Emily Le Coz if the Daily Journal reports:
TUPELO – Two people have been indicted in connection with the state attorney general’s investigation of the Sanctuary Hospice House.
The grand jury of Lee County returned a total of 33 misdemeanor counts against Marilyn Lehman, the agency’s clinical director, and medical director Dr. Paul White.
Lehman was indicted on 11 counts of practicing medicine without a license; White faces 11 counts of aiding and abetting Lehman and another 11 for neglect of a vulnerable adult.
Both are still on staff at the facility, which opened in November 2005 as a pilot project to provide hospice care in rural areas.
No longer employed, however, are two investigators from the Attorney General’s Office involved in the case, said White’s attorney, Tony Farese of Ashland.
“Investigator Don Scott and investigator Susan Parkins were fired as a result of their misconduct during grand jury proceedings several weeks ago,” Farese said. “It’s our position that this unjustified prosecution has been pursued for personal reasons by Mr. Scott and Ms. Parkins.”
Farese said the firings stemmed from the investigators’ having advised state witnesses to give statements to the press, and he plans to file motions to dismiss the charges based on that misconduct.
Attorney General Jim Hood declined to comment on the firings because they are personnel matters, but he said “the grand jury made their decision based on the facts.” …
Hmm, the state’s case seems to be off to a shaky start . . .
The charges underlying this investigation (euthanasia) are extremely serious. The handling of it appears farcical.
It’s a wonder that Hood has either foot left, as often as he (and others) have shot them.
Is this cover for Hoods problems?
I cannot parse or even access the filings but reading between the lines of the news article, with the understanding that I barely know Paul (as I barely know anyone in the community -gives me cover) or the Director and my only connection to Sanctuary House was by donation, I am not surprised at the indictments. Putting any practice under the electron microscope of an investigator, especially one like end of life care or ICU care where momentary judgements are made, would lead to the surprising discovery that nursing staff make decisions that docs later ratify eg increasing narc dosage at end of life without written orders. These are predicated on the trust professionals have for one another and the fact that its all about the patient, stupid. I await some more info regarding the actual factual basis for the complaints to see how they stack up against generally accepted care. I am fearful that generally accepted care will fail that close inspection from this perspective and am not sure that that failure is justified. I am sorry that it came to this, that it will taint a highly regarded local facility and generally perceived competent physician. Hopefully the complaints have little substance.
George
Well, Jawge, I reckon that’s the least rantly rant’s ever been ranted here, so well done. I’m glad we have your and Razor’s and other professional perspectives on stories like this one. Very valuable additions to our mix.
somslawyer 1
The issue of euthanasia at end of life is a touchy one and discussions about it in hospice situations have been mostly resolved to my satisfaction ina global sense. See The Doctrine of double effect:
http://plato.stanford.edu/entries/double-effect/
It is certainly up to discussion over whether a given situation involves the intent to kill or intent to help at the core. In my experience there are those rather cluesless individuals that do not understand this double effect principle or have a grasp on our mortality and our occasionally misguided attempts to keep people alive at all costs to the individual, the family and the professionals. I doubt anyone here would have that issue but it is amazing that it arises. (My wife was an oncology nurse and I did Internal medicine in the past.) I expect this turns on that and the issues I raised above regarding delegation of authority.
George
Having been involved in this organization since the beginning, I find it very discouraging watching lies and half truths come out about dedicated honorable professionals of the hospice house. The mission of the Sanctuary remains the same since it’s inception….. to provide compassionate care to the dying and their families in response to God’s call to serve one another. It has always been about loving care of those who are going through one of the most difficult times in their lives. As volunteers we wanted families to have their load as light as possible, so each an every day we are dedicated to raising over $2500 a day to keep the doors of this non profit open. Most people cannot understand our motives because they are pure and selfless. Our desire is to be the hands and feet of Jesus here on earth. I recognize I am ignorant of the underbelly of the legal system but I’ve had an eye opening awakening . It’s been an emotional and expensive lesson and it’s not over yet.
Further info for those interested in this: One of the interviewers from the AG’s office was reportedly clueless regarding the goals and setup of a hospice organization- this from a colleague interviewed by the AG’s health professional.
Nature Lover// That kinda’ tells the public what we have in PUBLIC OFFICE in the AG’S office. This is shameful, sad and disgusting if indeed it appears it’s another one of Jim Hoods’ poor judgement calls. I have never ever heard of anything but GOOD coming from The Sanctuary Hospice House, and what about the local elected DA would this not have first needed to be taken care of locally.
Is there some motivation for the indictments that might explain this? Someone with an axe to grind?
I, too, have heard wonders about Sanctuary. I have known families who were blessed by their services.
