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Greek Tragedy of A Lady Named Glenda Rodney Stich
Medical Industry’s Death Panels: Greek Tragedy of a Lady Named Glenda. Silverpeak Publisher PO Box 4, Alamo, CA 94507 www.silverpeak.org Copyright by Rodney Stich, April 1, 2012. All rights reserved. But any part of this book may be reproduced in an effort to expose the corruption in America’s health industry and bring about corrective actions. Make reference to this title. Because of the dynamic nature of the Internet, any Web addresses or links contained in this book may have changed since publication and may no longer be valid.
The views expressed in this work are solely those of the author and do not necessarily reflect the views of the publisher. The publisher hereby disclaims any responsibility for them. Stich, Rodney. Medical Industry Death Panels: Greek Tragedy of a Lady Named Glenda. ISBN for print book 978-0-932438-73-7 ISBN for e-book 978-0-932438-74-4
Revision of May 21, 2012. Table of Contents
1. Glenda’s Early Life in Oklahoma 2. Two Seniors, Pilots, Joining Together 3. First Medical Crisis: Glenda About to be widowed 4. Next Pastime Following Aviation: Recreation Vehicle 5. Glenda Diagnosed with Stage IV Esophagus Cancer 6. Cancer Became a Family Affliction 7. Glenda’s Cancer Drug Unavailability 8. Nearing the End of a Four Year Cancer Battle 9. Hospital Admission for Treatable Breathing Problem 10. Fraudulent Agreement to Provide Specific Treatment 11. Sham Certification of Terminal Illness 12. Ineligible Glenda Transferred to Hospice Facility 13. Hours Later: Glenda’s Sudden Suspicious Death 14. Funeral Services for Glenda 15. Researching Bruce’s Death 16. Doctor Euthanasia Through Morphine Overdose 17. Prevalence of “Homicide“ in America’s Medical Industry
18. Last in My Attempts to Fight Corruption 19. Hospice: the Good, the Bad, and the Deadly 20. Unrecognized Death Panels 21. The Guilty, the Complicit, and the Enablers 22. Criteria for Doctor Conduct to be Criminal Act 23. Sampling of Glenda in Happier Times 24. Afterword to the Glenda Medical Tragedy
Medical Industry’s Death Panels is the story of two lovers, seniors, both pilots, whose event-filled life came apart due to a series of corrupt acts by physicians in America’s medical industry. The joining of Rodney Stich, a former naval aviator, airline pilot, and federal airline safety inspector, with Glenda, was followed by years of interesting and exciting activities. This is the story of Glenda and her torturous path through cancer, surviving four years and in remission for esophagus cancer where the average survival is less than one year. Having survived four years after a Stage IV esophagus cancer diagnosis, and in remission, death came to Glenda through a series of corrupt medical actions after seeking relief for a treatable shortness-of-breath medical condition. Glenda’s death was physician-enabled through a series of blatant and criminal frauds in the medical industry. The book is an indictment of the cavalier, indifferent, and corrupt conduct by a group of physicians and medical facilities, and one of the reasons for the reported 30,000 or more deaths a year due to medical “errors.” People talk about possible death panels for seniors in the politically charged attention on health care changes. But death panels are already active in the United States. As usual, the American public has been kept in the dark about these corrupt medical practices.
With touches of a Greek tragedy, this is the story of a beautiful and talented woman and the problems she faced after being diagnosed in early 2008 with Stage IV esophagus cancer. It provides examples of arrogance and corruption in segments of America's medical industry. What Glenda experienced should be a warning for anyone, young or senior, who goes to a medical facility for even the most minor of treatable medical conditions. Follow Glenda through her suffering at the hands of physicians and medical facilities and see how their actions bring about the euthanasia of a great lady. This information must be known if people are to avoid and protect themselves and their loved ones when illness strikes. The medical industry has the same sleazy characters as most any other industry. For various reasons, Glenda and her partner, Rodney Stich, never formally married. The primary reason being Rodney’s attempts to expose high-level corruption made him vulnerable to lawsuits, which could affect Glenda's assets if they were legally married. In early 2011, Glenda's then-three-difficult years of fighting cancer was joined by Rodney being diagnosed with Stage III kidney cancer. Together, they encountered physician arrogance and misconduct in the American medical industry. Together, they battled elements in the medical field that are similar to the rampant misconduct throughout the United States. For decades, sexual crimes against children by Catholic priests were ignored and not punished. Likewise, for decades, doctor misconduct resulting in thousands of deaths yearly have had an even greater freedom from criticism and prosecution. Glenda experienced a form of medical treatment abuse that precipitated a premature death, despite having medical coverage under Medicare, Healthnet PPO, and ChampVa insurance (all of which performed admirably).
This book shows the need for patients, and their caregivers or loved ones, to become as informed as possible about medical treatment. The dangers, sometimes with fatal consequences, can be reduced from the effects of medical inertia, lack of physician competence in certain areas of healthcare, or outright misconduct.
About the Author
Rodney Stich had a colorful background. He was a Naval Aviator during World War II, receiving his Navy wings at the age of 20. At the age of 21, he became an instructor in PBY Catalina aircraft,
followed shortly thereafter by becoming the youngest U.S. Navy Patrol Plane Commander in World War II. After the end of World War II, he was an international airline captain in various types of aircraft, including the DC-3, DC-4, Martin 202; Convair 340; C-46; Lockheed Constellation; Boeing Stratocruiser, and eventually several jets, including the Convair 880 and Douglas DC-8. His Worldwide aviation activities included flying captain for Japan Airlines, sharing the cockpit with former Japanese World War II military pilots as copilots. He flew planeloads of Muslim pilgrims from throughout the Middle East to the holy cities of Mecca and Medina. In 1953, he found himself in the Middle of a CIAengineered revolution in Iran, among many other exciting moments. In 1962, he left airline flying and became a federal airline safety inspector for the Federal Aviation Administration (FAA) at a time when airline crashes were occurring seemingly every few months. As one of the most highly qualified inspectors in the FAA, he was given the task to correct the conditions resulting in the greatest number of airline disasters in the nation’s history. It was in this capacity that he discovered areas of corruption that would shape his life thereafter. Corruption, cover-ups, and deadly tragedies became routine discoveries as he and his many confidants uncovered an endless series of corrupt activities involving people in overt and covert government operations. After attempts to correct these conditions, which are described in various books, including History of Aviation Disasters: 1950 to 9/11, he left government and proceeded to expose what he had discovered, seeking to change the corrupt cultures. These efforts included publishing not-for-profit books, appearing as guest and expert on hundreds of radio and TV shows, starting in 1978. He also filed federal lawsuits under the federal crime reporting statute, Title 18 U.S.C. Section 4, seeking to force attention on corrupt activities that enabled many of the nation’s great tragedies.
As a result of these efforts, a continuing series of other former federal agents and other insiders provided him information on hardcore corruption of people in other areas of overt and covert government operations. Stich used this information in a series of other not-for-profit books that he wrote. Again, seeking to inform the people and bring about outrage to halt the various areas of corruption. One of Rodney’s first major sources for information on misconduct in covert government operations was a very unusual agent of the Central Intelligence Agency (CIA): Gunther Russbacher. Ironically, Russbacher received his initial flight training from the same flight instructor that had given Glenda her pilot training. He wrote about Russbacher in such books as Defrauding America and Drugging America. All of these efforts were unproductive. A culture of cover-up, public indifference, and protecting the guilty, enabled a continuing series of national tragedies to continue. This present book, Medical Industry’s Death Panels, is based upon what he personally experienced as he and his partner, Glenda, both endured the hardships of cancer.
The Purpose of the Book
Medical Industry’s Death Panels provides the actual experience and other information about the rarely publicized misconduct in the medical field that result in thousands of deaths a year. Discover, for instance: The need to research and become familiar with certain medical conditions that are being addressed. The need to cross check surgical or medical advice being given, which sometimes can lead to tragic or deadly consequences. The need to research the effects of certain medication being prescribed for home use or in medical facilities.
The important need to understand the pros and cons of hospice, and how failure to understand can result in needless suffering and death for yourself or a loved one. The need to understand that for many doctors, you or a loved one, are merely a business commodity, and that death can easily occur when profit is the physician’s primary interest.
Everyone will experience at some time in their life the need for medical attention for themselves or a loved one. Failure to recognize the inherent problems in the medical field can easily bring about a deadly outcome. This could happen to you, or a loved one for whom you are arranging medical care.
This book and the efforts behind it are in remembrance of a great lady whose life was prematurely brought to an end by gross misconduct in America’s medical industry. It is also dedicated to the memory of the thousands who have already been victimized by rogue personnel in the medical industry, where the same pockets of corruption exists as in virtually every other area of activity in the United States. Unfortunately, as with every other book written by Rodney Stich, using insider information on the relationship between corruption and great tragedies, Medical Industry’s Death Panels will suffer the same indifference. At least he tried. CHAPTER ONE
Glenda’s Early Life in Oklahoma
Glenda Guilinger was born on January 24, 1933, in Cromwell, Oklahoma during the Great Depression. Glenda’s father worked for Sinclair Oil Company, and had steady employment. The family did not suffer the economic hardships as many others did during the Great Depression. Growing up in Oklahoma
Glenda's mother was a seamstress and taught Glenda how to sew on her Singer treadle machine. Her father added an electric motor to it and Glenda made most of her dresses on it in her teenage years. Later, when the family moved temporarily to Tucson, Arizona, for Glenda’s pulmonary problems, her mother packed the sewing machine, frame and all, and carried it in the back seat with Glenda. Glenda’s Early Exposure to Quilting Glenda's grandmother was a quilter. Glenda remembered always having a “Sunbonnet Sue” or a butterfly quilt on her bed. One summer, Glenda's father made a quilting frame with little pulleys above Glenda's bed so that she could do her quilting. Glenda had a strong attachment to horses and was an excellent rider, often riding without a saddle. Eventually she had to disassociate herself from horses due to a strong allergy to them. More than once she was rushed to hospitals due to breathing problems from that horse-related allergy. More than once she was near death as the allergy caused breathing problems. Glenda attended Bow Legs High School, in Bow Legs, Oklahoma, where she was voted homecoming beauty queen in 1950.
Glenda at the age of 16 Glenda had a keen interest in aviation since the age of 15. In 1951, at the age of 17, she secretly saved her lunch money and used it to take flying lessons in a Cessna 140 at the Seminole airport. Her parents didn’t find out about her activities until an article appeared in the local newspaper announcing the licensing as a pilot of a young local high school girl. She took some of her high school friends, one at a time, flying over the small town of Seminole. In those days it was rare to see a young woman who was willing to take such extraordinary measures to achieve their life-long dream―flying.
Glenda crowned Homecoming Queen in 1950 She was an avid reader of non-fiction and fiction; a fabulous cook, known for the quilts she made, held a master's degree in criminal justice, and much more. In 1953, Glenda married a World War II Army soldier, Edwin L. Guilinger, who had been wounded during a major battle in Europe. She had three sons and a daughter from that marriage. Glenda attended Central State College and the University of Oklahoma, receiving a degree in Business Administration. Working as a Secretary at the University of Oklahoma gave her a chance to attend classes from 1964 to 1966. Glenda was juggling working, moving, and attending night classes at three different colleges.
Eventually, she received a degree in Business Administration. By then, she was working for the Department of Corrections. In 1979, her husband died from his World War II wounds. After he died, Glenda went back to school at night and earned her Master's Degree in Criminal Justice Administration, becoming a Correctional Case Manager. She was employed as a case worker at the prison where the warden’s wife, Bobbi Parker, left with one of the prisoners, Randolph Franklin Dial, leaving behind her children. They were not discovered for many years until 2005, when they were spotted living on a chicken ranch in Campti, Texas. Glenda moved to the Bay Area of Northern California in 1987 and was employed at the Naval Weapons station in Concord, California, from 1986 to 1992. She traveled extensively throughout the world. Along with her love of reading, Glenda loved doing crossword puzzles. Back into Quilting In the 80's Glenda learned the hard way that beginner quilters should take some basic quilting lessons. She joined a quilting group in Oklahoma City and started immediately on a Carolina Lily quilt. Thinking she knew it all, she appliqued bright red flowers with pretty green leaves and trim on it. Then she washed it and found the quilt now had turned pink from the red dye in the lilies. She eventually took all the lilies off and washed the quilt again in dye remover; the green leaves were unharmed. She then made sure her new red fabric wouldn't run and re-appliqued all the lilies on her quilt. She kept this quilt as a lifelong remembrance. One of her quilts was a large stunning “Baltimore Album” with a variety of colorful flowers and birds appliqued on each block. Glenda was one of the original members of the Rossmoor Quilting Club in the Walnut Creek, California retirement community. She contributed her skills to the creation of a variety of large quilts that were donated to various charities such as AFF, Meals on Wheels, and Habitat for Humanity.
Two Seniors, Pilots, Joining Together
I met Glenda in 1994. We were both senior citizens at that time. For laughs, I claim to have met Glenda in front of the prune counter at Safeway. We hit it off right from the start. I soon learned that Glenda had obtained her pilot’s license in 1951 at the age of 17. I had been in aviation since 1941, first as a radio operator in Navy PBY patrol planes and then later as a Naval aviator, Navy Patrol Plane Commander, international airline captain, and FAA airline safety inspector. Prior to meeting Glenda, I had been under unprecedented attacks by multiple groups to halt my exposure of what became a series of major national scandals. The attacks started in 1982 and eventually included over 50 lawyers and law firms, Department of Justice personnel, California and federal judges, and others. After corruptly stripping me of the $10 million in assets that funded my exposure activities, and other harm that is discussed in some of my books, these attacks slowed down by the time I met Glenda. My most loyal during that period of time before meeting Glenda was one of the smartest German Shepherds that I had ever encountered: Midas. When the abuse and harm were at extreme levels to where I actually cried, Midas would come over and lie down next to me, and look up at me. He knew there were problems. Occupied with Fighting High-Level Corruption And Fighting Massive Retaliation When Glenda and I joined in 1994, I had been fighting high-level corruption for many years and had become the head of a coalition of former government agents and other insiders exposing corruption that was resulting in a continuing series of major national disasters. These discoveries started after I had been given the assignment, as a federal airline safety inspector, to halt the corruption at a major airline that had more senseless airline disasters than any other air-
line, and even more than most other airlines combined. Those discoveries and the unprecedented actions I took to force an end to the corrupt acts are described in the not-for-profit book, History of Aviation Disasters: 1950 to 9/11. After leaving government, my activist activities included writing not-for-profit books using insider information, appearing as guests on radio and TV programs, and giving lectures. Glenda came with me when I appeared before groups in out-of-town speaking events throughout California. She also was the proof reader for some of the books that I wrote on covert activities in various government operations. My first book on this subject was published in 1978. It was the first of multiple editions of Unfriendly Skies. Later, as my many sources provided me with information on corruption in other areas, the next in a series of books on these subjects was called Defrauding America. The subject of corruption in overt and covert government operations and resulting national tragedies is too complex for what is being discussed here. My books are listed at amazon.com and other places, my web sites, including the main one, www.defraudingamerica.com, and a Google search using Rodney Stich as the search term, provide more details. Glenda became acquainted with many of my sources in the intelligence community, and other insiders who provided me a wealth of highly sensitive information. One unusual source, who always mentioned Glenda in his letters to me, was a former New York City Mafia figure, Gregory Scarpa, Jr. Scarpa had “befriended” a key al Qaeda figure, Ramzi Yousef, the mastermind behind the 1993 bombing of the World Trade Center. With this relationship, Scarpa obtained advance information about several major terrorist attacks upon U.S. targets, including 9/11. Why that information was not acted upon is one of the country’s biggest scandals that have yet to be exposed.
Details, as given to me by Scarpa, are found in the books that Glenda helped proofread: Crimes of the FBI-DOJ, Mafia, and al Qaeda; and History of Aviation Disasters: 1950 to 9/11. The information I obtained from Scarpa, and other sources, caused me to file a lawsuit under the federal crime reporting statute, Title 18 U.S.C. Section 4, in the federal courts in New York City. In 2005, Glenda went with me to New York City when I appeared before the U.S. Court of Appeals to give verbal argument on an appeal that I had filed in a federal action that was related to the 9/11 attack. That is another subject that is too complex to discuss here. Glenda Entered a New World, a World of Intrigue Glenda was brought into a different world when she and I became a couple. Although she was a licensed pilot at the age of 17 in 1951, she had not done any flying since then. Flying had been my life. During World War II, I was a Naval Aviator; then an international airline captain, a federal airline safety inspector, and finally, a private pilot with my own aircraft. Glenda and I were active in flying for the next nine years. Every few weeks I would have Glenda do a half hour of touch-andgo landings at the local Concord, California Buchanan Airport to get her proficiency back. We took many short local flying trips. Once a year we would rent a plane for about ten days and travel throughout the Southwest, which included flying the 180-milelength of the Grand Canyon, flying into Sedona, and other scenic locations. Glenda also became familiar with the world of intrigue, in which I had been deeply involved since the mid-1960s. These extensive experiences are described in great detail in my various books. The intrigue started with the politics—or corruption—that made possible many years of aviation disasters, and then expanded into numerous areas involving the CIA and covert national affairs. By proof-reading my books, Glenda learned from a variety of my confidants high-level secrets associated with some of the nation’s worst tragedies. These are described in my various books that are
available in digital and print formats at www.amazon.com and other internet locations. Glenda appeared with me throughout California as I appeared before groups describing the harm-enabling corruption for which I had considerable evidence. Glenda got to know, and to be the recipient of their comments, of many unusual people as they always wished Glenda the best in their phone calls, e-mails, and letters. These people included former personnel of the CIA, FBI, DEA, Customs, Secret Service, former drug smugglers working in covert U.S. personnel, and former Mafia figures. Glenda became familiar with serious matters involving federal judges as I sought to expose the corruption that I and other former government agents had discovered. The actions of these corrupt judges covered up for the corruption that I and my many sources had discovered and that enabled to occur some of America’s worst tragedies. After the hijackings of September 11, 2001, Glenda appeared with me in the federal district courts in New York City, where I presented oral argument in support of an appeal that I filed from the actions of chief judge Michael Mukasey who later became U.S. attorney general. Because of the enormous gravity of these matters, Glenda became part of my highly unusual efforts seeking to expose and halt the ongoing corruption that enabled many of the nation’s tragedies. In the process, she became acquainted with a highly unusual number of sophisticated insiders in America’s covert activities. She had the intelligence to handle herself well in these matters. It added to the interesting activities that we would share for many years. Glenda became acquainted with many of my sources in the intelligence community, and other insiders who provided me a wealth of highly sensitive information. One unusual source, who always mentioned Glenda in his letters to me, was a former New York City Mafia figure, Gregory Scarpa, Jr.
