Let Mandela Die In Peace!

The 94 year old Mandela is back to the hospital for the third time in four months with recurring infection, presumably pneumonia. After a week in the hospital he is in the ICU in critical condition.

This great man endured 27 years in prison (1), became the first black president of South Africa, overcame adversity, and left office when he could have stayed. He was the master of his fate, and the captain of his destiny, until now that is.

Weakened by disease and old age he is now at our mercy. Yes, at our collective mercy!

We should ask ourselves, what would have Mandela wanted for himself during these days of grave illness. Would he agree with our selfish pursuit of "keeping him alive at all cost"? Or would he have wanted to be allowed to die with dignity and comfort.

His legacy should not have to be his end of life "struggle", but rather his life story, his bravery, and his accomplishments.

He is a great man, but he couldn't foresee the challenges that would face him at the end of life, and so it is now up to his loved ones, which is the entire nation of South Africa, to decide when he can be "allowed" to die. 

Who in South Africa, and Mr. Mandela's immediate family, is brave enough to say "enough", I wonder.

Only lucky people die in their sleep, most elderly die from pneumonia, sepsis, UTIs, complications of chronic diseases, etc. 

When a 94 year is admitted to the hospital three times in four months it is considered an indicator of poor prognosis and often a marker of "end of life"; Failure to recognize this is a major injustice to the greatest man of our times.

I hope, for his sake, that his country will overcome their urge to keep him alive, and step out of the way for his natural death. He deserves a comfortable and peaceful death.

He should not have to fight for it, he should be allowed to die, not die despite our best efforts.

References:

(1)

http://www.pbs.org/wgbh/pages/frontline/shows/mandela/prison/

A Maine Law To Improve Patient Choice--Unlikely To Pass

NOW LIKELY TO PASS!! (As of 4/11/2013)

By: Jabbar Fazeli, MD

Last year, Medicare spent $63.5 billion on post acute care (on patients care after their discharge from hospitals). (http://www.medpac.gov/documents/Jun12DataBookEntireReport.pdf).

With that much money up for grabs, the hospitals in Maine, and elsewhere in the US, do all they can (within the very limits of the law) to refer their patients to service providers affiliated or owned by the hospital. The affiliations and common ownership span the entire healthcare system, from skilled facilities, home health and hospice organizations, to physician practices employed by hospitals and nursing home chains.

These referral pseudo-monopolies are made possible through limiting or discouraging patient choice at every step in the hospital discharge process. Patients leaving the hospitals to go to skilled nursing facilities are often steered to affiliated facilities. Those who go home with home health services also tend to be offered an affiliated provider. Patients arrive to skilled nursing home without knowing who their doctor will be because they were never offered a choice of physicians even when there is available choice.

In such a system, the independent and less connected providers (skilled facilities, home health, geriatric physicians, and hospices) are left at the mercy of unethical referral practices.

Some facilities in rural areas are in danger of being out out business and the communities losing their local nursing home beds.

The few physicians still willing to practice medicine in nursing homes can not expect their name to be given to patients as they are being discharge from the hospital to a nursing home. That lack of choice is especially troubling when patients are preferentially referred to a receiving physician who happens to be either employed by the hospital or the nursing home.

Given that the usurping of patient choice is at the core of this unethical practice in healthcare referrals, a bill (LD-447) was introduced in Maine calling for greater transparency and patient choice at every step of the hospital discharge process.

At the public hearing for LD-447 both the Hospital Association and the Maine Healthcare Organization testified in opposition, citing "administrative burden" associated with providing more transparency and more meaningful patient choice. It was also claimed that existing laws are sufficient, even though providers testified that the current laws are inadequate and hard to implement do to lack of standardization.

The only supporters for this bill came from small and independent healthcare businesses willing to stick their necks out and bite the hand that feeds them, the hospitals.

The Maine Medical Directors Association (MMDA) came in support of the bill as any referral monopolies can create a disincentive for attracting new geriatrician and nursing home doctors to the State of Maine. This bill also strengthens the role of local medical directors in corporate nursing homes.

A survey is now being conducted by the MMDA which shows that nursing home facilities don't necessarily agree with their organization, the MHCA, when it comes to the assertion that the provisions in the bill would create an "administrative burden". Very few think that hospitals "currently" provide patients with adequate choice.

Considering the powerful forces opposed to the bill, and the millions of dollars at stake, it is unlikely that this Maine bill will pass, but some of us will go though the motions and appear at the working session for this bill scheduled for 3/12/2013.

Wish me luck!

Update: 3/12/2013
Bill tabled until April 2, 2013. Stay gunned.

Update: 4/11/2013:
LD 447 passed the DHS committee unanimously today.. Yay!!!

Photo source: aafp.org