End of life care is such a difficult area of medicine – sometimes what is morally right might not be legally prescribed. I sure hope this doesn’t tarnish worthy care providers and cause North Mississippi to lose such a fine institutions.
I recall a statement on this site that the Lee Co. coroner never suspected anything.
Any ideas how this investigation came to be?
I am bothered by this story a lot. While the grand jury was meeting, they were trumpeting possible murder charges and now it’s some misdemeanors that sound from newspaper accounts like nothing?
I don’t know Sanctuary but if the doctor is who I think he is I’ve known him since he was a child and think very well of him. Something about this has a bad odor to it.
Nature Lover 4: I am familiar with the Doctrine of Double Effect. Its core is that the bad consequence be unintended. The leaks from the investigators here suggested that the consequences were intended. Pain control v lethality of dosage is an extremely complex issue; while not a physician, I play one in court at times. My point was that the investigators were incompetent or acted from preconception. Either one is unfair to the targets and a disservice to the public.
somslawyer I agree
I cannot reach the individual to get a sense of the investigators agenda if there was one or level of incompetence but that would be an interesting bit of info. I also do not know if it was the person terminated (pun intended)
Interesting. I was going to find out if either terminated investigator was a nurse but you need 2 pieces of info, eg license and last name, but to find out a Doc’s status anyone can know by name or location and screen the database…
Funny doctahs is good. Carry ON, Jawge. Watch them puns though.
This story really bothers me for a variety of reasons. First, it raises considerably more questions than it answers. Having somewhat of a little familiarity with the subject matter, I feel that it will be both unfair and unwise to address the particular instance, especially since I’ve not had the privilege to review the actual individual patient charts or instances of alleged wrong doing, if in fact that is even the case as NatureLover points out.
Interpretation of the "facts " surrounding medical and nursing care provided sometimes proves problematic unless you have access to the actual documents whereby any discrepancy or deviation from accepted standards of care could be observed. The article leaves out a few pertinent facts. Like why did it become a criminal case at all and not a regulatory issue involving the Mississippi Board of Nursing (if Ms. Lehman is a nurse) or the Board of Medical Licensure? Violations of the State’s Hospice Law, SEC. 41-85. ( http://www.mscode.com/free/statutes/41/085/index.htm )The misdemeanor charges used here are kinda airballing it at best with all the laws and regulations that abound to address the issue. We’ll have to see the actual filings to be able to determine on what to even comment about as relates to applicability of laws possibly violated.
However, I can think of a few quick points on potential possible basis for the charges and the additional causes of concern among the investigators. The particular charges used could stem from something as simple as a nurse taking a verbal order for a medication addition or dosage adjustment not having been counter-signed by a physician in a timely manner before the chart was reviewed or completed. Secondly, the charges could have been a product of sloppy or poor documentation on the part of the physician or nurse. Third, the charges could be the result of an overzealous interpretation of the inconclusive documentation or lack of proper policies and procedures in place. Fourth, there could have been a lack of adequate institutional policies; procedures or standing orders for ensuring adequate standards of care are being followed. Last, a complete misunderstanding of what constitutes poor or substandard adherence to standards of care by either the individuals charged or more likely the person(s) making the claim of deviation, e.g. the investigators/AG’s office in providing care for hospice or palliative care patients. None of these aforementioned instances can be considered remotely sinister, just sloppy and definitely not necessarily bad patient care, but bad paperwork.
I’m betting that the once again the sensationalism of the charges are going to be somewhat diminished once the actual facts are presented. Most especially since the grand jury returned charges against the physician with the misdemeanor section of the law instead of the felony portion provisions, http://tinyurl.com/6nl9fm
Professionals practicing palliative and hospice care are a rare breed, knowing that in most instances the patients are not going to "get well, " but they continue in their noble attempts to provide alleviation of pain and suffering, dignity, respect and comfort care for a journey all of us are going to take.
I personally would find it hard to override the urge to drive up the AG’s office and kick his arse if this is a grandiose attempt at political gain with no real basis in "fact " as he is quoted as saying it was based upon.
The purpose of hospice is NOT to heal. Its sole purpose is to provide comfort to terminally ill people (those who are about to die) and their families. These type of unique patients may not have any other alternatives — there is nothing to be gained by them taking up a hospital bed, and their insurance (if they have it) is not likely to pay for such anyway. And there may not be an appropriate place in anyone’s home for this type of care — the hospice house offers just such a place, where visitation with family or friends can occur. Its a place to die with dignity surrounded by loving people.