Scarpa had “befriended” a key al Qaeda figure, Ramzi Yousef, the mastermind behind the 1993 bombing of the World Trade Center. With this relationship, Scarpa obtained advance information about several major terrorist attacks upon U.S. targets, including 9/11. Why that information was not acted upon is one of the country’s biggest scandals that have yet to be exposed. Details, as given to me by Scarpa, are found in the books that Glenda helped proofread: Crimes of the FBI-DOJ, Mafia, and al Qaeda; and History of Aviation Disasters: 1950 to 9/11. The information I obtained from Scarpa, and other sources, caused me to file a lawsuit under the federal crime reporting statute, Title 18 U.S.C. Section 4, in the federal courts in New York City. In 2005, Glenda went with me to New York City when I appeared before the U.S. Court of Appeals to give verbal argument on an appeal that I had filed in a federal action that was related to the 9/11 attack. That is another subject that is too complex to discuss here. Some of my other sources that Glenda become involved in included the following: A couple, including the widow of a CIA operative, Santa Romana, involved in the secret retrieval of billions of dollars’ worth of Japanese loot hidden in the Philippines. I wrote about that matter in the book, Japanese and U.S. World War II Plunder. A former CIA figure, Gunther Russbacher, and his wife, Rayelan, of whom I wrote about in several of my books, including Defrauding America and also Drugging America. A former FBI agent, Richard Taus, working under an FBI supervisor that was involved in murders with a famous New York City Mafia figure known as the killing machine. I wrote about that agent in the book, FBI, CIA, the Mob, and Treachery. A former TWA captain, Hoot Gibson, for whom a movie was written concerning a high altitude jet upset.
A former FBI station chief of the Los Angeles office, Ted Gunderson, who had uncovered a major child sex crime ring involving high level political figures. And Others.
Reigniting Our Love for Flying Glenda and I started renting small single engine and sometimes twin-engine aircraft. I would often rent a plane and have Glenda do about thirty minutes of touch and go landings at Buchanan Airport at Concord, California. That brought back Glenda’s flying proficiency. She loved flying above the clouds in the San Francisco area. From 1995 until 2003, we flew trips every year throughout the Southwest, including flying the length of the Grand Canyon, over Lake Powell, Sedona, Bryce Canyon, Zion, and other top scenic places.
Glenda at Sedona Airport Our first stop after leaving Buchanan Airport in Concord was usually Las Vegas International Airport, with an occasional first stop at Death Valley. One landing at Death Valley was unplanned. We were in a single-engine aircraft flying over the Sierras on a hot day and trying to get a thousand feet clearance to get over the pass at the end of Kings Valley. The aircraft just didn’t have enough power to get the altitude. I told Glenda I would look for updrafts to get the needed altitude, or else we would have to divert southward where the mountains were lower. After about 20 minutes I managed to get the needed altitude to safety cross the Sierras. But by the time we made it across, Glenda
had to go to the restroom. I then put the nose down and headed for Death Valley, going from about 13,000 feet to below sea level at the Death Valley airport.
Glenda's son, Bruce, Las Vegas 1998 During one trip, we took Glenda’s son, Bruce, with us, covering many scenic places in the Southwest. He was ecstatic about the views from the aircraft of the outstanding scenery. Bruce had early-stage MS. Of all of Glenda’s children, he was the closest to Glenda, and the most vocal about his love for her. Even though he lived far away in Big Lake, Minnesota, he was in daily telephone contact with his mother.
Flying over the Rainbow Bridge and Lake Powell
Glenda loved flying over the Clouds Glenda and Her Love for Slot Machines Glenda loved traveling to Reno for her favorite hobby, the slot machines. She usually came out financially ahead and rarely lost. But I sometimes lost Glenda for hours at a time. Once, while staying at the Atlantis Hotel and Casino in Reno, I didn’t hear from Glenda for most of the day and it was then almost midnight.
I knew she went to the Silver Legacy to gamble. I called security personnel at the Silver Legacy, explaining my problem about not having heard from Glenda for hours. Security informed me that was normal conduct for gamblers. I described the car she was driving, and before ending the conversation—security stated there was a car matching that description leaving the parking area at that time. That was Glenda. Overall, our 18 years together were full of unusual and enjoyable events that seemed would never end. Never a dull moment. At home, I concentrated upon my information gathering and writing about corruption, and Glenda stayed busy with her various activities. At night, we relaxed and watched informative or interesting television shows.
One of dozens of quilts made by Glenda CHAPTER THREE
First Medical Crisis: Glenda about to be “Widowed”
Our flying came to an end in 2003. One of my six coronary bypasses from 1985 failed. I experienced severe unstable angina that was not relieved by any of the available angina medications. I was near death after that happened. Several cardiologists stated there was nothing they could do for me since my coronary vessels were too small for stents or another open heart surgery. Several times Glenda had to rush me to the hospital because of chest pains. I then made final funeral arrangements so that Glenda would not suddenly have to make all the arrangements from scratch. It was a sobering feeling facing death, thinking that within a matter of days, or a few weeks, I would be dead. Having Glenda as my “partner” was the best thing that happened to me. We had so many good times together, and now, for me, it would shortly end, I felt. I would again learn the value of doing medical research and not relying totally on physicians. This research was somewhat natural for me since I had been a pharmaceutical company representative for about five years after leaving the U.S. Navy and before flying for the airlines. That position required me to do considerable medical research in order to engage in intelligent conversations with doctors on the fairly sophisticated medications I was presenting for certain medical conditions. This practice, of doing research pertaining to various medical conditions, has continued over the years. While researching the Internet, I discovered a Medicare-approved non-invasive treatment that had worldwide use and was being used in some of the nation’s top medical centers. But the information was virtually unknown to most doctors. The theory is that these surges cause the formation of tiny blood vessels around coronary blockage. After 35 treatments, my angina was gone. I couldn’t believe it. Death was no longer at my doorstep. I was so impressed that I put up a web site to inform people about this treatment. www.heartsurvival.info.
The treatment creates additional paths for blood flow, called arterioles or collaterals, to provide additional pathways for blood flow to the heart that circumvents blocked arteries. In this way the treatment restores or improves the blood circulation to organs and tissues that have been affected by blockage in the normal blood supply. The treatment is known as EECP or Enhanced External Counter Pulsation, and encourages the formation of coronary arterioles or collaterals that circumvents blocked coronary arteries. “Previous studies have shown that EECP therapy can relieve symptoms of angina in heart failure patients,” said Dr. Soran. This study is significant, in that it is the first to show improvements in specific symptoms of heart failure. This study was the impetus for the larger controlled prospective PEECH (TM) trial (Prospective Evaluation of EECP in Congestive Heart Failure), which is studying the efficacy of EECP in a larger number of patients. Despite the fact that EECP is well proven and used by top medical centers, most doctors are unfamiliar with this treatment. One reason for this is that the people selling the machines do not have detail people making periodic calls on physicians, as is done by the pharmaceutical companies. There isn’t as much profit in selling EECP machines as there are in the billion-dollar-a-year pharmaceutical area. Another reason for resistance in using the treatments is that it takes profit away from surgeons and hospitals that do open heart surgery or stents. There is virtually no profit in referring a patient to a location that has the machine necessary for EECP treatment. Another tragic side effect is that people who are not candidates for stents or open heart surgery are allowed to suffer, or die, when non-invasive treatment is available. The EECP therapy eliminates the risks associated with stents or open heart surgery. I was able to convince my cardiologist, Dr. Michael Forrest, to authorize an out-of-medical plan referral to try it out. It consisted of 35 one-hour treatments, lying on a table with cuffs wrapped around
your legs and abdomen. Every time your heart beats, the cuffs contract, sending a surge of blood to the heart. This near-death experience again showed me the importance of not counting solely on medical help from an individual or a group of doctors. Often times, there is medical help from other sources that a particular doctor or group of doctors don’t know about.
Next Pastime Following Aviation: Recreation Vehicle
With the end to our flying activities, Glenda and I developed an interest in recreation vehicles. During one of our monthly trips to Reno, and while Glenda was gambling, I occupied myself looking at the classified section of the Reno Gazette. I saw an RV listed for sale that had a very low price. That motivated me to call the number. The seller drove the RV to the Reno Hilton where we were staying. I was impressed with it. Glenda wanted to wait and think about it, but I felt that was not practical since we would shortly be leaving Reno. I said, “We will take it.” That started a new life for us, replacing our aviation activities. That purchase started a new chapter in our lives, replacing the aviation phase. With the purchase of a 27-foot Class A Dolphin motor home, we took many short trips to campsites in Northern California, especially along the ocean, including nearby Bodega Bay. Glenda loved traveling with a “small one-bedroom” apartment, which included double bed, a shower, cooking stove, TV, and all the comforts of home―on wheels. Where else can you have the comforts of home while parked within a few hundred feet of the Pacific Ocean. Or, park in the wilderness or some other panoramic areas, with the comforts of home.
The meals prepared by Glenda on the four-burner stove or microwave appeared to taste even better than at home—while enjoying a spectacular view. I shortly discovered that it greatly helps to have mechanical skills to keep a used 27-foot “house on wheels” operational. Problems were common with the refrigerator, the hot water heater, the space heater, the air conditioner, and an endless number of other things.
The RV trips were a source of great pleasure for Glenda, with a different form of excitement than provided by our frequent airplane trips. CHAPTER FIVE
Glenda Diagnosed with Stage IV Esophagus Cancer
Our lives changed in early 2008. Glenda, then a youthful 75, reported to her primary care physician, Dr. Vona Lorenzana (Walnut Creek, CA), that she had difficulty in swallowing. This physician immediately referred Glenda to specialists, where the diagnosis was made of Stage IV esophagus cancer; cancer of the esophagus that had already spread to other organs. Stage IV esophagus cancer had an average survival prognosis of less than one year. The doctor giving Glenda the diagnosis gave Glenda the phone number of a surgeon and an oncologist on a handwritten note pad, with no other information. Being new to the area of cancer treatment, Glenda and I went to the surgeon whose name was on the slip of paper. That surgeon recommended surgical removal of the esophagus. At that point I started researching the many cancer treatment sites on the internet. I found that surgical removal of the esophagus, when the cancer had already spread beyond the esophagus, did not improve the cancer outlook, would not prolong life, and would greatly deteriorate the quality of life. Surgery was therefore out of the question. Disturbingly, the surgeon, who certainly knew of these many reports against surgical removal of the esophagus when the cancer was already metastasized to other organs, never mentioned this important life-affecting matter. He obviously was more interested in the money from the surgery than upon Glenda’s life. But this discovery would be only the first of others about the culture among some physicians in the medical industry. Starting With a Medical Oncologist The other name on the notepad paper was that of the Diablo Valley Oncology Center, and the oncologist, Dr. Robert Robles. While being seen by Dr. Robles, Glenda's esophagus eventually closed to where she could not eat or drink. That condition required referral to a surgeon, who then made an opening into her stomach and the
placement of a feeding tube so that she could feed liquid food directly into the stomach. Medical supply companies delivered food and a feeding pump to our residence, without any instructions as to how to use the equipment. Several serious medical problems occurred for which this writer sought help from Diablo Valley Oncology. Their lack of response created a situation where Glenda was near death, causing me to rush her to the hospital emergency section. If the cancer experience was not a new experience, I might have detected certain problems earlier. It wasn't until Glenda's dehydrated appearance was obvious that I rushed her to the emergency section of John Muir Hospital in Walnut Creek. That near-death experience caused me to request urgent help from the executive offices of John Muir Hospital. They established treatment for Glenda with another oncology group: Contra Costa Oncology's Dr. Michael Sherman. Months of radiation treatment at the John Muir Hospital campus at Concord, California, then followed. The first year of cancer treatment consisted of radiation, cancer drug infusions, and continual tests. Beating the normal maximum one-year survival from Stage IV esophagus cancer, the cancer appeared to be in remission. A one-year maximum survival is often the case with the discovery of Stage IV esophagus cancer. It looked as if Glenda would survive the cancer as the cancer drugs kept the cancer under control. Rough First Year of Esophagus Cancer The first year was the most difficult for Glenda. The closing of the esophagus; being forced to feed herself through a stomach tube; deathly sick from radiation and cancer drugs; and spending much of her time in bed. I felt extremely sorry for cancer victims showing up at chemo infusion appointments by themselves, when most cancer patients need a loved one, a caregiver, there all the time.
Seeking additional guidance, I took Glenda to the prestigious Stanford Medical Center in Palo Alto California. Fortunately for Glenda, she had not only Medicare to pay the bills, but also a PPO supplemental insurance issued by Healthnet, enabling her to go to virtually any doctor. And the plan worked very well for Glenda during her four years of cancer treatment. It was the opinion of the Stanford physicians that the cancer treatment that Glenda needed, weeks of radiation and endless chemo, could be done as well by the facilities in the Walnut Creek area, as at Stanford. There was an event in the Los Angeles area, in which I was scheduled to be a speaker before a group of about 700 people. I couldn’t think of leaving Glenda and had to cancel so as not to leave her alone, even for a few hours. A friend of mine took my place, former FBI chief of the Los Angeles office, Ted Gunderson. It was good that I didn’t leave Glenda during those few hours, as I ended up rushing her to the hospital in a near-death condition. Ironically, three years later, Gunderson died of cancer in 2011. I felt so sorry for Glenda. Sometimes when she lay motionless in bed, I would go to our Allen theatre organ and play soothing songs from the thirties, thinking it might make her feel better. Dr. Sherman's selection of oncology drugs appeared to stabilize Glenda's cancer. The normal life expectancy of someone diagnosed with Stage IV esophagus cancer was one year. Glenda went way beyond that. Once she started feeling better, I told Glenda that we have to make every day as pleasant for her as possible, and that whatever she wanted to do, or wherever she wanted to go, don’t hesitate for a moment to tell me. The surgeon that inserted the feeding tube directly into Glenda's stomach responded to a question, stating that the esophagus would never again reopen, and that she would need to feed herself for the remainder of her life through the feeding tube. Glenda and I then planned to again visit Stanford where physicians specialized in reopening the esophagus. But before this need occurred, Glenda’s esophagus did reopen, about a year after it had closed. The prior surgeon was wrong. Glenda was able to eat and drink normally.
Cancer treatment continued for several years, with repeated series of infusion of the cancer drug, Taxol, at Contra Costa Oncology, combined with CT and PET scans, and blood tests. Time consuming, but Glenda got a comfortable quality of life back. We planned to make many short trips to make every day count. Glenda beat the odds by living beyond the first year. The expected death did not occur as the personnel at the oncology center expected. In early 2011, small signs of cancer appeared in Glenda’s lungs. When the small cancer spots showed up in the lungs, I asked cancer specialists caring for Glenda how much time she had. I was told a few weeks. They were again wrong. The cancer drug, Taxol, given to Glenda in a series of infusions, brought that cancer under control. Toward the end of 2011, scans and blood tests indicated an absence of any cancer. Having survived every doctor prognosis, Glenda approached the end of the fourth year, her cancer was apparently in remission and she felt fine, except for occasional episodes of breathing problems from the years of COPD. Glenda’s years of COPD limited the places we could visit, with higher altitudes forcing Glenda to require oxygen. This condition seemed to be affecting me as well. Where Glenda and I formerly flew small aircraft at 14,000 altitude, such as over the Grand Canyon and the Sierras, the altitude of 6500 feet at Lake Tahoe reduced her energy level. It was worse for me! Family Support was Important for Glenda Glenda had three sons and one daughter, all of whom lived out of state. Martin who lived in Tulsa, Oklahoma. Mike who lived in New Jersey, and had himself been diagnosed in early 2011 with liver cancer that had already spread to another organ. Bruce, who lived in Big Lake, Minnesota, and who had Multiple Sclerosis (MS), and sometimes confined to a wheel chair. Also, a daughter, Lisa Kinney.
My daughter, Stephanie, in nearby Danville was the matriarch of a “clan” with spectacular gatherings every few weeks. They all took to Glenda and worshipped her.
Glenda and Rodney sitting with the “clan” Despite the past four years of intensive medical care, now that the cancer was in remission, and she had possibly the largest “family” ever, Glenda was happy. She left a note for me one day, showing how she felt:
Cancer Became a Family Affliction
In May 2011, I was diagnosed with Stage III kidney cancer. Events leading up to that diagnosis revealed another ugly side of medical care in America’s healthcare industry. In Glenda’s case, she was under the fee-for-service plan of Medicare and an excellent Healthnet PPO insurance. In my case, I had been for the past 40 years a member of the Kaiser Permanente HMO plan. Each had their good points, and each had physicians that were a threat and source of unnecessary sufferings and deaths. When I first experienced multiple symptoms that something was radically wrong, my primary care physician at Kaiser Permanente HMO in Walnut Creek, California, refused to order tests, primarily a CT scan. He stated that it was against Kaiser Permanente policy to order such tests for a health plan member of my age. That was an outrageous statement since I had a contract with Kaiser Permanente for medical care. It was medical fraud to now deny me that contractual care because I was older than the unwritten guideline by this for-profit physician medical group.
I was then forced to go to a physician outside of the Kaiser Permanente group. Upon describing my symptoms, he immediately ordered a CT scan. That scan showed advanced Stage III kidney cancer in the right kidney that had spread to fully engulf the related lymph node—ready to spread to a deadly Stage IV kidney cancer. I then provided the report and copy of the disk to several Kaiser physicians, including a urologist and the primary care physician. I was then subjected to coordinated pressure urging me to do nothing and wait until I personally experienced symptoms as the cancer spread to other parts of the body. That was insane. The curative or remission-causing benefits of cancer drugs would be lost. By the time additional symptoms became evident, the cancer would most probably be incurable and hospice would be the only avenue remaining for me. It was a death decree! But profitable for the for-profit Kaiser Permanente physician group. I objected repeatedly, and presented Kaiser physicians with evidence of the universally recognized cancer treatment at that stage, which was immediate surgical removal of the right kidney and the cancerous lymph node. Kaiser physicians then used sham arguments to dissuade me from surgery. These arguments included, for instance: I was too old for surgery. I had a stent that required blood thinning drugs such as aspirin, and that increased the risk of bleeding during surgery.
