The Problem of For-Profit Health Care Includes Long Term Care Services

ADAPT, long term care, nursing homes, Our News & Commentary Blog

Some who agree with Not Dead Yet on assisted suicide and euthanasia issues question and even criticize our orientation toward the health care system. This isn’t a forum for exploring overall health care policy in depth, but a few basics are worth mentioning.

The simple truth is that the primary mission of our nation’s for-profit health care system is to maximize profits, or income minus expenses, for shareholders and other types of owners by only spending as much on actual health care as the health care providers can get away with. This simple maxim was affirmed in a recent letter to the editor written by the former head of the national nursing home lobby (deceptively named the American Health Care Association), Paul Willging, in response to a September 23rd New York Times article, “At Many Homes, More Profit and Less Nursing.” In his letter, Willging, now associate director of program applications, division of geriatric medicine, Johns Hopkins University, wrote:

Your article confirmed an opinion I have held for some time. Even as past chief executive of the American Health Care Association, I began to suspect a possibly inherent contradiction between publicly traded and other large investor-operated nursing home companies and the prerequisites for quality care.

Can the investor’s focus (short-term profitability) simultaneously allow a comparable focus on the patient? I think the answer has to do with time frames.

Unfortunately, for many investors, those time frames are short. Earnings growth, quarter after quarter, is often paramount. Long-term investments in quality can work at cross purposes with a mandate for an unending progression of favorable earnings reports.

This is not to deny the existence of quality-oriented corporations. I see in many of them an increasing recognition that the value of the product is indispensable, if only for legislative and regulatory success. Your article suggests, however, that many of them still “don’t get it.”


Unfortunately, back when we in ADAPT began protesting AHCA and Willging in 1990, he used his business knowledge to oppose our civil rights and human rights mission.

The NYT article to which Willging responded focused on a growing trend involving the purchase of nursing homes by large private investment groups which are not subject to the disclosure requirements of publicly traded companies. After examining data available from the federal Centers for Medicare and Medicaid Services, the NYT analysis showed that these homes “have cut expenses and staff, sometimes below minimum legal requirements” and that these homes “scored worse than national rates in 12 of 14 indicators that regulators use to track ailments of long-term care residents, . . . include[ing] bedsores and easily preventable infections . . ..” The article included examples of resulting resident deaths.

So what about the regulators’ response to all this data? It seems that these private investment companies are very clever about using complex layers of corporate structure to both siphon profits and evade accountability. The owners create separate companies to collect their loot in rents and fees, leaving the company that operates the nursing home on a daily basis “holding the bag.” One private investment company executive defended this industry strategy as follows: “Lawyers were suing nursing homes because they knew the companies were worth billions of dollars, so we made the companies smaller and poorer, and the lawsuits have diminished.”

The health care system’s lack of accountability, and never-ending pursuit of ways to further insulate individuals and companies from responsibility for their actions, is perhaps the most significant recurring theme of this blog/web-site. One other way the nursing home industry pursues its interests with policy makers is through political contributions. On these and all nursing home related issues, I highly recommend the work of Steve Gold, an attorney who represents both ADAPT and Not Dead Yet.

No version of the health care system treats people with disabilities well [yet], but we’d rather pursue the goal of full disability respect and inclusion in the context of the fight for health care justice for all. In many health care justice rallies that focus on acute care, I’ve joined the chant, “People Not Profits,” but not all have recognized that this applies equally to long term care. The disability rights movement is sounding the alarm, but for us reform does not mean throwing more money at nursing homes. It means implementing our civil and human right to home and community based services that maximize consumer control while meeting individual needs. This is the solution to the “problem” of the coming wave of aging baby boomers, by the way, not euthanasia.—-Diane Coleman

Time for a Little Humor

humor, Our News & Commentary Blog, satire

It sometimes surprises people that we value humor here, but we’re grassroots activists who thrive on irreverance and an appreciation of the absurd. As we say in the introduction to the “Humor” section of our website:

…we maintain that humor is a great defense in terms of our stress level, and it can be used offensively as well. We’re fans of the famous — or infamous — community organizer Saul Alinsky. It’s no accident that he considered “irreverence” and “a sense of humor” as two extremely important qualities in activists and organizers. The ability to ridicule and laugh at the bigotry and “better dead than disabled” rhetoric that pervades our world keeps us fresh and ready for the new day and the next step in the struggle.