I am very skeptical of these allegations due to who and what it involves. And with the AG’s office involved, even more so. This type of prosecution “fits” the MO of the AG’s office like a glove —- including attributes of pettiness, political revenge, micro-management, and using a sledgehammer to kill a fly. In other words, it stinks.
I’d be happy for this to be settled quickly since the resulting bad PR for this particular facility and this type of specialized medicine/ care will result in large numbers of patients and their families suffering needlessly due to something that can most likely be easily remedied…of course there isn’t much press coverage for people doing the right things as there are the people doing the wrong these days.
I’ve had first-hand experience with an inpatient hospice facility (not the one in question). If the terminally ill patient is on Medicare, the hospital will not let them stay there and hospice is the only alternative if they have a condition that causes such pain that only serious narcotics can keep the patient essentially unconscious. I have nothing but admiration for those who are willing to work in such facilities. The few weeks I visited the one where my mother spent her last days just about did me in.
Lotus, I’ve been told I act and vaguely like Robbn’ Williams altho I do do a better doc than him.
Dr White showed remarkable equanimity when I saw him today. “I did not see myself in this situation when I was in med school” was his answer to my greeting and condolences. Id be a wreck myself. I wear my emotions on my sleeves-both of em.
No knock on Paul he usually seems calm .
It takes a special kind of angel or saint to work in a hospice and of the many people I’ve met associated with a hospice, I’ve NEVER heard anything but comapssion and concern. For someone to start picking at a Hospice….. In my book, they better have some clear and convincing evidence that there has been intentional harm inflicted.
It’s just not the kind of career that people flock to for personal glory, money, or fame. I’d say it is more of a calling than a career. And God bless every single person providing hospice care!
[Welcome to folo, greenradio, but since I don't want to get sued out of existence, I can't print such as that. Please don't go there again, okay?]
This is dreadful. Does Hood even understand what hospice care is? I would rather slap a hospice worker’s butt in jail for not giving enough pain medicine rather than to give too much. Don’t most terminally ill cancer patients die of medication due to unrelenting pain anyway? Jim, please go do something useful there are still unsolved civil rights murders out there.
JSH, I haven’t seen much that JHood knows about other than suing insurance companies for his own personal or professional benefit and enrichment. And things related to “family” members not being treated like common folk.
Good lawd he’s proving more despicable by the day…if that were possible.
Good news for the good guys in this ridiculous case:
5 families are attesting that they had no idea Hood was using their loved ones in his case and are protesting quite loudly. That eliminates almost half his supposed victims already.
To answer an earlier question: one of the AG’s investigators was an ex-cop and the other one a nurse with no clinical background.
I expect that B, the nurse , if indeed her background was limited, would have been a good choice for an investigator… not. Like a new Doc taking care of you with little clinical background. For links to these stories:
http://www.djournal.com/pages/story.asp?ID=271912&pub=1&div=News
And the one that speaks to my assertion that someone clueless about death or confused about it and hospice brought the accusations
http://www.djournal.com/pages/story.asp?ID=271913&pub=1&div=News
My assertion that this turned on an outsider’s view of medical care under the microscope as Razor listed some of the possibilities specifically seems more and more to be the case as the DJ article attests.
I am a nurse with years of clinical experience behind me (ain’t admitting to how many exactly – starting to get a mite touchy ’bout that). Once upon a time I was a chemotherapy nurse – and I have had more than one family member in hospice care. The fact that they would use a nurse with no clinical background to investigate ANYTHING just chaps me every which way… just gives creedence to the saying that a little knowledge is a dangerous thing
The bottom line is people go to hospice to die with dignity and comfort.
I have some knowledge of Sanctuary Hospice and the physician involved – Hood is barking up not only the wrong tree – he is in the wrong forest………..
I visited the Sanctuary Hospice House in Tupelo during their opening, and I have sent monetary contributions because I believe in their mission and their work. I am distressed at the charges made against those at the Sanctuary Hospice House in Tupelo. Although I’ve never had a family member there, I have friends who have had loved ones there, and they all consider the SHH a blessing to them.
I suggest that we make some lemonade out of lemons during this troubling period and ask that people do their own investigation. Please visit the SHH. See the facility and the work going on there. Talk to the families of the patients there. Imagine that you have a loved one at death’s door and ask yourself if you would want that person to be there.
My guess is that when you leave the Sanctuary Hospice House, you will also leave with them a prayer and a donation.
I guess I too am a little naive when it comes to certain things but I do know right from wrong.
My stepdad’s mother is one of the victims that the SHH killed during her stay ( which was I believe maybe 5 days). Their are true organizations that help with patients in hopice care and I honor those people. I hope that the legal system does not let my stepdad and the other families down and will punish and maybe shut down the SHH.