I then provided Kaiser physicians copies of numerous medical reports showing their excuses to be false. After nearly two months delay—wherein the cancer may have then spread to other parts of the body—the surgery was finally performed. After surgery, Kaiser physicians returned again to sham arguments to deny to me the universally recognized post-nephrectomy blood tests and CT scans. Again I had to provide copies of medical reports showing the urgent requirement of such tests. Three Kaiser Oncologists provided sham arguments. The first one said that the contrast used in CT scans was too dangerous for peo-
ple with only one kidney. The standard practice is to perform the CT scans without contrast. The second Kaiser oncologist stated that cancer drugs do not delay the spread of cancer, which was totally false. The third Kaiser oncologist simply walked out of the examining room when I questioned his excuse. Complaints to medical regulatory bodies in California were a waste of time. An appeal under Medicare was also a farce. The logistics of the appeal process is such that the patient has no information on what the physician is providing and therefore has no way to correct any falsehoods. The appeal process was inherently flawed and enabled the system to protect itself while defrauding the victim of any redress. By that time, possibly the web site I put up, defraudingamerica.com/kaiserpermanente.html, may have forced a rethinking. Or, I managed to get an oncologist who had the courage to oppose the prior “death squad!” Dr. Kaufman stated that I should have already had the tests done. He even provided me with some of the same medical studies I had earlier presented, showing the important need for those tests. Cancer then became a dual family matter. Fortunately, when I was in need of caregiver help, Glenda was in remission and relatively free of symptoms, and provided the help. At most other times, when Glenda needed help, sometimes emergency reactions, I was able to respond. Obviously, being a very busy caregiver taking care of Glenda’s cancer emergencies and around-the-clock needs, the misconduct by the Kaiser physicians made life more difficult for me and for Glenda. At this writing, I am waiting for the cancer to appear in other parts of my body.
Glenda’s Cancer Drug Unavailability
Vulnerable Cancer Patients are Suffering―and Dying— Because Of Profit-Related Shortage of Cancer Fighting Drugs For many months there had been a worsening shortage, or total unavailability, of cancer fighting drugs in the United States. One such drug was Taxol. Because of this shortage, vulnerable cancer patients were needlessly suffering the advance of cancer metastasis. Obviously, many were dying as a result. In what was once the most advanced nation in the world, cancer patients are suffering and dying of cancer because of drug shortages or unavailability. Greedy and Indifferent U.S. Pharmaceutical Companies And U.S. Pharmacies Versus U.S. Cancer Patients Numerous media reports blamed the unavailability or shortages on the refusal of pharmaceutical companies to produce the drugs because of a low profit level. In their eyes, it was okay to spend tens of millions on advertising drugs like Viagra and Cialis, that seek to increase sale of profitable drugs through continuous TV segments showing everything but the penis entering the vagina. But they had no money for dying cancer patients. Cancer drugs were easily available from government-licensed pharmacies in Canada but prohibited by laws in the United States to be used by oncology clinics and hospitals. People in the United States were suffering and dying because of the unavailability of cancer drugs that could have been easily obtained almost overnight from government-licensed wholesalers and pharmacies in Canada. One such cancer drug was Taxol, which Glenda had used for very small cancer cells that had spread to the lungs in early 2011. The first series of treatment with Taxol apparently eliminated the small spots of cancer that had appeared in the lungs. When Taxol was no longer available, the oncology center substituted Taxotere. That also appeared to keep the cancer in remission, but caused Glenda to suffer nauseating side effects. When the cancer spots appeared in Glenda’s lungs, I asked one of the medical personnel how long Glenda had to live. The answer
was a few weeks. Months later, in November 2011, blood tests showed no signs of cancer. The CT and PET scans were negative for cancer as well. Again, medical personnel were wrong in their estimate of Glenda’s prognosis. Government Bureaucrats Barring Importing Cancer Drugs from Canadian Approved Drug Suppliers In August 2011, when Glenda’s oncology clinic was unable to obtain the Taxol cancer treatment drug that had been keeping Glenda’s cancer in remission, I asked the purchasing agent at the cancer clinic where Glenda was receiving cancer drugs if they would use Taxol if I obtained it from drug suppliers approved by the Canadian government. He replied: I was at a conference recently, where one of the speakers talked about a big federal enforcement push against oncologists who purchase chemotherapy drugs from outside the US (mainly Canada), and use them for patients, billing Medicare or other payors as if the drugs had been purchased in the U.S. The speaker said the government [bureaucrat] takes the view this violates FDA regulations and probably Medicare billing law as well. The feds are apparently all over this issue. Politician's Legislation Barring Reimportation Of Cancer or Other Drugs Produced in the United States U.S. politicians wrote into law the Federal Food, Drug and Cosmetic Act (FD&C Act) that barred prescription drugs that were made in the United States and exported to a foreign country from being reimported into the United States. U.S. Politicians Protecting Cancer Drug Shortage Schemes! In 2009 President Barack Obama made a deal with major pharmaceutical companies to prevent reimportation of pharmaceuticals into the United States from Canada and other countries, even though the pharmaceuticals were either originally manufactured in the United States, or inspected and approved by major nations. The Obama administration made it illegal to reimport these drugs, even though they had been saving lives in Canada and other countries and were unavailable in the United States.
The Obama White House has acted for the prior two years to bar Americans and U.S. medical providers from access to governmentlicensed pharmacies in other countries. In 2010, President Obama supported a law known as COICA that would shut down websites of international pharmacies, the ones making available such lifesaving cancer drugs as Taxol and others. That would protect the sometimes obscene profits of drug suppliers in the United States. Carrying out of this political stunt resulted in cancer patients deprived access to needed treatment and also increased the cost when the drugs were available. That legislation has been followed by an even more draconian denial of treatment to cancer and other patients. That legislation had been given the somewhat bizarre name, Preventing Real Online Threats to Economic Creativity and Theft of Intellectual Property Act of 2011 (PROTECT IP Act). As Barack Obama campaigned to be President of the United States, he promised to support legalization of imported drugs from government-licensed pharmacies and suppliers in Canada and other nations. After Obama became President, he and Rahm Emanuel, his Chief of Staff, opposed legislation to legalize the importation of prescription drugs from Canada and other nations. They acted to protect the huge and obscene billion-dollars-a-year profits of many large pharmaceutical companies. The Obama administration in December 2010, through the White House Intellectual Property Czar, Victoria Espinel, stated the administration planned to order the complete shutdown of reputable Canadian and international online pharmacy sites. They planned to pressure Google, VISA, MasterCard, and others to halt business with Canadian drug suppliers. Revolving-Door Bureaucrats Blocking Access to Cancer and Other Drugs Unavailable in U.S. In 2000, the Medicine Equity and Drug Safety Act (MEDS), provided that prescription drugs manufactured in the United States and exported to certain foreign countries, be reimported from those countries for sale to American consumers. That legislation would reduce the price of drugs in the United States and also enable cancer or other important drugs to be obtained when not available in
the United States. That protection, life saving for some, was blocked by revolving door bureaucrats. One provision in the legislation required that the benefits of the legislation be subject to the approval of Health and Human Services. They would decide by themselves whether adequate safety could be maintained and whether costs could be reduced significantly. Health and Human Services bureaucrats, starting with Secretary Tommy G. Thompson, claimed that this reimportation was not safe. Subsequent shortages and non-availability of life-saving cancer drugs then continued the shortage of major cancer drugs in the United States. The FDA's own internet site admitted that it had the authority to approve these drugs from Canada. Here are a few excerpts from that link: The Medicine Equity and Drug Safety Act (MEDS), enacted in 2000, would have allowed prescription drugs manufactured in the United States and exported to certain foreign countries to be re-imported from those countries for sale to American consumers. Supporters of the bill hoped that lower drug pricing in other countries would be passed along to consumers. But former Health and Human Services Secretary Tommy G. Thompson responded by saying that, while he believed strongly in access to affordable drugs, he could not implement the act because it would sacrifice public safety by opening up the closed distribution system in the United States. Though the law was enacted in 2000, before the bill can take effect, one provision requires that the HHS secretary determine whether adequate safety could be maintained and whether costs could be reduced significantly. Both Thompson and his predecessor, Donna Shalala, concluded that these conditions could not be guaranteed. The current policy [of denial] is not a law or a regulation, but serves as guidance for FDA personnel. The importation of certain unapproved prescription medications for personal use may be allowed in some circumstances if all of these factors apply:
If the intended use is for a serious condition for which effective treatment may not be available domestically. If the product is not considered to represent an unreasonable risk. If the individual seeking to import the drug affirms in writing that it is for the patient's own use and provides the name and address of the U.S.-licensed doctor responsible for his or her treatment with the drug or provides evidence that the drug is for continuation of a treatment begun in a foreign country. If the product is for personal use and is a three-month supply or less and not for resale, since larger amounts would lend themselves to commercialization. If there is no known commercialization or promotion to U.S. residents by those involved in distribution of the product.
That means if you buy your high blood pressure or other medication from a foreign country because it's cheaper—even though a drug with the same name is approved for sale in the United States—generally the drug will be considered unapproved and the FDA's personal use guidance will not apply. The Drug Enforcement Administration has additional requirements for controlled drugs. $500,000 Fine In August 2011, pressure by bureaucrats in the U.S. Department of Justice caused google.com to pay a huge fine of $500,000 to the government for not succumbing to the political pressure barring Americans access to drugs from online government-approved Canadian pharmacies. Department of Justice personnel claimed that the sale of pharmaceuticals from government-licensed pharmacies in Canada violated the federal Food, Drug, and Cosmetic Act and the Controlled Substances Act. The argument they used was that the importation of prescription drugs from Canada was illegal and that the Food and Drug Administration could not ensure the safety and effectiveness of the drugs from government-licensed sources.
Google had blocked ads for many foreign online pharmacies but continued allowing government-licensed Canadian Internet pharmacies to place ads. In 2009, Google blocked pharmaceutical ads from non-government-licensed firms, requiring online pharmacy advertisers to sign up for a certification program run by the National Association of Boards of Pharmacy. The new legislation, Protect Ip Act, required Internet Service Providers and search engines to block access to all non-U.S. based online pharmacies, and prevent credit card issuers from accepting charges made from any pharmacy other than those in the United States. Protests Based Upon Free Speech Violation Many protests were raised about the legislation's effect upon free speech, and called legislation such as COICA “a dangerous new encroachment of the government into our lives.” It is also another form of censorship. Protests Should Be on People's Suffering and Deaths! Made possible by the above conduct are endless series of premature deaths, as well as enormous pain and suffering by cancer victims. These consequences can only be felt by the victims themselves who can't defend themselves against this outrage, and by the family and friends of those that are needlessly suffering because of this misconduct. Protection Against Drug Counterfeiters Available Without Denying Cancer Patients Life Saving Drugs Bribe-taking U.S. politicians and major pharmaceutical companies spin the truth about what is being done by claiming they only want to keep the American public safe from counterfeit drugs peddled by unlicensed Canadian and international companies. But this protection can be achieved by other means, such as blocking the purchase of drugs from non-government-licensed pharmaceutical companies. In Canada, for instance—certainly not a third world country— drugs imported for sale in Canada or for subsequent export must be approved by Canada's health department. The Canadian requirements for approval under Canada’s Food and Drugs Act and Regu-
lations are rigid. These requirements are reportedly equal to or more stringent than that of the U.S. FDA requirements. Each drug is labeled with an Identification Number (DIN) and must be manufactured at a plant that meets the approval of Canada’s GMP Regulatory Requirements. $500,000 DOJ Fine for Helping Cancer Victims Get Life-Saving Medication An article (August 30, 2011) in Dealbook by Peter J. Henning addressed the $500,000 paid by Google to settle the charges made by employees of the U.S. Department of Justice for having allowed Canadian pharmacies (most of whom were government licensed) to place advertisements appearing in Google search engines. These advertisements saved Americans huge amount of money by buying identical overpriced medications sold in the United States, in many cases simply reimporting drugs shipped from U.S. companies to Canada at prices much lower than Americans had to pay. The article stated in part: Behind Google’s $500 Million Settlement with U.S. The Justice Department’s settlement of a criminal investigation of Google for allowing Canadian pharmacies to advertise drugs for distribution in the United States reflected an effort by prosecutors to extend the reach of federal drug laws. This may present future challenges to Internet search companies over their advertisements. Google entered into a nonprosecution agreement with the government last week over the use of its AdWords program by Canadian pharmacies that helped them sell prescription drugs in the United States in violation of a federal law, 21 U.S.C. § 331(a). That law prohibits causing the “introduction or delivery for introduction into interstate commerce of any food, drug, device, tobacco product, or cosmetic that is adulterated or misbranded.” Google agreed to forfeit $500 million, representing both its advertising revenue from the Canadian pharmacies and the revenue the pharmacies received from American customers buying
controlled drugs. The company also agreed to enhance its compliance program for drug advertising. The Canadian prescriptions sold to American customers were considered “misbranded” under the statute because they were not approved by the Food and Drug Administration. In some cases, the drugs were obtained from countries other than Canada that lacked adequate regulation of pharmacies. The statute prohibits the “introduction or delivery” of the drugs, but Google was not involved in any way in their actual transfer into the United States, which is the usual means of proving a violation of the statute. Instead, the Justice Department viewed Google as an accomplice to the crime by enhancing the ability of the Canadian pharmacies to reach American consumers. Can a search engine be held responsible for how consumers use the products or services allowed to be advertised on it? That question goes to a core issue in the criminal law regarding the responsibility of suppliers for the use of products they sell. Unlike a private lawsuit alleging negligence, the Justice Department’s nonprosecution agreement with Google involved an assertion that the company aided a criminal violation — i.e., that it was an active participant in a crime. To prove accomplice liability, the prosecution must show the defendant provided some assistance in the commission of the crime, which can include counseling or encouraging the offense. There is a fine line between supplying goods that are later used for the commission of a crime and actually assisting in its completion. Even if one does furnish some measure of assistance, the law further requires that the accomplice be aware of the user’s intention to commit a crime and intend to give some assistance or encouragement in its completion. Google was not involved in the actual movement of the prescriptions, but the government viewed its role as sufficiently
important to the success of the Canadian pharmacy sales that it was similar to someone who actually supplied or shipped misbranded drugs. Google’s $500 million payment was labeled as a forfeiture of the revenue that both the company and the Canadian pharmacies received, not a criminal fine or civil monetary penalty. While Google paid out that money, it did not experience any additional monetary punishment for its conduct. Peter J. Henning, who writes White Collar Watch for DealBook, is a professor at Wayne State University Law School. Sampling of Internet Sites Addressing This Hoax Against the American People At RxRights.org appeared the article under the heading, “Government Censorship Campaign to Block Affordable Access,” and stated: “The White House has initiated a Draconian crackdown on online pharmacies that puts the health of millions of Americans in jeopardy. American consumers’ access to sources of safe and affordable prescription drugs has been endangered before, but never before like this. Last month, Intellectual Property Czar Victoria Espinel, announced the government’s plans to completely shut down online pharmacy sites as an extension of the proposed Combating Online Infringement and Counterfeits Act (COICA).” Another article by IntoxiNation, headlined, Obama and Rahm’s Flip-Flop on Drug Importation, stated: “When they were members of Congress, President Obama and Chief of Staff Rahm Emanuel strongly backed measures to legalize the importation of cheaper prescription drugs from Canada and other nations. On Tuesday, the Obama administration―siding with the drug industry―thwarted a bid by a bipartisan group of Senators to add the provision to the Democratic
health care bill when it was clear the amendment threatened to derail the overall legislation, a top Obama priority.” A Huffington Post article, headlined Pharma Deal Shuts Down Health Care Debate, and stated: “The White House, aided by Sen. Tom Carper (D-Del.), is working hard to crush an amendment being pushed by Sen. Byron Dorgan (D-N.D.) to allow for the reimportation of pharmaceutical drugs from Canada, Senate sources tell the Huffington Post. As a result, the Senate health care debate has come to a standstill: Carper has placed a “hold” on Dorgan's amendment and in response, Dorgan tells HuffPost, he'll object to any other amendments being considered before he gets a vote on his.” In TechDirt, the heading stated, US IP Czar Gets Companies to Cut Off Unlicensed Online Pharmacies, stating: “It's for “unlicensed web pharmacies,” and everyone plays up the spam and the fake (potentially dangerous) drugs. Those are a serious problem. But they also lump in the (quite common) grey market pharmacies as well -- which often allow people to get drugs from outside the country at much more affordable rates. Shutting down fake drug sellers is fine. Shutting down the grey market drug sellers is a bit of a bigger issue.” A series of article in NaturalNews stated: “At a tune when drug industry corruption is reaching a pinnacle of public exposure, the US Food and Drug Administration (FDA) is actually proposing eliminating one of the few pseudoeffective measures in place that restricts the agency from becoming a full-blown Big Pharma “rubber stamp” consultant.” “But of course, the FDA and the monopoly pharmaceutical industry in the United States won't stand for anything resembling the free market. And that's what this issue is all about―in America, we can purchase dishware made in China, clothing made in Mexico, automobiles made in Japan, but god forbid should we try to purchase prescription drugs from Canada.”
“Sometimes truth is stranger than fiction, especially in this case. Lloyd Grove, a columnist for the New York Daily News, says that the pharmaceutical lobby in the United States, a group called PhRMA, actually commissioned the writing of a fiction novel designed to scare Americans into avoiding prescription drugs from Canada. The book was supposed to tell a story of terrorists who altered prescription drugs from Canada in order to kill Americans who were buying them over the internet or crossing the border to buy them at lower prices.” When it comes to blocking the importation of prescription drugs from Canada, pharmacists are a creative bunch. First, they cited safety concerns, but ignored the statistics that show U.S. pharmacies are just as likely to improperly fill prescriptions as Canadian pharmacies. Then they backed the ridiculous position of the FDA that terrorists were going to attack the United States by somehow lacing prescription drugs from Canada with toxic chemicals. That didn't make any sense either, since most prescription drugs are already toxic (they are now the third leading cause of death in the United Stated), meaning that it might be impossible to tell which customers were killed by the drug vs. which customers were killed by “terrorist” contaminated drugs.” “The FDA is getting desperate in the war to monopolize the U.S. pharmaceutical industry and prevent citizens from purchasing prescription drugs at lower prices from Canada and elsewhere. They've now invoked the “terrorism” label in the fight to suppress consumer free choice. Unbelievably, FDA commissioner Lester Crawford is now saying that prescription drugs from Canada are a threat to U.S. consumers because terrorists might be attacking us through those prescription drugs. This idea is so ridiculous as to be laughable.” FDA warns of deaths from Canadian pharmacies while ignoring far more deaths due to mistakes or deliberate acts by U.S. pharmacies.