Finding topical things that cause those of us around here to laugh are a cause for celebration. This latest is from The Onion – “America’s Finest News Source:”

Suicide Note Makes Convincing Case

(excerpt)
SHERMAN OAKS, CA—Though friends and family of Michael Swinton, 15, were initially devastasted upon hearing the news of his recent suicide, many agreed Thursday that the explanatory note he penned prior to his death made surprisingly compelling points supporting his decision to take his own life.

“At first, all I could think was what a tragedy it was that he’d thrown away his life like this,” said Swinton’s mother, Debra. “But I was ultimately swayed by the part in which he talked about how he no longer wanted to be an emotional burden on everyone, and how everything would be easier if he were gone. It’s hard to argue with that kind of logic.”

What struck me is how skillfully the Onion staff combined the traditional coverage of the suicide of a teenager with the increasingly popular story that validates the suicides of old, ill and disabled people. The result is painful – because we have seen these quotes and sentiments before – but they’ve been put into an unexpected context.

This isn’t the first time that the staff at the Onion has shown it’s skill at satirizing stock coverage of one of our issues. For example, their 1997 article, ‘Vehicular Manslaughter Doctor’ Assists In 23rd Doctor-Assisted Vehicular Manslaughter, perfectly captures a typical maintream media treatment of Kevorkian, down to the “experts” quoted and the types of things they say:

(excerpt)
GRAND RAPIDS, MI—Dr. James Munson, known to millions as the infamous “vehicular manslaughter doctor,” participated in his 23rd doctor-assisted vehicular manslaughter Monday, running over an 81-year-old Michigan woman.

Munson, who was arrested and charged with first-degree vehicular manslaughter in the incident, hit Mildred Peters of Portage, MI, with his 1994 Ford Escort in a supermarket parking lot, killing her instantly.

“She was clearly in terrible pain,” said Munson, who did not know the woman. “She was moving very slowly, and it was a struggle for her just to push the shopping cart to her car. I don’t even think she would have been able to lift her groceries into the trunk without help. All this woman wanted was to die in a dignified, painless manner. Thank God I was able to give her that chance.”

So read, enjoy and laugh a little. We’ll get back to being serious tomorrow. –Stephen Drake

AP Reporter Does Sloppy and Superficial Job on Battin Story

media issues, Oregon, Our News & Commentary Blog, research

The Associated Press presents a challenge to those of us concerned with media coverage. With the growth of electronic media and the downsizing of newsroom staffs, the Associated Press and other wire services play an increasingly dominant role in reporting stories and framing the relevant issues contained in those stories. When they get things wrong, the misinformation spreads like a computer virus.

Criticism of AP coverage isn’t new for us. Two of the four entries on our “Journalists’ Hall of Shame” page are devoted to AP reporters. Chicago Reader columnist Mike Miner and Diversity, Inc. both covered NDY’s complaints regarding the AP-Ipsos poll on Kevorkian and assisted suicide earlier this year.

This latest example of AP reporting isn’t so much about outright misinformation as it is about sloppiness and superficiality.

AP reporter William McCall’s story about the Battin study is making the rounds now in Oregon and Canada. Typically, McCall goes to pro-life sources for criticisms. This is a pattern for McCall who has seldom if ever mentioned disability opposition to euthanasia and assisted suicide, even in those cases in which disability groups filed friend of the court briefs, as in Oregon v. Ashcroft and Gonzales v. Oregon.

In this story, McCall’s main source for criticism of Battin and the study comes from quotes lifted from a prolife site. Readers unfamiliar with Alex Schadenberg and the Euthanasia Prevention Coalition might assume that it’s a prolife group rather than a broad coalition of people opposed to legalization of assisted suicide and euthanasia:

“This is a study that, at best, can be referred to as propaganda,” wrote Alex Schadenberg, head of the Euthanasia Prevention Coalition, on the http://www.lifenews.com/ Web site.

That’s not the worst of this article, though. McCall touches on the undisclosed author conflict of interest issue when he identifies Death With Dignity National Center as an organization that is devoted to influencing public policy. He leaves the defenses put forth by both Battin and the director of the organization unchallenged. Peg Sandeen, director of DWD National Center, described Battin’s role in the organization as “minimal.”

