sometimes Medicaid and the Veterans Administration. But rigorous oversight and a clear understanding of hospices’ precise roles, responsibilities, and services haven’t followed suit, Kaiser Health News has found.

The news service said that corner-cutting, profit-driven, and callous profiteers have popped up in hospice, a movement built by religious and nonprofit Samaritans to provide dignified, humane care for end-of-life patients and to assist families.

They and their loved ones at death’s door are in poor position to research hospice providers and to stay away from sketchy operators. They clearly need more help from regulators, who need to ensure quality, compassionate care is the norm. It also is fair to say that most patients and families say their hospice experiences have been good—and the families express deep gratitude for the work of most providers.

Trading on the dead

Reuters news service has put together an impressive but saddening four-part investigation of this trafficking, some of it a necessary part of medical education and research but much of it craven. As reporters Brian Grow and John Shiffman reported:

No national registry of body brokers exists. Many can operate in near anonymity, quietly making deals to obtain cadavers and sell the parts. … In most states, anyone can legally purchase body parts. A Tennessee broker sold Reuters a cervical spine and two human heads after just a few email exchanges. Through interviews and public records, Reuters identified [the company] Southern Nevada and 33 other body brokers active across America during the past five years. Twenty-five of the 34 body brokers were for-profit corporations; the rest were nonprofits. In three years alone, one for-profit broker earned at least $12.5 million stemming from the body part business. Because only four states closely track donations and sales, the breadth of the market for body parts remains unknown. But data obtained under public record laws from those states – New York, Virginia, Oklahoma and Florida – provide a snapshot. Reuters calculated that from 2011 through 2015, private brokers received at least 50,000 bodies and distributed more than 182,000 body parts.

Reuters says brokers get bones, organs, and whole cadavers by paying pittances to the poor, or by networking with funeral homes and morticians, some of them clearly unscrupulous purveyors of parts purloined without any kind of consent.

A real but gruesome need

Cadavers and various human parts, to be sure, are critical to medical education and research, Reuters reports. That doesn’t mean patients or their families would consent to how these materials get used, including in ghastly military studies of the effectiveness of various armaments.

Purchasers also have a dubious role in the body-parts market: They’re in dire need of them, and they must have some sense that they of sufficient study or experimental quality. At the same time, medical schools and researchers walk a fine line in asking too many questions about the supplies and suppliers.

The news service profiles Science Care, a top of the line broker-dealer company that has looked to McDonald’s for a model in efficient delivery of sizable amounts of good products. The story on the firm is hard-to-take but important reading, reducing the marvels of humanity to a commoditized kind of Soylent Green.

Paging Dr. Baksheesh

Cynics might say it merely is a matter of dehumanizing degree: What, after all, is to be made of yet another study, newly published in a medical journal, that shows how easily doctors get bought off by Big Pharma—and even more so when the sums increase.

Researchers found that among their study subjects “39.1 percent of prescribers received gifts ranging in value from $7 to $200,000, while the rest received none. Health care providers given gifts wrote an average of 892 prescriptions compared with 389 for those who accepted none. The average cost of a prescription was $135 for gift recipients and $85 for the others. Gift recipients chose the brand-name drug a third of the time, compared with a quarter of the time for non- recipients. Any gift was associated with higher cost prescriptions, but the larger gifts had an even greater effect. Those who received gifts worth more than $500 during the year averaged $189 per prescription.

This study, by the way, was based on data on almost 3,000 doctors practicing in the Washington, D.C., area. It falls in line with earlier, similar research that showed that for $20 or so—the cost of a lunch with pizza and a couple of sodas—Big Pharma reps not only persuaded MDs to prescribe their most costly and branded products but at higher rates than their peers. Researchers said the simple act of paying attention to the doctors, not necessarily in buying them lunch, passing out swag, giving them samples or other items of increasing value, sealed deals.

This all gives a pathetic view of medical practitioners and their lives, right? Hold that dose of sympathy and kindness, please, because Druv Khullar, an MD, MPP, and a writer for the New York Times “Upshot” column, has some angering information on research that shows how Americans get gouged by special interests that flood health care with money, money, and more money—especially to buy influence with lawmakers and regulators.

He has reported that:

In 2016, the health care industry spent half a billion dollars on lobbying, with pharmaceutical companies, hospitals and health professionals making the largest contributions. In 2009, the year the Affordable Care Act was debated, health care lobbying exceeded $550 million. (Last year, by comparison, defense lobbying totaled $129 million, and the gun lobby spent just $10.5 million.) Closely related to industry lobbying is the political maneuvering that congressional leaders use to pass legislation — specifically, targeted provisions known as earmarks, ‘sweeteners’ or pork barrel spending.

Health care cash floods U.S. politics

Khullar cites a new study of such pork, the research by Zack Cooper, Amanda Kowalski and Jennifer Wu at Yale and by Eleanor Powell at the University of Wisconsin-Madison. They analyzed a provision in the Medicare Modernization Act of 2003, a bill that provided prescription drug benefits and which President George W Bush and other Republicans staked a lot on.

That act also included “Section 508,” a provision that’s complicated but, in brief, quietly became a boon—or a boondoggle—for hospitals and their profitability. To bolster their benefits under this section of the law, hospitals threw money at GOP lawmakers. They ended up expanding their treatment of Medicare patients, and receiving significantly more from the federal government to do so. They expanded their buildings, added technology. And, of course, they paid their executives even more extravagantly.

What’s less clear in the huge upswing in medical services attributable to Section 508, and its renewal, is whether patients and the public benefited, Khullar says. In fact, he has concluded:

America’s increasingly burdensome health care spending has many roots: new technologies, high drug prices, fragmented care, administrative expenses and the like. But lobbying and political maneuvering can increase costs, too — without clear benefits for patients, communities or society at large. Often these costs are borne by all of us, while the benefits — if any — go to a favored few. Excess medical spending, then, is driven not only by inefficiencies in our health system, but also by those in our political system. Our solutions, it seems, must confront that uncomfortable reality.

In my practice, I clearly see not only the harms that patients suffer while seeking medical services but also their heart-wrenching struggles to figure how they will pay for the skyrocketing costs of medical care. Although Big Pharma has received some recent fire for its whopping prices, doctors and hospitals may attract less attention for their huge costs. Their bills add up to a little more than half the nation’s health care spending, and doctor salaries alone—averaging $250,000 annually—continue to be a baffling cost-driver in this nation’s medical system.

Whether it’s in hospices, body parts’ dealing, doctors gift-taking, or hospital lobbying, the results of huge money and unfettered capitalism in our medial system aren’t good. Health care comprises 17.8 percent of the nation’s GDP, and Americans are spending more than $3 trillion in this sector. It’s clearly so awash in money that it’s getting tougher by the instant to tell if there are white or black hat players around—or whether it’s all just a matter of who has their hand out and how much cash, clean or unclean, they demand.