“Maryland joins list of states wanting to obtain drugs from Canada. The state of Maryland joins a growing list of cities and states attempting to import prescription drugs from Canada. Montgomery County says it could save $6 million to $10 million a year by giving its employees the choice of filling their prescriptions through certified Canadian pharmacies.” An April 21, 2008, article in naturalnews.com, titled, Drug Racketeers, stated: “The discovery that drug companies have been ghostwriting scientific studies using in-house writers, then paying (bribing) doctors and high-level academics to pretend they were the author of the article is making shockwaves across conventional medicine. This latest revelation of scientific fraud exposes.” “Boston has now done the math and realized that buying prescription drugs from Canada -- rather than paying sky-high prices under the U.S. drug monopoly -- will save it millions of dollars each year. More and more U.S. cities are doing the same thing: making deals with Canadian pharmaceutical companies to deliver prescription drugs at prices that undercut the monopoly prices of the U.S. pharmaceutical industry.” An AARP article, March 20, 2011, headlined, Obstructive Legislation Efforts in United States, stated:
“Dems, GOP Support New Bill to Allow Lower-Cost Drugs
From Canada. Americans could save billions of dollars. Once again, a bipartisan group of senators is attempting to give American consumers and pharmacies the right to import lowercost prescription drugs from abroad, with a new focus on safety issues, which derailed similar legislation in the past.” Once again, a bipartisan group of senators is attempting to give American consumers and pharmacies the right to import lowercost prescription drugs from abroad, with a new focus on safety issues, which derailed similar legislation in the past. “For years, Michigan families have been forced to pay outrageous costs or cross into Canada to get reasonably priced prescriptions,” Stabenow said in a statement. “The fact that the
exact same FDA-approved drugs are a fraction of the price in Ontario defies common sense.” Over the past decade millions of Americans have ignored U.S. law to seek cheaper prices from Canada, most often by mail order. Currently, for example, the price for a 30-day supply of Lipitor 20 mg, widely used for high cholesterol, is $156.41 through the mail-order pharmacy of the American company Costco, compared with $48.20 to $69.86 from licensed online pharmacies in Canada and some other countries, according to price-comparison website. The new bill would permit pharmacies and registered wholesalers to buy drugs from Canada and other selected countries, opening the way for health insurance companies and government programs like Medicare and Medicaid to lower their drug costs. The Congressional Budget Office estimated that a similar bill introduced last year would save federal taxpayers more than $19 billion. Medications at Half the Cost This means that consumers could not only legally import drugs for their own use but also buy them from their local pharmacies at prices estimated by the bill's sponsors to be 35 to 55 percent lower than they are now. Legislation to legalize drug importation has been signed into law twice previously, during the presidencies of Bill Clinton and George W. Bush. But they never went into effect because the health secretaries in those administrations declined to guarantee the safety of imported drugs as each law required. The new bill proposes more ways to ensure the safety of imported drugs. They include allowing imports only from FDA-inspected manufacturing plants in specific industrialized countries that have tough safety standards, requiring tamperproof packaging, and enforcing rules to verify the “chain of custody” — all the stages a drug goes through between manufacturer and consumer. The bill also includes measures to prevent pharmaceutical companies from impeding importation, as some have done in recent years by cutting off supplies to Canadian pharmacies that sold lower-cost drugs to Americans.
Even if this legislation passes the Senate, its fate would be uncertain in the House, experts say. Previous drug importation bills have fallen to parliamentary procedures or political maneuvering. A bill very similar to the current one, introduced by then-Senator Byron Dorgan (D-N.D.) in 2009, was attached as an amendment to health care reform legislation, but failed to garner the 60 votes needed to overcome a filibuster. [Standard payment of bribes to members of Congress still does not result in public outrage!]
John Hopkins Medicine Health Letter states of drugs imported from Canada:
“One way to purchase medications at a reduced cost is to buy them online or by phone from Canadian pharmacies. The U.S. Food and Drug Administration (FDA) opposes foreign drug purchases, warning that these sales pose serious safety problems. While importing Canadian medications is against U.S. policy, the FDA has said that it will not prosecute individuals who import small amounts (three months or less) for personal use.” A June 24, 2011, article at medpagetoday.com, headlined, A shortage of paclitaxel (Taxol), a chemotherapy workhorse for ovarian, breast, lung, and colon cancers, demonstrates once again how vulnerable U.S. hospitals and clinics are to an increasingly unreliable pharmaceutical supply chain, leaving patients at risk. Last month, paclitaxel joined 196 other drugs on a shortage list compiled by the American Society of HealthSystem Pharmacists in Bethesda, Md. Although no one has been able to quantify the number of lives jeopardized by the shortages, the lengthy list underscores that the country is in the midst of a “public health crisis of drugs overall,” said Cynthia Reilly, director of the group's practice development division. Paclitaxel made the list May 13, with a June 16 update. Additions in the last month include such chemotherapy mainstays as doxorubicin, daunorubicin, carboplatin, vincristine and cytarabine, as well
as the quick-acting anesthetic propofol, the injectable painkiller Fentanyl injectable forms of several powerful antibiotics: clindamycin, ciprofloxacin and gentamicin. An ABC News Medical Unit report (June 23, 2011) stated:
shortage of Taxol, an intravenous chemotherapy workhorse for ovarian, breast, lung and colon cancers, demonstrates once again how vulnerable U.S. hospitals and clinics are to an increasingly unreliable pharmaceutical supply chain, leaving patients at risk. Paclitaxel, the generic version of Taxol, joins 196 other drugs on a shortage list compiled by the American Society of HealthSystem Pharmacists in Bethesda, Md. Although no one has been able to quantify the number of lives jeopardized by the shortages, the lengthy list underscores that the country is in the midst of a “public health crisis of drugs overall,” said Cynthia Reilly, director of the group's practice development division. For more than a year, “we've been having a crescendoing of drugs that are in short supply. This has been going on for some time now,” said Dr. Michael P. Link, a Stanford University pediatric oncologist who serves as president of the American Society of Clinical Oncology. He called the paclitaxel crunch “another add-on.” Although some drug shortages can be eased with simple substitutions, regimens that use paclitaxel often lack equally effective substitutes. “That's what makes not just this, but all of the chemotherapy shortages significant,” Reilly said. “There's cancer patients who will die because of this. This could change their survival.” At http://cancer.about.com, a June 23, 2011 article addressing the Taxol shortage stated: “For some clinics across the nation, the supply of Taxol is running low. Doctors and patients are experiencing a shortage of
the chemotherapy drug used to treat ovarian and breast cancer in women. While no official cause of the shortage has been released, many doctors and patients are placing the blame on corporate economics. Taxol is a generic drug, which equals a low profit margin. The logic behind this theory is, why produce a large amount of a drug when profits are low?” At www.medpagetoday.com: More information on what politicians are doing to harm ill Americans as they pander to bribe-giving special interests. www.rxrights.org.. “Some pharmaceutical industry folks, and their political allies, like to make the point that our nation’s seniors no longer need access to lower cost foreign medication because they now have new and improved Medicare drug plans. But a new report by IMS indicates that drug costs are having a negative effect on public health, including for our seniors. Put simply, the data indicates that even with the improvements and savings offered by Part D of Medicare (Medicare’s drug benefit), seniors still struggle to afford the drugs they need.” Scandals at Bristol-Myers Squibb Pharmaceutical Company, the original sellers of Taxol. Scheme involving two anti-cancer drugs. Attorney General settlement with Bristol Myers Squibb over conduct delaying generic for Taxol being available. 2004A 2003 FTC consent order involving Bristol Myers Squibb stated that the company: “Engaged in a series of anticompetitive acts over the past decade to obstruct the entry of low-price generic competition for three of Bristol's widely-used pharmaceutical products: two anti-cancer drugs, Taxol and Platinol, and the anti-anxiety agent BuSpar. Bristol avoided competition by abusing federal regulations to block generic entry; deceived the U.S. Patent and Trademark Office (PTO) to obtain unwarranted patent protection; paid a would-be generic rival over $70 million not to bring any competing products to market; and filed baseless patent infringement lawsuits to deter entry by generics.”
Glenda Was Affected by Taxol Cancer Drug Shortage In mid-2011, the cancer drug Taxol appeared to be keeping Glenda’s cancer under control. But then, the oncologist could no longer get Taxol and had to substitute another cancer drug, Taxotere. That caused Glenda to suffer more side effects. On June 24, 2011, a PET scan showed small cancer spots had spread to her lungs. A subsequent series of treatment with the Taxol drug removed any traces of the cancer. During that Taxol treatment, its unavailability required substation with Taxotere, which brought about uncomfortable side effects. Nearing the end of 2011, Glenda was doing well. Her CT and PET scans, and blood tests, indicated her cancer was in remission. CHAPTER EIGHT
Nearing the End of a Four Year Cancer Battle
Glenda's Adopted Family Living near Glenda and I were my daughter, Stephanie, and her husband, Jerry. They hosted almost monthly family events, attended by over a dozen members of the clan. They adopted Glenda as part of the family and treated her like a queen, increasing the quality of her life. Glenda’s Long Standing COPD For many years Glenda had pulmonary problems that required occasional hospital visits for what is commonly called a COPD exacerbation. These can result from bacterial or fungus infection, allergies, or other causes. Treatment includes treating the infection, the allergy, the use of or change of inhalers and pulmonary rehabilitation treatment. Corticosteroids, such as Prednisone, Solumedrol, and Flovent play a key role in improving acute COPD breathing problems. In late 2010, Glenda developed a fungus infection of the lungs that impaired her breathing and required treatment with a fungus medication. During these times the periodic use of oxygen was required. It is common to see people using oxygen in public.
Stephanie-Rodney-Glenda Round Hill Country Club, Alamo, CA 12-9-11
Glenda at home on December 23, 2011 In November 2011, Glenda started having to use oxygen more frequently. But she was able to attend a Christmas party and a New Year's eve party hosted by my daughter, Stephanie and her husband, Jerry Stadtler. Despite the need for using oxygen, Glenda looked forward to warm weather and taking short trips, including a sea cruise to Alaska. Glenda regularly exercised on the treadmill. With the help of oxygen, she would easily go for 25 minutes at about 2.2 miles-perhour speed. I was lucky to go three minutes at 2.7 mph!
Christmas Party at the Stadtler’s, December 25, 2011 Ironically, Glenda was nearing the end of the fourth year since the early 2008 diagnosis of Stage IV esophagus cancer and tests showed the cancer was in remission. She was well on the way to having either experienced a cure, or repeated remissions from a deadly form of cancer. Glenda was about to suffer the painful consequences of cavalier physicians’ attitudes, the indifference, and corrupt conniving conduct. She was to become another victim of unprosecuted medical corruption and medical euthanasia—or medical homicide. I am talking about the tens of thousands of deaths a year from physician “errors,” or incompetence. What was done to Glenda was criminal.
Hospital Admission For Treatable Breathing Problem
On January 5, 2012, one of Glenda's shortness of breath episodes caused me to admit her to John Muir hospital in Walnut Creek, California. Unknown to us at that time, a series of medical errors compounded by a series of medical frauds, Glenda would never return home. Hospital physicians diagnosed Glenda with a fungus infection— which she previously had a year or two earlier. She also had a small amount of fluid on the lungs. She would remain in the hospital until January 14, 2012, at which time she would be transferred to a skilled nursing facility for pulmonary rehabilitation treatment. Nurse's Concern about Glenda's Untreated Pressure Ulcer on Glenda’s Back While in the hospital, Glenda developed pressure ulcers on her back that were causing her increasing pain. While my daughters, Patty and Stephanie, were visiting Glenda at John Muir hospital on January 12, one of the nurses expressed concern about the wound. The nurse was so concerned about what she saw on Glenda’s back that she took pictures of it. Pressure Ulcers are Serious Medical Problems A pressure ulcer is a serious medical problem, requiring special care by a wound specialist. The most basic of such treatment is to keep pressure off the wound by lying on the side rather than the back, and also putting a protective boot over the area. Since the pressure wound was on Glenda’s back, it is standard to have the patient kept in bed lying on the patient’s side. In Glenda’s case, I never once saw her in any position but on her back. That position worsened the problem, and could be expected to keep the wound from healing. Pressure ulcers and their treatments are described at a Mayo Clinic site (www.mayoclinic.com/health/bedsores/DS00570):
Tests, such as tissue cultures to diagnose a bacterial or fungal infection.
Determining the size and depth of the ulcer. Tissue cultures to check for cancerous tissue needing surgery. Treatment by a physician dealing in wound care; a wound specialist. Surgical, mechanical, enzymatic, or autolytic debridement of dead tissue. Constant repositioning in bed. Special cushions to take the weight off of the ulcer area. Pain management that does not adversely affect pulmonary efficiency. This means avoidance of morphine sulfate or other morphine containing drugs that were used around the clock on Glenda. Topical rather than systemic pain medication would be indicated. Avoidance of hospital bed positions that result in a shearing effect as the patient slides and irritates the bed ulcer. Subsequent visits by doctors took no action as to treatment of the pressure ulcers on Glenda’s back, nor did doctor reports show any meaningful reference to the serious condition.
Glenda at John Muir Hospital, Walnut Creek, CA For Shortness of Breath Treatment.
Pressure ulcers/wounds on Glenda’s Back, Jan. 13, 2012 A possible cause of the pressure ulcers could be the MRSA bacteria, sometimes called the “super bug.” That bacteria is common in medical facilities, is difficult to treat, and causes great pain. No tests were made to determine the presence of MRSA. A subsequent three-day hospital stay at Kaiser Permanente Hospital started brief treatment for the super bacteria, MRSA. After the brief treatment, the pressure ulcers were then ignored. The pain from the untreated pressure ulcer was affecting Glenda’s will to go on. At one point, she just wanted to go to Manor Care skilled nursing facility (SNF) and just give up on treatment. I explained to Glenda that she could not be transferred to the Manor Care SNF (Rossmoor Parkway, Walnut Creek) unless she accepted pulmonary improvement treatment rather than palliative treatment. She then had a totally different outlook on life. She wanted treatment and she wanted to live! The development of pressure ulcers on Glenda’s back, over her spine, created a costly problem. A description of pressures sores at Medscape (http://emedicine.medscape.com/article/1293614overview) stated in part:
Although they are technically separate entities, the terms decubitus ulcer, bedsore, and pressure sore are often used interchangeably in the medical community. Decubitus ulcers … occur at sites overlying bony structures that are prominent when the person is lying in a recumbent position. The prevalence of pressure sores in hospitalized patients has been reported to be from 14-21% over the last decade. The cost to heal a single full-thickness pressure sore may be as high as 70,000 dollars. The overall annual cost has recently been estimated to be between 5 billion and 8.5 billion dollars, with the cost of hospitalacquired pressure ulcers between 2.2 and 3.6 billion dollars. Many factors contribute to the development of pressure sores, but pressure leading to ischemia and necrosis is the final common pathway. The inciting event is compression of the tissues against an external object such as a mattress, wheelchair pad, bed rail, or other surface. Irreversible changes may occur during as little as 2 hours of uninterrupted pressure. Skin is able to withstand ischemia from direct pressure for up to 12 hours. By the time ulceration is present through the skin level, significant damage of underlying muscle may already have occurred, making the overall shape of the ulcer an inverted cone. Pressure ulcer prevalence in long-term care facilities is an estimated from 11-30%. Among patients with neurological impairments, pressure sores occur with an incidence of 7-8% annually, with a lifetime risk estimated to be 25-85%. Medical Care With thorough and comprehensive medical management, many pressure ulcers may heal completely without the need for surgical intervention. Successful medical management of pressure ulcers relies on key principles, including pressure reduction, adequate debridement of necrotic and devitalized tissue, control of infection, and meticulous wound care. Wound debridement Many patients require operative debridement, … neurosurgical ablation of spasticity, amputation, or reconstruction.
Debridement is aimed at removing all devitalized tissue that serves as a reservoir for ongoing bacterial contamination and possible infection. Extensive debridement should be performed in the operating room, but minor debridement is commonly performed at the bedside. Although many of these patients are insensate, others are unable to communicate pain sensation because of cognitive dysfunction. Adequate pain control should be provided prior to any debridement, and vital signs often are a good indicator of pain perception. Great care should be taken during bedside debridement, as significant bleeding may occur. In 1947, Kostrubala and Greeley recommended excising the bony prominence and adding padding for the exposed bone with local fascia or muscle-fascia flaps. Overall, patients with pressure sores are important users of medical resources. They require 50% more nursing time, remain hospitalized for significantly longer periods, and incur higher hospital charges. Another study on Pressure Ulcers, titled, Understanding the Seriousness and Complexity of Pressure Ulcers Relating to Continuum of Care, by James G. Spahn MD, FACS, stated in part: Understanding the seriousness and complexity of pressure ulcers relating to continuum of care requires addressing government regulations, legal responsibility, appropriate medical practice guidelines and financial responsibility. To accomplish this goal, pressure ulcer management must be done not only from admission through discharge, but continued to the next level of care by all medical facilities and homecare agencies. The governmental regulations are well-defined in the Social Security Act of 1965 through the Medicare Modernization Act of 2003. The conditions of participation mandate that hospitals, long-term care facilities and homecare agencies all must comply with the Social Security Act regulations. These governmental regulations mandate a seamless continuum of care for the patient who is deemed to be at risk or who has an existing pressure ulcer. Preparing Orders for
Pulmonary Rehabilitation Treatment John Muir hospital physicians determined that Glenda’s shortness of breath could be improved with pulmonary rehabilitation treatment and ordered that this treatment be given to Glenda at a skilled nursing facility (SNF). Hospital personnel selected Manor Care Rossmoor Parkway in Walnut Creek, California. Manor Care would be paid by Medicare and Glenda’s Healthnet PPO for providing the pulmonary rehabilitation treatment. On January 13, 2012, John Muir hospital physicians prepared a final report before transferring Glenda to Manor Care SNF for pulmonary rehabilitation treatment. That final report indicated Glenda was doing well. The following are excerpts of that final January 13, 2012, report by John Muir hospital physicians showing Glenda’s breathing problems to be under control and not at a critical stage: Please refer to Dr. George Slater's interim summary dictated on 01/12 for details. Briefly, the patient was admitted to the hospital with shortness of breath. I assumed care from Dr. George Slater on 01/13, the date the patient is to be discharged to a skilled nursing facility. Clinically, she is doing relatively well. Asymptomatic on 2 L of oxygen. She looks comfortable without any shortness of breath or tachypnea. Vital signs have been relatively stable with 02 saturations 97% to 100% on 2 L per nasal cannula. [emphasis added.] Skilled Nursing Facility A skilled nursing facility is a medical facility that provides specific medical care for certain medical conditions. Different SNFs have specific units addressing certain medical conditions. It is therefore extremely important, with life-affecting consequences, that anyone going to a SNF, goes to one that has the personnel and equipment to rehabilitate their particular medical problem. For Medicare to pay for medical care in a skilled nursing facility certain conditions must be met: The patient must have spent at least three days in the hospital as an in-patient and not under observation. Patient should check with the hospital physician to confirm that the hospital
stay is not in the hospital only for observation. The hospital must state that the patient needs skilled medical care for a particular medical condition. A doctor must sign an order admitting the patient to a skilled nursing facility. The patient must go to a Medicare-certified skilled nursing facility.
Manor Care Rossmoor Parkway did not have the treatment that they were implying to John Muir hospital that they would provide to Glenda. Its nearby SNF competitor, Kindred SNF, did have.