That description doesn’t survive close scrutiny, at least in terms of her work with DWD board member Tim Quill. As we reported yesterday, Death With Dignity Board Member Tim Quill published a commentary in BMJ that covers some of the same ground as Battin’s study – and refers to it. Clearly, the study was shared with Quill for his effort to “spin” Battin’s study and impact the policy discussion in the medical community in the U.K. Quill didn’t disclose his professional affiliation with Death With Dignity National Center, either.

What else didn’t make it into McCall’s article?

Well, although the Oregon experience with assisted suicide is discussed in glowing detail, there is absolutely no mention of the scandal with the Nursing Review Board and its failure to report two nurses who admit “assisting” in a patient’s suicide. There is no evidence the patient requested this “assistance” and the time delay is so great that there are doubts of a successful prosecution even in regard to assisted suicide charges, let alone a charge of manslaughter or murder. In fact, there is no way of knowing if the case we already know about that the Nursing Board mishandled is an isolated case or the tip of the iceberg. Without real oversight and accountability, there’s no way to know.

McCall could have learned about these things if he’d bothered to call us, as he obviously reached out to Compassion and Choices. He knows who we are. He talked at length with Not Dead Yet president Diane Coleman a couple of years ago. I don’t know why he hasn’t picked up the phone since then to see if we have a new slant or some new information on a story.

Maybe it’s that he already has his story and doesn’t need people like us to mess it up by providing information and perspectives that depart from the established script.

The script? It’s pretty clear here at the end:

Assisted suicide is still opposed by a number of major groups, including the American Medical Association and the Roman Catholic Church.

No room for disability advocates or activists in that cast of characters. –Stephen Drake

Battin, Quill Use “Research” for Political Purposes

assisted suicide, Our News & Commentary Blog, reality check, research

Today’s edition of the Daily Utah Chronicle, the student newspaper of the University of Utah, has yet another story on Battin’s study titled “Assisted suicide not more common for poor.” The reporter contacted us last week, and more of our critique is present in this article:

One argument against physician-assisted suicide is that it will create a “slippery slope” leading to infanticide for deformed babies and that patients will be influenced in their decision by family pressures or the financial costs of treatment.

Critics are questioning the validity of the new study.

Stephen Drake, a research analyst for Not Dead Yet, a national disability rights group, argues that the researchers ignore the full definition of “slippery slope” — that euthanasia will eventually extend past whom it was intended for. Drake said for the past few years, the Netherlands have been giving the green light to infanticide.

Battin argues that in the Netherlands, the government hasn’t even made a law concerning infanticide.”In a legal issue the Dutch tolerate, but don’t prosecute a practice immediately — they wait until they can decide where the borders are,” she said.

Drake also argues that the data being collected are “non-verifiable” and are based on what doctors choose to admit.

“We have a variety of data in our study — doctor’s reports and death certificate reports — which doctors can’t lie about,” Battin said.

What’s interesting is that Battin’s “refutations” actually confirm the statements we’ve made. When Battin says that the Dutch “don’t prosecute… until they can decide where the borders are,” she is agreeing with a kind of “slippery slope” approach to euthanasia policy that the Dutch have adopted.

Further, when she says they have a “variety of data” that “doctors can’t lie about” she isn’t denying that much of the data is exactly the kind of non-verifiable information we’ve said it is. And, while I hate to be the one to break the news to her, doctors have been known to lie on death certificates and other medical reports for less than noble reasons.

There’s more…

Kathryn Tucker, legal affairs director at Compassion and Choices, said that the study is an important piece of work and warns others not to put too much credence on arguments made by organizations like Not Dead Yet.

Interesting quote from Tucker. Why shouldn’t others put too much credence on our arguments? Because we’re political and have an established position in this debate? Isn’t the same true of Tucker? Come to think of it, the same is true of Battin.

One last bit from this article…

Battin wouldn’t discuss her opinion on the issue, saying that her view is not relevant to the study.

“Every person has a view about this study, but our research was intended to look for evidence of these 10 groups being vulnerable, not to make a statement on whether it should be legalized or not,” she said.

Methinks the researcher and political advocate doth protest too much.