Glenda, Jan 11, 2012, John Muir Hospital John Muir hospital personnel should have known that Manor Care did not have such a program. By transferring Glenda to a skilled nursing facility (SNF) that did not have the treatment they were ordering set in motion a series of medical frauds and mistreatment that would end tragically.
Prior to Glenda's Transfer to Manor Care, Its Admissions Director Admitting to Absence of Pulmonary Rehabilitation Unit and Refused to Accept Glenda Several days earlier, my daughters Stephanie Stadtler and Patty Milam, arrived at Manor Care on the afternoon of January 12, 2012, to inquire whether the facility would take Glenda. Admissions Director Laura Stengel stated Glenda would not be admitted. Stengel stated that Manor Care did not have a pulmonary rehabilitation unit and would not accept Glenda. Stengel explained that without such necessary facilities Glenda could not be expected to show improvement and Medicare would not pay for their services. When I heard this, Stephanie and I returned to Manor Care and discussed Glenda's admission with Laura Stengel to confirm that Manor Care would not accept the transfer of Glenda from John Muir hospital. Stengel again stated that Manor Care did not have any COPD treatment or pulmonary physicians and therefore would not accept Glenda. That conversation occurred on January 13, 2012. Kindred SNF Stephanie and I then went to nearby Kindred SNF. The admission personnel, Jennifer Hanson and Stephanie Kushi, bragged about their special pulmonary rehabilitation unit and pulmonary physician, and showed us a room that Glenda could be transferred to immediately. I gave the approval for Glenda to be admitted. Kindred personnel then called the case worker at John Muir hospital to arrange for Glenda's transfer. Upon doing so, it was discovered that John Muir hospital had already made arrangement for Glenda's transfer to Manor Care. Manor Care fraudulently implied to John Muir hospital personnel that it had the medical treatment for which the hospital was transferring Glenda. They accepted Glenda for COPD treatment despite the fact they had no facilities or pulmonary specialist to address COPD problems. That deception would shortly prove tragic for Glenda.
Fraudulent Agreement To Provide Specific Treatment
On January 14, 2012, Glenda arrived at Manor Care. She was delighted. She had a smile on her face, and now wanted to live, despite the fact that she was still suffering pain from the raw pressure ulcer over her spine. She didn’t know about the fraud being perpetrated upon her or what would soon occur. Starting with a fraud, agreeing to provide the pulmonary rehabilitation treatment for which she was transferred from John Muir hospital, to a combination of denial of such treatment, compounding that denial with drugs that worsened her breathing, ignoring a painful pressure ulcer associated with the super bug, MRSA, and other violations of honest and recognized care, overwhelmed Glenda with tragic consequences, By accepting Glenda for pulmonary rehabilitation treatment, when Manor Care had no such program or pulmonary specialist, Manor Care risked being cited by Medicare and California regulators for fraud. Manor Care would be billing the federal government and Glenda’s insurance plan for treatment that they did not have. That would constitute a crime. Medicare would soon question her presence at Manor Care for pulmonary rehabilitation when Manor Care did not have that type of medical unit. Glenda would of course not be showing any improvement, which would increase the risk of being sanctioned or charged with fraud by Medicare. That risk of being exposed was quickly addressed by Manor Care personnel.
Glenda Jan 15, 2012 Manor Care, Looking and Feeling Good—Holding a teddy bear made for her by grandchildren of her Adopted family Manor Care's Immediate Decision to Discharge Glenda and Promoting End-of-Life Hospice! Glenda was at Manor Care less than 24 hours when a physician, India-trained Dr. Smita Chandra, came into the room while I was visiting Glenda. With no time to have assessed Glenda's medical condition, not competent in pulmonary conditions, and no time to start pulmonary rehabilitation (which they didn't have), Chandra told Glenda that she was not capable of having her shortness-ofbreath improved upon and that she should seek palliative care. Hospice! That meant end-of-life hospice for Glenda who had two treatable medical conditions! She didn’t have a terminal illness with less than six months to live, and all the medical reports indicated she had a treatable condition. I didn’t know it at the time, but Chandra was a doctor paid by Hospice of the East Bay whose sole reason for existence is offering hospice to people. The India-trained doctor stated that Glenda had to leave the facility.
Glenda's spirits plummeted. After four years of cancer and COPD treatment, and now looking for relief, she was being thrown out of the facility that she set her heart on. Somewhat contradictory to the statement about Glenda’s inability to improve the shortness-of-breath condition, Dr. Chandra stated that Manor Care had no pulmonary rehabilitation facilities, which had already been admitted several times by Manor Care admissions director Laura Stengel. I was outraged at this blunt talk to a frail lady within 24 hours of her arrival! I protested, stating that Glenda had been sent by John Muir Hospital doctors for pulmonary improvement treatment and that Manor Care had accepted her on that basis. I protested that Glenda was looking for treatment, not palliative care. I stated that John Muir Hospital doctors would not have sent her to Manor Care for rehabilitation if they did not think her condition was suitable for it. Dr. Chandra became argumentative while Glenda appeared ready to cry. I resented the doctor causing a confrontation in front of a very frail lady. I stated that this may be the practice in India, but totally unacceptable here in the United States. Glenda was grief stricken. I immediately faxed a complaint to Manor Care (January 16, 2012) about the immediate dismissal plans. At that time, I was unclear about the consequences of the frauds being perpetrated upon Glenda. Pertinent parts of that fax stated: I was told by Dr. Smita Chandra during my first discussion that there is no pulmonary doctor on the staff or one that comes to Manor Care. This surprised me. She said that Glenda must go to her pulmonary doctor as a regular patient; Glenda is in my estimation in no condition to do so; nor should she be put through that stress. Unless you have some suggestion, I will have to try to find a pulmonary doctor that will come to Manor Care and first check with her primary care physician, Dr. Vona Lorenzana. (Her regular pulmonary doctor is an Iranian, Dr. Ramin Khashayar. Despite several faxes requesting the medication that Glenda is taking, the treatment options, etc. and de-
spite the fact that I am responsible for arranging for Glenda’s care, he refuses to respond.) Possibly these foreign doctors are bringing to the U.S. the culture in their country. On Sunday morning, I had a response from your staff doctor, Smita Chandra, which is the worst I have ever encountered, either during my years in the medical field, or my many years as caregiver. As caregiver for a very frail lady suffering breathing problems from an apparent lung infection on her COPD status, I found Dr. Smita Chandra arrogant during a visit at the Manor Care facility (Rossmoor Parkway). In front of the patient who had just been admitted two days earlier from John Muir Hospital, Chandra was emphasizing discharging her into palliative care at home. I objected, stating she was here for rehabilitation care to improve her serious breathing problems. Chandra then, in front of the frail patient, accused me of being confrontational. I made the following note of the problem: The patient was then in emotional distress fearing she would be discharged from the rehabilitation facility, which she felt would be a death decree. Assuming Chandra was from India, I stated to her that her type of confrontational attitude in front of a frail patient may be the norm in India, but it was not tolerated here in the United States. I found everyone else I came in contact with at Manor Care to be very considerate (referring to the working personnel). Pattern of Non-Response There was no response to that fax. Throughout Glenda’s stay at Manor Care, each of the half dozen faxes seeking information about the treatment being provided to Glenda went unanswered. The probable reason for not responding was to keep me uninformed about the lack of treatment and mistreatment that was occurring. Manor Care Management and Physicians
Engaging in Deadly Fraud upon Glenda Unknown to me at that time, Manor Care management and doctors were engaging in fraud, and now were trying to extricate themselves from the consequences.
Glenda at Manor Care (January 15, 2012) Manor Care management and physicians:
Fraudulently, and with deadly consequences, accepted the referral by John Muir hospital personnel, accepting Glenda for pulmonary improvement when they knew they did not have the facilities, and then upon Glenda's arrival, moved to discharge her, knowing their conduct would create great stress and possibly death. Lacked a pulmonary rehabilitation program. Lacked a pulmonary specialist. Did not provide pulmonary breathing exercise sessions, or change any of her medications that would be normal actions by a competent pulmonary specialist.
Did not provide even the most basic treatment for the painful pressure ulcer over her spine. Round-the-clock drugging with drugs harmful to COPD patients.
Manor Care Ignoring Glenda’s Worsening Pressure Ulcer The pressure wound that developed at John Muir hospital became progressively worse at Manor Care. Rather than bringing in a wound specialist to treat the wound, Manor Care physicians dosed Glenda with round-the-clock morphine-related pain killers. These morphine drugs were absolutely contraindicated in patients with breathing problems (excepts in minute and immediate one-time cases). Providing Universally Recognized Treatment Would Increase the Risk the Initial Fraud be Discovered If Manor Care had provided the universally recognized treatment for the serious pressure ulcer it would have extended her stay. That would risk having the initial fraudulent acceptance recognized and acted upon. Instead, morphine and morphine related drugs. Dosing Glenda with Round-the-Clock Drugs That Decreased Pulmonary Function From Glenda's arrival at Manor Care, the denial of pulmonary rehabilitation treatment was combined with heavy dosing of drugs that worsened her pulmonary breathing problems. Among the doctors ordering such drugs, besides supervisory physician Dr. Martin Jimenez, was Dr. Smita Chandra. Glenda was also given round-the-clock drugs that were either contraindicated for people with breathing problems, or had side effects worsening such problems. That practice showed utter disregard for the effects upon Glenda’s life. One such drug was Norco (hydrocodone-Acetaminophen). The warnings associated with that drug state: “Emergency type of side effects” (each of which Glenda experienced, as reported in Manor Care records):
Shallow breathing, slow heartbeat. Swelling in mouth, face, lips, or tongue. Airway constriction (bronchospasm) and wheezing.
Anxiety. Causing serious breathing problems. Dry mouth. Loss of appetite.
At www.ehealthme.com, the following warning is stated: “This is a post-marketing study of COPD (Chronic obstructive pulmonary disease) among people who take Norco. The study is created by eHealthMe based on 33 reports from FDA and user community.” Duramorph (morphine injection) is a systemic narcotic analgesic for administration by the intravenous, epidural or intrathecal routes. It causes serious side effects: slow/shallow breathing, … mood changes (such as agitation, hallucinations, confusion) … slow/fast heartbeat. ... swelling (especially of the face/tongue/throat) … trouble breathing. ... This medicine should not be used in … lung diseases (such as asthma, chronic obstructive pulmonary disease-COPD), breathing problems (such as slow/shallow breathing, sleep apnea) ... Because COPD patients have compromised breathing already, ... very inefficient breathing, overly high doses of morphine can quickly cause these patients to stop breathing. Morphine's Adverse Effect on COPD One of morphine's main adverse effects is slowing down the respiratory rate, i.e., respiratory depression. If the dosage of morphine is too high for what the patient is accustomed to, the respiratory depression can become severe and actually stop the breathing periodically for a few seconds or many seconds. http://www.hospicepatients.org/no-prn-morphine-copd.html, A sampling of the warnings stated in that article: “One of morphine's main adverse effects is slowing down the respiratory rate, i.e., respiratory depression. If the dosage of morphine is too high for what the patient is accustomed to, the respiratory depression can become severe and actually stop the breathing periodically for a few seconds or many seconds. This pattern of breathing where the patient stops breathing (skipping breaths) and then starts breathing again is termed “apnea.” Apnea commonly occurs as a result of the terminal illness and the dying
process, when certain metabolic changes occur in the patient's body. Mar At http://seniors.kaiserpapers.org/hos.html: “Morphine suppresses the patient's drive to breath and creates the appearance of inadequate breathing. It also sedates the patient and creates noisy breathing as the tongue relaxes back in the throat. To use morphine for treatment for shortness of breath is LETHAL.” If the breathing is stopped completely without restarting, the patient dies. Because COPD patients have compromised breathing already, ... very inefficient breathing, overly high doses of morphine can quickly cause these patients to stop breathing. Treatment for the Pressure Ulcer Would Have Compounded Manor Care’s Problem with Fraudulent Acceptance for COPD Treatment If Manor Care’s management and physicians had provided recognized specialized treatment for the painful pressure ulcer on Glenda’s spinal area it would have required an extended stay at Manor Care. That extended stay increased the possibility that federal and state regulators would have discovered the sham acceptance by Manor Care for the pulmonary rehabilitation treatment that it did not have. Another Drug with Adverse Effects Lorazepam, also known as Ativan, was given to Glenda round-theclock. That drug is known to reduce pulmonary function, and more so in elderly people. That was the exact opposite to what Glenda needed. A typical Ativan warning is the following: Ativan injection is contraindicated in patients with severe respiratory insufficiency. As if that was not bad enough, the respiratory decreasing effect of Ativan was then combined with another respiratory decreasing drug, Norco 10-325 MG tablet (and morphine). Manor Care's Head Physician Withholding Information From Person Arranging Glenda's Medical Treatment
During all this time, Manor Care's physician-in-charge, Dr. Martin Jimenez, withheld from me all information about the treatment being given to Glenda, despite the responsibility to provide such information on the basis of I being Glenda’s domestic partner for the past 18 years, the person totally responsible for arranging her medical treatment for the prior four years, and had power of attorney to make such decisions. More problems: Glenda's Pulmonary Doctor Abandoning Critically Ill Patient Glenda's pulmonary doctor, Ramin Khashayar, had literally abandoned Glenda during these difficult days. I sent multiple faxes to Dr. Khashayar seeking information on Glenda's care, all of which were ignored. These were sent on January 6, 2012, another on that same day, and one on January 12, 2012, informing Khashayar of Glenda’s breathing problems and complaining of his refusal to help his patient. That included the frauds being perpetrated by Manor Care management and physicians treating Glenda. I sent a complaint to the California medical board (January 18, 2012) concerning Khashayar’s refusal to respond to Glenda’s breathing problems. A long-time movie producer friend of mine, D.J. Donnelly, heard about my problems with Khashayar and contacted the executive offices at John Muir hospital. That, and the complaint to the Medical Board of California, resulted in Khashayar calling me on the phone and accusing me of blackmail. Blackmailing Phone Call from Glenda's Pulmonary Doctor On the evening of January 17, 2012, I received an obviously hostile phone call from Dr. Khashayar. He accused me of blackmailing him by complaining about his conduct. Blackmail for complaining about abandoning a dying patient? Khashayar stated he did not visit Glenda because he did not have a contract with John Muir hospital. (That was a lie, as he later had Glenda brought back to John Muir for the removal of the fluid from on her lungs.) Khashayar's conversation was so bizarre and indicative of the abandonment of Glenda in her near-death condition that I pressed
the record button on a recorder halfway through his call. A partial transcript of Khashayar phone call follows: Rodney: [Because of your refusal to communicate with me], I am in the dark about Glenda’s treatment and condition and don’t know what to do. … Glenda is upset, and this is not the way to go. Dr. Khashayar: What do you want me to do? [Take care of his patient!] Dr. Khashayar: The path that you have taken, I can’t see her anymore. [Filing complaint with medical board about his abandonment of his patient and refusal to respond to the person responsible for arranging Glenda’s medical care.] Rodney: You won’t see and treat her. I’m desperate to find someone to see her. Dr. Khashayar: Dr. Lorenzana called me and asked me as a favor to see Glenda. [Rodney had complained to Dr. Lorenzana, Glenda’s primary care physician, about Khashayar’s abandonment of Glenda during the critical breathing problem.] Dr. Khashayar: Do you want me to go and see her? Rodney: Why can’t you write some type of report on Glenda and state what should be done? Dr. Khashayar: I don’t like people blackmailing me. [In Khashayar’s mentality, a caregiver is a blackmailer if he objects to medical misconduct.] Dr. Khashayar: I was going to see her; she is a lovely woman. But because you are blackmailing me, I am not going to see her. The only way that I am going to see her is if you send me a fax and rescind what you have told me. And if I get a fax from you withdrawing all of your comments, and you ask me nicely to go see her, I will do it. [Khashayar’s form of reverse blackmailing!] Dr. Khashayar: Because of your attitude, I am not going to go there. The only way I am going to go there is if you write a letter,
send a fax as you have done before, and rescind all the complaints and everything you have said, and ask me to go see her. [The doctor's responsibility to his critically-ill patient cannot be predicated on rescinding a complaint to the California medical oversight board!] Dr. Khashayar: I have no responsibility to go to that nursing home; she can come to see me in my office. [Glenda was critically ill.] Dr. Khashayar: Do you want me to see her? Send a letter and essentially rescind, all of your accusations … Once I get that fax, I will see her tomorrow. If I don’t get it, there is no way nobody can make me see her. There is no law that says I have to see her. Rodney: I’m not sure about the law, but by abandoning a patient there may be some criminal aspect to it. Dr. Khashayar: I have no obligation to see her. …If you want me to go see her, all you have to do is write a fax rescinding what you said and ask me to go see her. End of reverse blackmailing call from Iranian physician. Iranian Doctor Compounding Abandonment With Inflicting Stress Upon Suffering Patient Not satisfied with the harm inflicted upon Glenda by his neglect and refusal to intervene in the frauds being inflicted upon Glenda, Khashayar inflicted more stress upon her. Following that phone call, Khashayar had a letter dated January 20, 2012, hand delivered to Glenda, complaining about my conduct. Khashayar then increased the stress by requiring Glenda to sign the bottom of the letter acknowledging that she received it. That conduct compounded the stress upon Glenda resulting from what was being done to her at Manor Care That stunt was pulled on a frail lady suffering pain from the untreated pressure ulcer and the untreated shortness of breath problem. Both of which were compounded by round-the-clock drugs that increased anxiety and even had suicidal side effects. The abuse Glenda was suffering from physicians in the medical industry should have received national headlines. The medical Board of
California never responded to my complaint. If they had, these medical abuses would have halted, and what was shortly to happen to Glenda would not have happened. Like every government oversight agency I have encountered during the last 40 years, that California medical board was staffed by personnel more devoted to protecting the wrongdoers in the medical industry than protecting the public. They were enablers of the conduct that resulted in numerous deaths. Massive Violations of Recognized Patient-Caregiver Bill of Rights in Full View of California Regulators Physician responsibilities to patients are stated in an American Hospital Association site: Effective health care requires collaboration between patients and physicians and other health care professionals. Open and honest communication, respect for personal and professional values, and sensitivity to differences are integral to optimal patient care. As the setting for the provision of health services, hospitals [and physicians] must provide a foundation for understanding and respecting the rights and responsibilities of patients, their families, physicians, and other caregivers. Hospitals must ensure a health care ethic that respects the role of patients in decision making about treatment choices and other aspects of their care. (www.patienttalk.info/AHA-Patient_Bill_of_Rights.htm) Rushing Glenda to the Nearest Hospital Because of Critically Low Body Oxygen Level Possibly due to the stress caused by Khashayar’s conduct, the next day, on January 21, 2012, Glenda was rushed to nearby Kaiser Permanente hospital in Walnut Creek because of a dangerously low oxygen level. Normally, she would have been sent to John Muir Hospital, but because of her critical breathing condition, the nearest hospital was selected. That was Kaiser Permanente. Doctors at Kaiser Permanente hospital found that Glenda had pneumonia. That explained part of Glenda’s breathing problems, which compounded the breathing problems brought about by the round-the -clock dosing with the not-to-be-given morphine drugs.
MRSA Bacteria in the Pressure Ulcers Since pressure ulcers or wounds are often caused by, or worsened by the presence of the MRSA bacteria, Kaiser Hospital ordered a MRSA culture. Excerpts from some MRSA Medical Reports:
MRSA skin infections can sometimes grow from a small, contained infection to one that involves internal organs or important systems in the body―including the bones, joints, heart valves, lungs, and bloodstream. The vast majority of these serious infections are linked to health care exposure. Recent reports have found nearly 19,000 MRSA deaths in a single year. Prognosis (outlook), and potential complications For people with MRSA infections. Statistics from the Kaiser foundation in 2007 indicated that about 1.2 million hospitalized patients have MRSA, and the mortality (death) rate was estimated to be between 4%-10%. These data has not been updated by the CDC yet. Another study suggested that the mortality rate may be as high as 23%. In general, the average adult death rate was about 5% of infected patients in 2010. In general, CA-MRSA has far less risk of any complications than HA-MRSA as long as the patient does well with treatment and does not require hospitalization. However, people who do suffer complications generally have a chance for a worse outcome, as organ systems may be irreversibly damaged. Complications from MRSA can occur in almost all organ systems; the following is a listing of some that can result in permanent organ damage or death: endocarditis, kidney or lung infections (pneumonia), necrotizing fasciitis, osteomyelitis, and sepsis. Early diagnosis and treatment usually result in better outcomes and reduction or elimination of further complications. http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_I D=45809. At the government's web site for MSRA: http://www.nlm.nih.gov/medlineplus/ency/article/007261.htm. Staph skin infections cause a red, swollen, and painful area on the skin. There may be drainage of pus or other fluids from the site. Symptoms are more likely to occur where the skin has been cut or
rubbed, or in areas where there is more body hair. When patients get MRSA in health care facilities, the infections tend to be severe. These staph infections may be in the bloodstream, heart or lungs, urine, or at the site of a recent surgery. Symptoms of these severe infections include:
Rash. Shortness of breath. Chest pain. General ill feeling (malaise)
Tests to determine whether a wound is infected with MRSA bacteria include blood culture, culture from the infected sites, grams stain or culture of the drainage fluid from the infection. Extreme pain is often associated with MRSA infections. Glenda was transferred from Kaiser Permanente Hospital to Manor Care two days later, on January 23, 2012, before any treatment for MRSA could continue. Manor Care was obsessed with removing Glenda from the facility; treating her medical conditions would block that need. Glenda’s Breathing Improved After Removal of Fluid on Her Lungs Finally Occurred The following day, January 24, 2012, possibly due to pressure, Khashayar, arranged for Glenda's transport from Manor Care to John Muir hospital for the thoracentesis removal of the fluid on her lungs. Manor Care records indicated that Glenda was feeling much better after the removal of that fluid. Khashayar had previously stated to me, during the January 19, 2012 phone call, that he did not have a contract to perform at John Muir hospital. That, of course, was false. If that fluid had been removed earlier, Glenda's pain and depression would most probably have improved and changed Glenda's decision to just give up. Seeking Help from Glenda's Primary Care Doctor, Vona Lorenzana
Pressure was building as Manor Care sought to evict Glenda. On January 26, 2012, I sent a fax with an urgent message to Dr. Vona Lorenzana, Glenda's primary care physician, who had not seen Glenda for some time. I briefly explained part of the problems and asked her for help. In that message I stated: If you have any suggestions, Glenda can sure use them now. Manor Care wants to discharge Glenda on the doctors’ assumption that she has reached a plateau or unable to improve further. [Emphasis added.] Since the removal of fluid from her lungs a few days ago, Glenda has shown improvement. … As for physicians’ estimate of Glenda’s remaining life, when she was diagnosed with Stage IV esophagus cancer four years ago, physicians considered she would not be alive beyond a year. … When her esophagus totally closed during radiation, the physician said it would never reopen. It reopened. A year ago medical personnel said Glenda only had a few weeks to live. Now, they wish to discharge her from the skilled nursing facility because they think she cannot improve any further. At that time, I did not recognize the enormity of the physician misconduct that was occurring. If I had, that letter would have been far stronger. However, Dr. Lorenzana, being a doctor, certainly recognized at that time what I would later recognize. Among the serious problems affecting Glenda that Lorenzana had to know included the following:
Glenda’s problems were the untreated shortness of breath and inadequately treated painful wound on Glenda’s back. The unfilled pulmonary rehabilitation treatment ordered by John Muir hospital. The fraudulent acceptance of Glenda by Manor Care when the SNF lacked that form of treatment. The around-the-clock dosing with drugs that should not be given to a patient with COPD. The pain from the untreated pressure ulcers and contamination with the MRSA bacteria.
The availability of Kindred SNF, 200 feet from her office building, that did have the pulmonary rehabilitation treatment ordered for Glenda.
All of the physicians involved in the misconduct against Glenda were members of a small local group known as John Muir Physician Network. Dr. Lorenzana’s conduct protected them, and this would be deadly for Glenda. Dr. Lorenzana faxed back a reply the following day, January 27, 2012: Dear Rodney: I am so sorry to hear about Glenda's plight. It is unfortunately an insurance problem. They are the ones that make a determination of how long a patient can be in a skilled nursing facility. What Dr. Lorenzana’s physician colleagues were doing to Glenda wasn’t any insurance problem! That answer did not address the problems, especially since prior faxes to Dr. Lorenzana went into problems more deeply. For instance:
A January 20, 2012, fax to Dr. Lorenzana described the abandonment of Glenda by her pulmonary physician since she first entered John Muir hospital on January 4, 2012. Since then, and earlier, she had no pulmonary specialist to address her shortness of breath problems. That was Glenda's primary medical problem, her cancer, which was in apparent remission. A January 16, 2012, fax to Dr. Lorenzana explained to her the absence of a pulmonary rehabilitation unit at Manor Care— which automatically signaled that Glenda was not receiving the pulmonary improvement that was intended, and that Manor Care was not capable of evaluating whether she was capable of showing improvement.
It is recognized in the medical industry that a primary care physician serves as the patient's first point of entry into the health care system and as the continuing focal point for overseeing needed health care services. As Glenda's primary care physician, Dr. Lorenzana had responsibility to investigate and correct any shortcomings. Instead, she protected the wrongdoings of her associates.
If Dr. Lorenzana had contacted me, I would have given her the remainder of the problems that the doctor did not know about. In any difficult medical condition, a careful diagnosis often relies on the patient's history of symptoms, and this is why it is so important that physicians communicate with the patient's close family or caregiver. However, sufficient information was provided to Dr. Lorenzana, and Glenda's life was involved, to where she should have sought further information. That failure would have tragic effects for Glenda within a few days! Systematic Withholding All Information from Glenda's Caregiver Throughout this period, I sent faxes to the Manor Care facility seeking information about the treatment being provided to Glenda. Every request went unanswered, a grave violation of responsibility to the person responsible for arranging for, and overseeing, Glenda's medical treatment. Manor Care's physician-in-charge was Dr. Martin Jimenez, and a member of the John Muir Physician Group. Every request was ignored, despite the fact that I had sole responsibility for arranging for Glenda's treatment and was responsible for determining if the treatment was adequate. Glenda's pain, and inability to check medical sources for information, left her vulnerable to whatever conduct, or denial of treatment, Manor Care physicians were providing. Faxes sent to Glenda's pulmonary physician, Dr. Khashayar, were also ignored. The following are some of the faxes that I sent:
January 16, 2012 Caregiver complaining about immediate discharge following Glenda's arrival at Manor Care. January 17, 2012 Message left at nurses' station, and reference to pulmonary physician abandonment. January 20, 2012 Memorandum justifying transfer to Kindred. January 25, 2012 Suggesting steam inhalation for Glenda's breathing problems. January 25, 2012 Relaying Glenda's report of pain medication and withholding of pain medication. January 26, 2012 Notifying Manor Care about rescinding all signed copies for failure to return copies.
January 28, 2012 Requesting copies of all medical records pertaining to Glenda before her discharge. January 29, 2012 Enlargement on the above matter. January 30, 2012. Fax sent to Manor Care about Glenda's pain preventing major medical decisions. January 30, 2012 Addressing Glenda's deteriorated condition induced by Manor Care misconduct. February 17, 2012 demanding, again, copies of medical reports that they repeatedly withheld, jeopardizing Glenda's life.
Glenda Asking Stephanie to Seek Help from Glenda's Oncologist During a conversation between Glenda and Stephanie, Glenda asked Stephanie to call her cancer doctor, Dr. Michael Sherman, of Contra Costa Oncology, seeking his help. Stephanie called Dr. Sherman (Jan 26, 2012). In a later email to me, describing the conversation she had with Sherman, Stephanie wrote: I actually did talk to Dr. Sherman. It was a strange conversation. I told him that Glenda has asked that I call him to get his advice as Manor Care was discharging her next week (possibly). He said, “Well, she can now go home with Rodney,“ and that is good. I said, “No, they are not releasing her because her condition has improved; she is extremely weak and they feel there is nothing else they can do for her”. He then asked, “Does she want to live or die” which was strange. I said that what she really wants to do is to get treatment. That is what she told me she wants more than anything. He said to call back tomorrow to his office and his office will give me the phone # for Provident Care. Dad, I am so worried about all of these moves. At the end of her life, she needs to have the least stress possible. She told me that she really just wants to die. My feeling from talking to Dr. Sherman is that he really isn't much help right now and obviously doesn't realize the condition that
Glenda is in. The lack of a real doctor overseeing all other doctors bothers me. Each one is just doing their “own thing”. Earlier, Dr. Sherman’s cancer treatment extended Glenda’s life, for which I am grateful. That was his job responsibility for which he was well paid. But his repeated refusal to respond to my questions was a serious lack of responsibility. His prior refusal to respond to my requests kept me from seeking his help while Glenda was being literally criminally abused at Manor Care. At major cancer centers, or at any oncology group, the oncologist would be carefully following their client's progress and treatment, and be a part of their care. Not so here! Glenda was simply a commodity! Glenda at Manor Care, January 26, 2012, With Hope of Transfer to Kindred SNF Despite the harmful effects of heavy dosing with Ativan and narcotics that worsened Glenda's pulmonary condition, and despite the heavy pain from the pressure ulcer on her back, Glenda still looked good and looked forward to recovery and going home. I told Glenda not to worry about being discharged from Manor Care as Kindred SNF would admit her, and that facility had the pulmonary rehabilitation unit that John Muir hospital ordered for her. Glenda Rejected by Kindred Admission Personnel I contacted Kindred admission personnel to arrange for Glenda’s transfer into their facility. I notified them of what they already knew, that there was an outstanding order from John Muir hospital for Glenda to receive pulmonary rehabilitation, that it had never been provided, and that the cost would be fully covered by Medicare and Healthnet PPO insurance. Manor Care management and physicians had sought to cover their own misconduct by stating to Kindred admission personnel that Glenda was not capable of having her breathing problems improved upon. But the wrongdoing at Manor Care was obvious to Kindred, and I made that known to them. Professional courtesy
possibly caused them to ignore Glenda’s plight. Kindred admission personnel rejected Glenda’s admittance to their facility.
Glenda, Manor Care, January 26, 2012 They had a moral and legal responsibility to accept Glenda. She had a valid order for pulmonary rehabilitation treatment, and they had a specific unit to provide this treatment. Glenda had yet to receive that treatment. Glenda’s admission would be paid by Medicare and Healthnet PPO insurance. I immediately faxed a protest to Kindred, stating in part: January 26, 2012 to Stephanie and Jennifer Hanson: After careful research, I think I know why Manor Care wants to discharge Glenda Guilinger: When I first contacted the admissions director at Manor Care, she flat-out refused to accept Glenda, stating they were not set
up for pulmonary cases. But then when John Muir Hospital notified them that Glenda would be sent there, they must have felt obligated to take her. Glenda was doing marginally until a few days ago, but when the fluid that the hospital knew was on her lungs prior to her transfer was finally removed, she greatly improved. She looks much better now. She and I thought that the pulmonary rehabilitation unit that Kindred has may improve her COPD enough to where, if needed, she could go back on cancer therapy. Glenda and I wondered if transfer from Manor Care to Kindred could be done now, especially if you had a single room available. Can you advise? Again Contacting Kindred Skilled Nursing After I learned that Kindred’s admission personnel had refused to accept Glenda, I was angry, and sent a January 29, 2012, fax to Stephanie and Jennifer: Hello Stephanie and Jennifer Hanson, Having written many books on great misconduct at the national level in the past, I feel another one must be done on the problems of people with serious illnesses receiving care from medical providers. What I’ve seen in the last four years demands that certain information be made known. There is one area I am writing about that involves Manor Care, Kindred Transitional Care, and Glenda Guilinger. Kindred had agreed to admit Glenda until, possibly by mistake, John Muir Hospital sent her to Manor Care, Walnut Creek. Laura Stengel at Manor Care had already told me that they did not have a pulmonary rehabilitation unit and therefore would not take Glenda. However, when John Muir Hospital advised them that Glenda was on her way, they accepted her. But within 24 hours, long before the attending physician or any pulmonary specialist
could have made an intelligent decision about Glenda’s progress, the talk by Manor Care physicians was to discharge Glenda. The politics behind that tactic are unknown to me—at this time. In my opinion, there were some kind of “irregularities” with Manor Care’s conduct relating to Glenda. I informed you of these questionable tactics. When we tried to have Glenda transferred to Kindred, the prior willingness to admit her was rescinded. This must have been done on the basis of Manor Care’s decision and whatever reports their physicians made. Since their physicians, and Manor Care itself, have repeatedly refused to turn the physician reports over to me—despite the fact that I make the decision as to Glenda’s care, I have no knowledge of what was in those reports. The suspicious pattern of trying to discharge Glenda, despite the fact that she has shown visible improvement, indicates some other problem which has yet to be understood. The efforts of Manor Care, and the refusal by Kindred to now admit Glenda, has so greatly upset Glenda that she now wants to die. Her spirits were formerly high, and now her will to live has been taken from her. I want to detail this outrageous matter on my Internet sites and in the not-for-profit book I am now writing. No response. They knew their refusal to accept Glenda would result in her premature death at hospice. Glenda was just another commodity! Outraged County SNF Ombudsman Suggested Filing an Appeal My daughter Stephanie and I were frantically seeking to find a suitable facility upon Glenda's removal by Manor Care. We called the county ombudsman (Nancy at 925-685-2070) with oversight for skilled nursing facilities, and explained the problem. She stated that I should file an appeal of the discharge order, which would provide several extra days to find a suitable facility. I planned to do that, but events were snowballing rapidly and the appeal was never filed. One problem; Manor Care said they would
refuse to recognize me as having any control over Glenda’s decision to abandon treatment and select hospice. They had encouraged Glenda to state that I no longer had any control over her decision to go to hospice. Glenda, racked with pain, her mind clouded with mind-altering drugs, and pressure from all sides to select hospice, refused to listen to me. Glenda didn’t know she had treatable medical conditions and that her problem was medical misconduct denying her the available treatment. She also didn’t know about some of the horror stories of people put to death after selecting hospice. “I want to die,” Glenda cried! The obstacles faced by Glenda and I were overwhelming. Glenda, who had wanted to live, now wanted to die. She didn’t understand what was going on. She finally succumbed to the pain, the abuses, the physician’s abuses and deliberate infliction of stress; the connivance of key people in the healthcare industry; the scheme by Manor Care physicians and management; and finally, the rejection by Kindred. Glenda's judgment was further affected by the mind-altering drugs, the lack of knowledge about the pros and cons of hospice, and unaware of pulmonary treatment that was out there, but denied to her. The final straw was the combination of the Manor Care fraud and Kindred's refusal to accept her. “I want to die,” cried Glenda! Manor Care Physicians Encouraged Glenda To Exclude Me from Her Decision to Die Glenda refused to listen to me that there was treatment out there and I would get it for her. She stated to Manor Care physicians and management that she alone would make the decision, and that was to go to hospice. Physician obligations required that Glenda be informed of such material matters as:
She had never received the pulmonary rehabilitation that was ordered by John Muir hospital physicians and therefore her ability to have her breathing improved was never determined.
Medication given to Glenda round-the-clock, while a patient at Manor Care, was known to cause deterioration in her breathing difficulties. Manor Care management and physicians had engaged in fraud by accepting her for pulmonary rehabilitation when they did not have that type of medical care. The intense pain from the infected wound/ulcer on her back could be addressed by physicians specializing in such medical problems. A series of physicians were engaging in medical fraud against her. Glenda never belonged in hospice. Hospice is for people whose medical problem is untreatable and where the patient simply wants relief from pain.
Glenda had two medical problems at issue. One was the shortness of breath for which John Muir hospital physicians ordered pulmonary rehabilitation treatment—that by fraud was denied to her. The other problem, the primary reason for giving up, was the pressure ulcer on her spine that needed treatment by a wound specialist that was never provided to her, and possibly compounded by pain from the MRSA bacteria. The combination of denial of pulmonary care by the deception of Manor Care physicians and management, the denial of pulmonary rehabilitation, and the dosing with drugs that depressed pulmonary function, and caused suicidal thinking, caused Glenda to give up and want to die. She never knew the factors that put her in that position. The Mayo Clinic Staff website says of Depression: Depression is a medical illness that causes a persistent feeling of sadness and loss of interest. Depression can cause physical symptoms. Depression can lead to a variety of emotional and physical problems. ... may make you feel as if life isn't worth
living. … Symptoms … Frequent thoughts of death, dying or suicide. Deadly Consequences of Electing Hospice There are pros and cons about hospice. For many people with treatable medical conditions, it is often a death sentence. Glenda’s decision to go for hospice had the following consequences, which she did not understand: Curative treatment for the pressure wound would not occur. Corrective treatment for shortness of breath would not occur. Any new treatable medical problem usually goes untreated. The morphine used to deaden the pain from treatable pressure ulcer or any other treatable medical problem will hasten death due to the adverse effect upon her breathing.