Although it’s gone virtually unnoticed here in the U.S., last week’s issue of BMJ featured a commentary by Tim Quill. Those familiar with the euthanasia debate know him as a long-time advocate of legalized assisted suicide and euthanasia, and a member of the board of directors of Death With Dignity National Center (Battin serves on the advisory board of this organization). Quill’s advocacy and affiliation are not mentioned in the information attached to his commentary. The title of his commentary is “Physician assisted death in vulnerable populations.” Sound familiar? It should.

Quill’s article discusses various “research” that suits his political objectives, including the research of Battin and her colleagues. It is hard to believe that Quill’s commentary and Battin’s study being published so close in time is coincidental. It looks orchestrated and coordinated.

And it’s political. Britain has been debating legalization of euthanasia and/or assisted suicide for a number of years. It’s been a highly contentious topic within the British Medical Association. Quill’s commentary is obviously meant to have an impact on the public policy debate in the United Kingdom, at least within professional circles.

There’s nothing dishonest or particularly unusual for advance copies of research to get shared with interested colleagues. But it’s disingenuous for Battin and Quill to claim the high ground of academic objectivity while engaging in very direct political action. –Stephen Drake

Addendum: Wesley Smith looked closely at the dates of the submission of the Battin study and its acceptance – looks like the “peer reviewers” were extremely fast readers!

Classic Reads: Libertarian Thomas Szasz Cuts Through the Crap on Assisted Suicide and Kevorkian

assisted suicide, Kevorkian, Our News & Commentary Blog

A lot of people who support the idea of the legalization of assisted suicide claim they do so on libertarian grounds. It’s no surprise – libertarians have the same shortage of critical thinkers in their ranks that seems to be the norm across the political spectrum.

Thomas Szasz is one of those exceptionally clear and critical thinkers – whether you agree with him or not. And it’s well worth reading what this man has to say on any number of subjects.

Today, though, I want to highlight a couple of short pieces that help expose some of the hypocrisy in much of the assisted suicide marketing.

For example, in a 2001 Op-Ed titled “Assisted Suicide is Bootleg Suicide” he makes the following points:

On Tuesday, a federal judge in Oregon extended a court order that stops Ashcroft from dismantling the law until the state can prepare arguments defending it. Liberals, who revere medical paternalism, condemn Ashcroft’s move. Yet classic liberals and libertarians who respect the rule of law should applaud it. “Decisions about when and how to die are best left to patients … not legislators,” wrote Jerome Groopman of Harvard.

I agree and wish it were so. The truth is that psychiatrists routinely prescribe involuntary “treatment” for patients whom they consider dangerous to themselves. Physician-assisted suicide laws permit doctors to write prescriptions for lethal drugs under certain circumstances. Supporters of such laws misrepresent them as permitting patients to decide when they want to die.

Assisted suicide and euthanasia proponents have been largely successful in uncoupling the realities of public policy toward suicide from their own advocacy. It’s almost unheard of find an assisted suicide propent asked how they feel about the reality that many people are hospitalized and medicated against their will for “being a danger to themselves.”

In a 2002 Op-Ed titled “Kevorkian Warps the Values He Touts,” Szasz took a critical look at Jack Kevorkian and didn’t like what he saw:

Misleadingly, Kevorkian’s subjects were called “patients.” However, Kevorkian had no license to practice medicine, and the people he “helped” did not come to him to be diagnosed or treated. They came to be killed and often traveled long distances to secure his services. If they could do that, they could have killed themselves by other means. They came to Kevorkian, then, either to obtain lethal drugs to which they had no access but Kevorkian did, albeit illegally; or they came to die by Kevorkian’s hands rather than their own, anxious to depict medical killing as “therapy.” Kevorkian was eager to oblige portraying himself as a heroic fighter for a right to suicide. In his book, “Prescription: Medicide,” Kevorkian stated that “helping suffering or doomed persons to kill themselves . . . is merely . . . a distasteful professional obligation. . . . What I find most satisfying is the prospect of making possible the performance of invaluable experiments or other beneficial acts.”

To the press and the public, Kevorkian represented his activities as a medical obligation, imposed on him by his conscience and medical degree. To make himself appear a medical savior, he falsely diagnosed his “patients” as dying. Eventually, his conceit got the better of him, and he was sent to prison, where be belongs.

We’ll be posting more on Kevorkian over the next couple of weeks, but check out more of what Szasz has to say in the meantime. –Stephen Drake