All of these death-accelerating problems could be avoided by getting Glenda into the medical treatment that had been ordered and was universally recognized. Still More Obstacles! I was under heavy pressure to find a nursing home that would admit Glenda, which would give me time to obtain the medical treatment that had been denied to her. As if I didn’t have enough problems from the series of corrupt physicians, Glenda was pushed to go for hospice by members of her own distant family. None of them played any role in the grueling four years of medical care that I managed for Glenda, and none of them knew, or inquired, into what was being done to her. Pressure to Accept Hospice from Glenda’s Family A granddaughter in Oklahoma, studying to be a nurse, pushed for hospice. A little knowledge can be dangerous. Her granddaughter didn’t know that Glenda did not have a terminal medical problem; that Glenda had two treatable conditions; that once hospice is selected, pain medication replaces curative treatment.
Another obstacle came from Glenda's daughter, Lisa Kinney, who worked for a pharmaceutical company in Seattle. While I am working to divert Glenda from her desire to give up and instead get her the medical treatment that had been denied to her, her daughter sent me ugly emails for opposing Glenda’s desire to abandon treatment and go for a premature death. A sampling of her emails to me at this critical time included the following samples: You are a sick man. Please stop torturing the person you claim to love. Get off the goddamn internet, go spend her last days with you and stop indulging your paranoid fantasies. We don't want to have to get the court to get you away from her, but if you force us we will do so. You are a sick, sick, man. That was the daughter who never visited Glenda once while I was caring for Glenda during the prior four difficult years until Glenda’s cancer went into remission. The only exception being once, that was in December 2011—as a side trip when the daughter drove down from Seattle to Sacramento to display her two water dogs in a dog show. Being close, she managed to travel the few extra miles to finally visit her mother. She could see that Glenda was leading a relatively active life. The next month, this same daughter was pushing for her mother to select hospice! Glenda's daughter worked for a pharmaceutical company at their Seattle office. The website for that company stated it specialized in developing improvement for pulmonary conditions. I never heard of Glenda's daughter offering any help with Glenda's pulmonary problems. At a later date, looking over Glenda’s emails on her computer, I saw where Glenda was advising her daughter, Lisa, that the money in a trust account that Lisa would receive upon Glenda’s death, would instead be used for nursing home care when another source of funds was used up. If Glenda chose hospice, the trust would not be exhausted and death would come sooner. It is of course unknown as to what role this had in the daughter encouraging her mother to go for hospice and not to listen to my request to abandon that decision.
The combination of events was too much for Glenda. The stunt pulled by Manor Care management and physicians; the pain from the untreated pressure wound; the rejection by Kindred skilled nursing facility; the support by her family for hospice, and everything else, was too much. Glenda thought hospice would relieve the pain. But in most cases, once hospice is elected, the treatable medical conditions remain untreated, including subsequent treatable medical conditions. The pain would get worse, and a fatal dosage of morphine would end an otherwise treatable medical problem. Sham GIP Hospice Certification for Glenda’s Treatable Medical Conditions Manor Care records stated that Glenda was to go to GIP hospice. GIP hospice is General Inpatient (GIP) level of care for patients with untreatable, terminal medical condition, that have at most, only a short time remaining, generally considered to be less than two weeks. With full knowledge that Glenda had two treatable medical conditions, the unmet pulmonary rehabilitation treatment and the medical facility-resulting pressure (decubitus) ulcers, and their denial of treatment, combined with mistreatment, they were falsely showing on the records that Glenda was to go to GIP hospice, and insuring that it would occur. That was a death sentence expected to be carried out within a matter of days! The meaning of GIP Hospice GIP refers to General Inpatient care in a hospice facility that is expected to be short term, generally less than two weeks and solely for pain control and when death is imminent. An Internet description of GIP hospice care states: “GIP level of care is always short term, typically for less than two weeks. Patients are evaluated on a case-by-case basis and generally may be admitted for pain or symptom that is uncontrolled despite aggressive treatment efforts or when death is imminent and symptoms are uncontrolled.”
That was also the practice followed by Bruns House hospice. With only six beds serving the entire community, and the only hospice facility in that area, its recognized practice was to limit admission to patients with only seven to ten days expected life remaining. A Hospice of the East Bay form, dated January 31, 2012, described the short period of expected stay at Bruns House, defining it as Inpatient (GIP) level of hospice care at Bruns House for a short time, usually 3-5 days … [Emphasis in their form]. The Bruns House hospice form stated: As a Bruns House patient, or Responsible Party for a Bruns House patient, I hereby acknowledge that … medical criteria is required by Medicare, medical and Private Insurance Companies to qualify for the General Inpatient (GIP) level of hospice care setting, as determined by the hospice team, may receive GIP level of hospice care at Bruns House for a short time, usually 3-5 days or as long as the symptoms require 24 hours of nursing care to manage. The Bruns House physician will assess each patient to determine that the required medical criteria have been met. If symptoms stabilize, and the patient no longer meets the criteria for the GIP level of care, I understand that the patient will be discharged from GIP level of care to a routine level of care status in a care setting outside of the Bruns House. Glenda was definitely not a terminal case when I brought her to John Muir hospital for a shortness of breath condition caused by the return of a previous fungus infection in the lungs. Gross medical malpractice combined with medical fraud—and further worsened by what meets the definition of medical homicide or euthanasia, brought an end to an active life for a great lady, Glenda!
Sham Certification of Terminal Illness
The complicity of two physicians was needed to remove Glenda from Manor Care, abandon the pulmonary treatment that had been denied to her, and settle for a premature death in hospice. Two physicians had to sign a legally required Certification of Terminal Illness (CTI). One was Glenda’s primary care physician, Dr. Vona Lorenzana, Walnut Creek, and the other was Dr. Jan Spencer. Her only known medical practice was as a consulting physician with Hospice of the East Bay, an organization devoted to entering people into end-of-life care!. Their Certification of Terminal Illness required that the physicians certify, and imply, that:
The medical condition for which Glenda was in Manor Care skilled nursing facility (shortness of breath) was untreatable and that she would die of that medical condition within six months. (Glenda’s two medical conditions for which she was in the hospital were the untreated COPD and the inadequately treated wound on her back. The underlying esophageal cancer was in remission and had not been involved in this period of medical care. Glenda’s oncologist was waiting for Glenda to be released from her present treatment so as to continue the cancer remission treatment.) That the pulmonary rehabilitation treatment ordered by John Muir hospital to improve her shortness of breath had been given to Glenda and found ineffective. (Manor Care had no such unit and therefore Glenda never received the pulmonary rehabilitation treatment.) That there were no irregularities or fraud in the medical care for Glenda while at Manor Care that contributed to her present condition. That Glenda was made fully aware of the above irregularities, knew that she had been fraudulently denied the pulmonary rehabilitation treatments and treatment for the painful pressure
ulcer, and knew that these conditions could be corrected.
That Glenda’s family and caregiver were brought into the decision-making process, and agreed. Instead, I was aggressively barred from doing so, in order to cover up for the series of corrupt acts by doctors and management. Glenda’s distant family was not involved in Glenda’s care in any way. That the statutory, regulatory, and case law requirements for hospice had been met before signing the Certification of Terminal Illness.
Dr. Vona Lorenzana, a general practitioner, signed the CTI on Tuesday, January 31, 2012. She certified that death would be from esophageal cancer. But Glenda wasn’t being treated for esophageal cancer, and Glenda’s oncologist wasn’t involved and could not have made any such prognosis. The following is a copy of the January 31, 2012, CTI that Dr. Lorenzana signed: Hospice of the East Bay Guilinger, Glenda P# 14286 Pt Name Attending Physician: Dr. Martin Jimenez Dr. Vona Lorenzana Attending Physician Certification of Terminal Illness This is to certify that the above named patient has a prognosis of six (6) months or less, if the illness runs the normal course. I recommend this patient be admitted to hospice services. Preliminary Hospice Diagnosis: Metastatic esophageal cancer (per referring physician) (Single diagnosis most likely the life expectancy) Final Hospice diagnosis to be determined by Hospice of the East Bay Physician and Interdisciplinary Team based on Local Coverage Determination (LCD) guidelines.
Please send pt demographics, H&P, fact sheet, Physicians progress notes and Discharge Summary. Physician Orders and Initial Plan of Care: 1. Hospice RN to assess, evaluate and admit to Hospice Care as appropriate. 2. I agree to an initial plan of care (POC) as determined by the Interdisciplinary team (IDT) and patient/family. Revisions to the POC will be made as indicated by changes in patient/family needs. The attending physician will be informed of POC revisions. 3. Current medication and care orders will be continued until changed by attending Physician or the Hospice of the East Bay Physician. 4. Comfort Medications Orders and Wound care per attached guidelines until changed by attending Physician or a Hospice of the East Bay Physician, per Plan of Care to be established. 5. Attending Physician to follow patient for pain/symptom management. If attending Physician is unavailable, Hospice of the East Bay may call MD Group or Hospice of the East Bay Physician about this patient. Hospice of the East Bay to report changes in level of care to the attending Physician. 6. Medical Social Worker will assess and evaluate psychosocial needs. Spiritual Care Counselor to assess and evaluate patient for spiritual and emotional care needs. 7. Volunteer per patient/family request. 8. If Patient is on cardiac medication or diagnosed with hypertension or hypotension, the attending physician will be notified if systolic blood pressure is less than 90 mm HG or if the systolic blood pressure exceeds the baseline by 30 mm HG or greater. I want to follow my patient in the following capacity:
Continue to be the attending Physician while my patient is in Hospice. Remain available but allow Hospice Physician to consult as needed for end of life symptom management. Keep me informed of major changes. Notify me of patient’s death.
Attending Physician: Dr. Vona Lorenzana 1/31/12 Regulations relating to Certification of Terminal Illness require a narrative to support the statement, and copies of supporting medical records. Those records provided no support for the prognosis of death within six months from esophageal cancer. On the contrary, they revealed the two treatable medical conditions for which treatment was available, and the medical misconduct that blocked Glenda from receiving that treatment and the overdosing with drugs that worsened Glenda’s condition. Dr. Lorenzana could not have been ignorant of what her colleagues had done to Glenda. Lorenzana’s declaration stated that the coordinating with family occurred. No such coordination or agreement occurred. I was the only person involved with Glenda’s care and every physician involved in this group knew I opposed the death decision for Glenda to forego treatment and select hospice. Brief Rubber Stamp by Hospice Physician Dr. Jan Spencer The record shows that the CTI by Dr. Jan Spencer, a physician consultant at Hospice of the East Bay, wasn’t dated until February 2, 2012. She cavalierly stated nothing to support her short off-theshelf death decree. Dr. Spencer’s Certification of Terminal Illness stated: Charts/Clinical Notes Period: 01-31-2012 through 02-01-2012 Hospice of the East Bay –Bruns House Patient: P142896 Guilinger, Glenda Address: 2849 Miranda Avenue, Alamo, CA 94507
Use Code: N Effective Date: 01-31-2012 Discipline: MD - Medical Director Note: Hospice Physician Certification of Terminal Illness This is to certify that the above named patient has a prognosis of six (6) months or less, if the illness runs its normal course. Effective 1/31/12, I recommend this patient be admitted to hospice services. Terminal Diagnosis* metastatic esophageal cancer (*single diagnosis most likely limiting the life expectancy) 78 yo woman with metastatic esophageal cancer and history of DM11 and CAD …. Attestation: I confirm that this narrative is based on my review of the patient's medical record and/or examination of the patient. Jan Spencer, MD Hospice Physician 2/2/12 Signature: Glenda was not being treated for esophageal cancer; her oncology physician was not involved during Glenda’s stay at Manor Care SNF or the two hospital visits for shortness of breath, and based solely on Manor Care requests. Major falsehoods arose with those two certifications:
There were no reports in any of the medical facilities that cared for Glenda between January 5, 2012, and January 31, 2012, addressing Glenda’s underlying cancer. The reports throughout that period focused on Glenda’s shortness of breath. John Muir hospital physicians believed that Glenda’s breathing problems could be helped by pulmonary rehabilitation treatment (which
Manor Care physicians denied to Glenda).
The certification of terminal illness had to cover up for the prior misconduct inflicted upon Glenda, including what has already been stated. Glenda was diagnosed four years earlier with Stage IV esophagus cancer. Treatment had put that cancer in remission; her oncologists had scheduled Taxol cancer treatment for Glenda prior to her shortness of breath problem and had planned to start that as soon as Glenda returned home; and there was no involvement of her oncologist in Glenda’s medical treatment or any contacts throughout the period from January 5, 2012, to January 31, 2012. Both physicians signing the Certification of Terminal Illness stated that death would come from esophageal cancer. Neither doctor was a cancer specialist. Their certification contradicts everything written by physicians at John Muir Hospital and Kaiser Permanente hospital during the prior several weeks of treatment. Their CTI assisted in covering up for the major medical misconduct occurring while Glenda was at Manor Care. Their CTI allowed or encouraged Glenda to abandon the pulmonary rehabilitation treatment that unknown to her, she never received, and instead go to Bruns House hospice, a unit of Hospice of the East Bay, to die. They both knew that the John Muir order for Glenda to receive pulmonary rehabilitation still existed, that she had never received that treatment, and the nearby Kindred SNF had that treatment. Instead of arranging for Glenda to receive that fraudulently denied treatment, by deception, cover-up, and sentenced Glenda to a premature death by their sham Certification of Terminal Illness. Neither of the two physicians made any effort to inform Glenda of these matters when in desperation she decided to give up the
available medical treatment that was unknown to her. Instead, they both covered up for the medical crimes and became accomplices.
Both physicians played major roles in denying to Glenda the pulmonary rehabilitation that could have extended her life, and resulted in her premature death. |
To this sordid coterie of physicians, Glenda’s life was cheap, and easy to bring to an end. A Manor Care memorandum dated 1/31/12 by Manor Care's physician in charge, Martin Jimenez, showed him arranging for Glenda's transfer to Bruns House hospice facility in Alamo, California. Jimenez wrote: On Tuesday, Glenda was transported to Bruns House, arriving about 2 pm on January 31, 2012. Glenda's Hospital Records Stated Favorable Pulmonary Status Although the hospital records did not reflect the favorable pulmonary status of a 21-year person, they did not indicate a near-death condition. They indicated the status of a normal person with COPD. The John Muir hospital physician reports, the latest being January 13, 2012, about two weeks before Glenda's suspicious death at Bruns House hospice, were normal and common for a COPD patient. The Kaiser Permanente hospital physician records, dated January 22, 2012—just over a week prior to Glenda's death, were also normal and common. John Muir hospital promptly provided the records that I requested that related to Glenda's January hospitalization. A key January 13, 2012, discharge report showed Glenda to be far from a hospice case. Her cancer was in remission. The COPD that she had lived with for years was giving her problems, but she wasn't on death's doorsteps. A portion of two John Muir hospital reports stated: Clinically she is dong relatively well. Asymptomatic on 2 L of oxygen. She looks comfortable without any shortness of breath or tachypnea [Abnormally fast breathing] Vital signs have been
relatively stable with O2 saturation 97% to 100% on 2L per nasal cannula. Other additional comorbidities [effect of all other diseases] include a history of allergic bronchopulmonary aspergilosis [diseases caused by fungus, a difficult-to-treat condition Glenda initially acquired approximately a year earlier, and might still exist.] Kaiser Hospital Reports Showed No End-of-Life Problems Segments of Kaiser Hospital physicians’ reports stated a medical condition that in no way indicated a hospice situation, and a condition amenable to competent medical treatment: Jan 21, 2012: Kaiser Permanente: Assessment and Plan: History of present illness: Glenda A Guilinger is a 78 Y very pleasant female ... presented to ER with worsening dyspnea and productive cough for last week. Pt had long hix [history] of severe COPD and allergic bronchopulmonary aspergillosis [allergic reaction/infection due to fungus, which she had a year earlier], had few hospitalizations in John Muir for dyspnea and last hospitalization was on 1/5 and was discharged to Manor care on [Jan] 13 for similar symptoms and was treated with steroid and abx [antibiotics], complained of worsening dyspnea at exertion with dry cough for last week after she was discharged back to Manor Care ... Pt denied chest pain but continued to have both legs swelling as she had for years. Respiratory ROS [review of system]: positive for cough, sputum changes and tachypnea. Cardiovascular ROS: no chest pain or dyspnea on exertion. Physical exam: General appearance—Alert with mild distress due to dyspnea on O2. DYSPNEA: possible cause including COPD exacerbation triggered by pneumonia, will start abx including coverage for MRSA, treated with possible influenza, start steroid., continue bipap with breathing treatment, pul[monary] consult[ant] due
to hix [history] of allergic bronchopulmonary aspergillosis. Pt had recent angiogram of chest done recently which was negative. Jan 22, 2012: Kaiser Permanente Progress Note: Hospital Day 1: HP1: Patient with Hx of COPD, ABPA previously treated with itraconazole and metastatic esophageal cancer admitted for SOB, D/C summary from 1/15/12 from John Muir reveal normal echo, with small b/l effusions. [Note: ABPA is a disease in which the fungus grows in mucus (evoked by inflammation), and causes intermittent bronchial obstruction. Difficult to treat. Glenda originally diagnosed with this a year earlier.] Assessment and Plan: Dyspnea in a patient with COPD, metastatic esophageal and b/I pleural effusion likely from COPD exacerbation and anxiety. Chest CXR looks b/l effusions. [Fluid on lungs.] ... she'll need thoracentesis. She had a recent echo which showed normal LVF. Right now she is saturating at 99% on 2 lits. COPD exacerbation and possible pneumonia. Disposition: transfer patient to John Muir of d/c back to SNF in 2-3 days. Dyspnea in a patient with COPD, metastatic esophageal and b/I pleural effusion likely from COPD exacerbation and anxiety. ... try diuresing with Lasix and repeat CXR [chest x-ray]. If effusion is not decreasing she'll need thoracentesis [removing the fluid on her lungs]. Right now she is saturating at 99% or 2 lits. Plan: Lasix, ... COPD exacerbation and possible pneumonia. Assessment: stable. ... possible cause including COPD exacerbation triggered by pneumonia, will start abx [antibiotic] including coverage for MRSA, treated with possible influenza, start steroid, continue bipap with breathing treatment, pul[monary] consult[ant] due to hix of allergic bronchopulmonary aspergillosis. Pt had recent angiogram of chest done recently which was negative.
Psychotropics consent and treatment [Patient approval needed before using the psychotropic drug, Ativan, because of frequency of altering behavior and emotions, and judgment. This drug was repeatedly given to Glenda from that point on.] Subjective: patient still complains of SOB with dry cough. She also complains of chronic back pain. General appearance: alert, and in mild respiratory distress. On January 23, 2012, Glenda was transferred back to Manor Care. At that time, the thoracentesis procedure to remove fluid on her lungs, which had first been detected during her initial John Muir hospital stay (Jan 4, 2012 to Jan. 14, 2012) still had not been done, and the possible fungus infection in her lungs may have still existed. Kaiser Hospital Reference To Dreaded “Superbug,” MRSA The January 21, 2012 Kaiser Hospital report mentioned the dreaded MRSA “superbug,” and associated it with Glenda’s breathing difficulties. It could also have been the cause of, or involved in the pressure ulcers on Glenda’s back. The presence of MRSA is usually associated with great pain. This very important reference was totally ignored by Manor Care physicians. The following are excerpts from medical reports on the government's web site for MSRA: http://www.nlm.nih.gov/medlineplus/ency/article/007261.htm. Highlights of Series of Doctor Frauds Inflicted upon Glenda at That Stage First fraud by Manor Care management and physicians. Manor Care management and physicians accepted Glenda with the agreement to provide that treatment, which they did not have. This fraudulent acceptance was most probably made so as to continue the uninterrupted referrals of patients from John Muir hospital. Manor Care personnel now had to rid themselves of Glenda before Medicare regulators discovered claims for the pulmonary rehabilitation treatment that they did not have. The first fraud was then followed by others, and would shortly result in Glenda’s premature death (homicide) followed by the
apparent suicide of a son when he was informed of Glenda’s death. Next fraud. Within 24 hours of Glenda’s arrival, a physician at Manor Care, Hospice of the East Bay’s Dr. Smita Chandra, (and management) fraudulently stated to Glenda that her shortness of breath could not be improved upon and that she would have to leave. That was before any pulmonary rehabilitee was provided (which would never be provided); before any pulmonary specialist would have had time, to make such evaluation; and made by a doctor trained in India. That was extremely stressful upon Glenda and played a role in her desire to accept treatment—if it were ever provided; which never occurred! Next fraud. Denying treatment for the pressure ulcers over Glenda’s spine that were causing severe pain. That condition required special treatment at the SNF and the attention of wound specialists. But if that was provided, it would have extended Glenda’s stay at Manor Care on the pulmonary rehabilitation treatment that Manor Care did not have, and significantly increase the probability that Medicare (or California regulators, or Healthnet PPO insurers) would discover the deception. In addition to not providing the ordered pulmonary rehabilitation treatment, Manor Care personnel now withheld treatment for the worsening and painful pressure ulcer over her spine. Next fraud. Doctors attending Glenda substituted for pressure ulcer treatments drugs that are never to be given to patients with pulmonary problems. Morphine sulfate, other morphine related drugs, and others that have adverse effects upon a person’s breathing. Next fraud. Manor Care physicians and management repeatedly blocked me from receiving information on Glenda’s treatment, even though I was her common law husband for 18 years; I was her caregiver for the past four years on other medical conditions, and had power of attorney over her medical treatment. That refusal was apparently to hide from me the continuing pattern of medical misconduct and fraud that would eventually be fatal for Glenda.
Next fraud. As I sought to arrange for Glenda’s transfer to nearby Kindred skilled nursing facility where there did exist a pulmonary unit, Manor Care personnel contacted Kindred admission personnel and falsely stated to them that Glenda was incapable of having her shortness of breath improved upon. This required covering up for the fraudulent acceptance of Glenda for treatment it did not have; the round-the-clock dosing with morphine and other drugs that should not have been given to Glenda and worsened her breathing. Complicity by Kindred admission personnel. Kindred personnel then refused to accept Glenda, despite have a skilled nursing facility licensed by the state and approved by the federal government; payment would be made by Medicare and Healthnet PPO insurance; and Glenda met the conditions for admission. Although Manor Care painted a fraudulent picture of Glenda’s medical status, I had made Kindred aware of what was actually occurring. Kindred personnel knew that Glenda would go to hospice if they rejected her, and became complicit in her subsequent arranged death. Next fraud. Manor Care management and physicians manipulating Glenda’s decision made to abandon treatment for her treatable medical conditions and elect the death decree of hospice. Next fraud. Manor Care personnel stated to me that they would not recognize my right to appeal Glenda’s dismissal, despite my right to do so, and Glenda’s questionable mental status and lack of understanding of what was being done to her. Next fraud. Two physicians were directly involved in assisting Manor Care’s removal of Glenda by signing Certification of Terminal Illness fraudulent stating that Glenda had less than six months to live, and that she would die from esophageal cancer. That medical condition was not involved in any of the treatments at the facilities involved. Glenda had been in remission for that cancer that was diagnosed four years earlier; she was scheduled to continue her remission treatment; her pres-
ence for this period of hospital and skilled nursing facility did not address the cancer matter. Next fraud. Under control of Hospice of the East Bay’s Dr. Smita Chandra, Glenda was put to death, within hours of arriving at Bruns House hospice, with morphine overdose. Double Tragedy: One of Glenda's sons, Bruce, apparently commits suicide immediately upon hearing of his mother's death. Standard American culture of cover-up by people and groups responsible for reporting corruption. America's endemic culture of blissful ignorance and/or blissful indifference.
Outrageous Attacks upon Glenda by Series of Doctors The facts show that a series of doctors and medical facility managers engaged in medical misconduct that inflict great suffering and denial of prepaid medical treatment upon Glenda. They lied, as a group, convincing Glenda that her medical problems and pain were untreatable and that she should give up seeking treatment and accept palliative pain relief: premature death! An organized criminal organization, operating a medical facility, couldn’t do any worse. Admission to Bruns House Hospice for People with Maximum of Seven to Ten Days to Live Bruns House hospice had only six beds, and was the only hospice facility in that area. It operated on a very short admission time, with people dying every few days. Its unpublished but recognized admission policy was limited to people with a maximum time remaining before their estimated death of seven to ten days. Pictures I took of Glenda at Manor Care definitely didn’t reveal anyone with a terminal illness, and certainly not seven to ten days! This was bizarre. It was as if a group of people in the medical industry were determined to put Glenda to death. Unfortunately, they would succeed, with many enablers! A Medical Horror Story: Possibly One of The
Most Illustrated and Documented Case of Doctor Misconduct in the United States Glenda was certainly far removed from dying within ten days, or six months. She just needed the care that had been ordered for her shortness of breath; plus treatment for the pressure wound; and elimination of the morphine drugs adversely affecting her breathing. The plight of a vulnerable senior being defrauded out of her life by a group of physicians protecting each other’s medical misconduct should be the center piece of America’s medical discussions. Medical slogans with no support in reality prevents the public from learning about the abuses throughout the medical industry. They cover up for the rogue doctors, the thousands of yearly deaths by medical errors, medical abuses, and outright medical homicides. Hospice is framed in euphemistic terms, and many times that is correct. But without an in-depth understanding of the subject, many medical personnel are free to engage in homicide without being criminally charged. Before my visit to Glena at Manor Care on January 30, 2012, I had prepared the following memorandum for Glenda: Jan 30, 2012 Briefing for Glenda Many Important Points to Keep in Mind—And the Serious Consequences from the Wrong Move Now • As for hospice, Glenda can always make that decision later if need be. But if she makes it now, that eliminates any hospitalization, which could conceivably result in her suffering excruciating pain from denial of hospital treatment later on. Hospice can be selected later if necessary. Right now there is the possibility of her staying at Manor Case; or discharge from Manor Care and going home, hiring part time help. Second pulmonary specialist opinion
can also be sought, along with her present pulmonary physician. • • Maybe, within a month, getting accepted into another skilled nursing facility. Having available hospitalization and pain relief if it becomes necessary, something that is forfeited if hospice is selected. There ARE conditions that can develop during hospice that inflicts excruciating pain, for which hospice's for-profit agency cannot handle. Glenda needs to keep in mind the heavy burden other loved ones experience if she abandons the benefits of a hospital for home hospice. Mike sent me an email about the awesome burden upon the family as Glenda's father died of emphysema. If he had been in a hospital, his final days would have been easier, and the family would not have had to go through the overwhelming stress. As for appealing any possible Manor Care discharge, that is a standard action and not anything abnormal. The appeal extends the time in Manor Care during which we can arrange other care for Glenda. For maximum pain relief, and abandonment of hospital pain relief, hospice has serious drawbacks, being why many dying people do not use it.
• • •
While at Manor Care and before I could raise these issues with Glenda, Manor Care social director and other personnel induced Glenda to block my efforts to appeal her discharge and prevent her transfer to hospice of the East Bay’s Bruns House. That tactic would turn into a death decision for Glenda within two days.
Ineligible Glenda Transferred To End-of-Life Hospice Facility On Tuesday afternoon, January 31, 2012, Glenda was transported to Bruns House hospice in Alamo, California, arriving at 2 PM. Bruns House is a unit of Hospice of the East Bay, headquartered in nearby Pleasant Hill. The group is supported by donations that provide income for their employees, including India-trained Dr. Smita Chandra, involved in the initial fraud against Glenda, and Dr. Jan Spencer, one of the two signers of the sham Declaration of Terminal Illness. Glenda was happy. She thought life would get better for her, that she would get relief from the pain of the untreated pressure ulcer on her back. Visiting Glenda an hour later, I found her in a good mood. She didn’t understand the sordid record of doctor-induced euthanasia that the mainstream media leaves unreported. She didn’t understand that she had been defrauded by physicians seemingly acting in unison. Like most people who don’t read about such things, she trusted the physicians. Glenda was unaware of the negatives in hospice, or that she had just given up the opportunity for treatment of her two treatable medical problems. I planned to find a medical facility that would provide the pulmonary rehabilitation treatment that John Muir hospital physicians had ordered for her. At that time, I didn’t know about the pain-causing untreated pressure ulcer. A person can opt out of hospice at any time, and it was my intent for this to take place and get Glenda the treatment she needed. She could then return home. Additional misconduct quickly ended my efforts.
Bruns House Hospice, Alamo, California Glenda didn't belong in the hospice program, and certainly not in Bruns House hospice. That facility, with only six beds, the only hospice facility in the area, is intended for those patients with a very short time to live. The unpublished but recognized admission policy requires an estimated seven to ten days survival. Glenda obviously did not meet that criteria! Glenda Looking and Feeling Well, Away From the Stress: January 31, 2012 Glenda was already feeling better when she arrived at hospice on January 31, 2012. That improvement may have been due to the final removal of the fluid on Glenda's lungs four days earlier. Glenda was busy all afternoon. She was calling people on the phone telling them about her new location; doing crossword puzzles; reading the newspaper; and carrying on conversations. She hardly looked like a person belonging in any medical facility, and certainly not a hospice where remaining life expectancy was measured in days.
Glenda, Late afternoon, January 31, 2012 India-Trained Manor Care Doctor Taking Over Glenda's Morphine Dosage Schedule As my daughter Stephanie and I sat by Glenda's bed, I was shocked and outraged to see entering the room Dr. Smita Chandra. She was the doctor from Manor Care who played a key role in covering up for the fraudulent admission of Glenda to Manor Care for pulmonary rehabilitation treatment, a program the facility did not have. She was the doctor at Manor Care whose actions sought to cover up for Manor Care’s fraudulent acceptance for pulmonary rehabilitation ordered by John Muir hospital physicians. She was also a doctor on the staff of Hospice of the East Bay that seeks patients for their end-of-life operation. Without Glenda having had time to settle in, without the pulmonary rehabilitation treatment, and with Glenda looking good despite the pain from the untreated pressure ulcer, Dr. Chandra stated to Glenda that her shortness-of-breath was not capable of being treated and that she should seek palliative care: hospice! The arrogance of Dr. Chandra covering up for her involvement in the Manor Care admission fraud, compounding it by telling Glen-
da, seeking relief from treatable medical condition, to instead select end-of-life route that the doctor’s organization was involved in, was sufficient for a permanent disbarment. But worse was to come, and a medical homicide action was something a competent and honest prosecutor should consider. I now wondered what role this doctor would now have that would affect Glenda's life. That doctor would now be in charge of the pain-relieving drugs given to Glenda and her care. This disturbed me greatly! When Stephanie and I left that evening, Glenda was still smiling, talkative and showing no sign of any personal distress. That would shortly change. Added Stress for Glenda When Stephanie and I started out the door of the Bruns House, I walked over to the window where Glenda was lying, and she waved us back. Back inside by Glenda’s bed, Glenda told Stephanie about the phone calls she received from her daughter that made derogatory comments about me and severely criticized my efforts attempting to keep Glenda from going to hospice. A combination of my poor hearing from years of airline piloting and Glenda’s weakened vocal cords made it difficult for me to understand what Glenda was saying. My daughter later conveyed to me what Glenda said. Glenda was very distressed as a result of those calls. We then left. That was the last time that I would see Glenda as a normal human being before the deadly effects of morphine overdose took effect. CHAPTER THIRTEEN
Hours Later: Glenda’s Sudden Suspicious Death
Upon arriving at Bruns House early the following morning I couldn’t believe my eyes. Instead of a smiling and active Glenda, she was comatose and gasping for breath. She was transformed
into a totally different woman from when I had left hours earlier. Something was done to her! Glenda was Obviously Given a Fatal Dose of Morphine The only explanation for this sudden and unnatural transformation was a morphine overdose. Euthanasia. Or, homicide! That would explain Glenda’s comatose condition and difficulty breathing. At that time, I did not understand these events. If I had experience with morphine overdose cases, I would have immediately recognized what was done to Glenda. If I had been smarter about these matters, and had the right connections in the medical industry, possibly I could have had Glenda quickly moved and treatment given to counteract the deadly morphine overdose. But no one can be expected to know what was being done to Glenda. Unknowingly Watching a Loved One Put to Death! Throughout the day on February 1, 2012, people were calling on the phone from Glenda’s birthplace in Oklahoma and elsewhere. The phone would be placed next to Glenda's ear while people told her how much they loved her. Glenda was comatose, but they felt that she could hear them. It was a tragic sight!
Watching someone, especially someone you love very much and around whom your world revolves, being put to death by a morphine overdose, is a very disturbing experience. How could this be, I thought. I brought Glenda to the hospital a short three weeks earlier for a relatively modest breathing problem, and now she was comatose and gulping for breath. She was fine a few hours ago. This was not natural. I didn’t realize it at the time, but this was medical homicide in action, in the United States, and done with total immunity!
Early Morning February 1, 2012, Glenda Dying A coma—or death—can be induced by heavy opiates, such as morphine. It was strange that Glenda was looking and feeling good the evening that Stephanie and I had left her. Twelve hours later she was comatose and having trouble breathing and her body was twitching. It is not the sight one wants to view of a loved one!
Paula, one of the “clan,” one of the many who loved Glenda Watching a Loved One Put to Death Signs of opiate overdose that I observed shortly before Glenda died included respiratory depression, shallow breathing, and body twitching, precise signs of opiate over dosage! All day I sat by Glenda's bed, occasionally holding her hand. I thought of the many great moments we shared together, and of the things she stated just a few weeks earlier that we would do when the weather got warmer. In early evening, Glenda started myoclonic jerking, which is often the side effect of heavy opioid administration. It is a disturbing sight to watch. Finally, at eight p.m., thinking that Glenda would survive the night, I left for home so as to get enough sleep for the next day's vigil. But no sooner had I arrived home, a call from Bruns House said Glenda was near death. Rushing back, the 15 minutes it took
me to arrive was not quick enough. A beautiful life was over for Glenda.
Glenda, dead of morphine overdose, within hours of arrival at Bruns House I was devastated. This could not be! Glenda was a functioning lively human being. I returned to the home that would never again see Glenda. It is difficult to express the grief that overwhelmed me, and resurfaces time and time again. Denial of medical treatment ordered by John Muir hospital physicians; fraud related to accepting Glenda for medical treatment Manor Care did not have; untreated pressure ulcers; mistreatment with morphine and mind-altering drugs; withholding information from Glenda’s caregiver—me; coordinated doctor misconduct diverting Glenda from treatment to deadly hospice; and then morphine overdose. Anyone can be put to death that seeks treatment for a treatable condition to a quick death under this culture!
Compounded Greek Tragedy When I returned home near midnight, Wednesday, February 1, 2012, I immediately e-mailed to Glenda's sons news of Glenda's death: Bruce, Martin and Mike. Bruce was in daily telephone contact with Glenda from his home in Big Lake, Minnesota, where he lived alone. He was also in daily contact with me by email. He was enthused about doing internet research for me on the various areas of corruption that I continued to write about. The research appeared to give Bruce a feeling of accomplishment. He embraced it with a feeling of doing something important. Between Glenda and I, there was constant communication throughout the day. Extension of Massive Medical: Bruce Found Dead! Martin and Mike tried to reach Bruce by phone to determine if Bruce could travel for Glenda’s funeral. Their phone calls to Bruce went unanswered. Fearing that something may have happened, they had the police in Big Lake, Minnesota check his residence. That check found that Bruce had died, apparently after being told of his mother's death. Probably a suicide. A double Greek tragedy! A small and unsophisticated community like Big Lake, Minnesota probably did not have the funds or interest in conducting an autopsy. At a later date, I wrote to the police chief in Big Lake, Sean Rifenberick, offering to provide information that could possibly help find a reason for Bruce’s death. Rifenberick didn’t think enough to even respond.
Bruce during happier times during a flying trip throughout the Southwest: Bryce National Park Incredible Series of Events Looking back, it was preposterous to realize that I brought Glenda to the hospital for a relatively modest treatable shortness-of-breath problem and now, three weeks later, Glenda was dead, and her son, Bruce, apparently committed suicide! How could such a tragedy occur? Where were the medical regulators? Where was the media? I would later find what I had repeatedly discovered during the past 40 years of exposing great scandals: they were enablers by their cover-ups and silence.
Euthanasia or Homicide without Punishment Subsequent research revealed that euthanasia, or homicide, by medical personnel is common in the United States, and not reported by the mainstream media. Glenda’s euthanasia and/or homicide would be simply one more case that had the perpetrators walk away unpunished. Morphine Overdose Surely Recognized by Attending Medical Personnel Assuming that the morphine overdose given to Glenda at Bruns House was inadvertent—hardly—medical personnel in hospice environment know the symptoms of morphine overdose, and the drug to immediately reverse its deadly effects. These are available in all hospice and hospital facilities. The symptoms of morphine overdose, shallow slow and shallow breathing, shortness of breath, hypotension, trouble swallowing, convulsions. Drugs that reverse morphine/narcotic overdose include Narcan (Naloxone) and provide complete or partial reversal of opioid effects. Narcan is an opioid antagonist used to counteract the effects of morphine. Narcan is a pure opioid antagonist, in that it has no pharmacologic activity other than to counteract the effects of morphine. CHAPTER FOURTEEN
Funeral Services for Glenda
There are hectic necessities to be done upon the death of a loved one. An obituary was sent to the Contra Costa Times for a threeday placement, and an obituary to the Rossmoor News, a paper for the 9,000 member retirement community where Glenda was well known for her sewing and quilt activities. The funeral services were held on February 8, 2012, at Hull's Mortuary in Walnut Creek, with Pastor Cherie Reid of Grace Presbyterian Church conducting the services. Several members of my
family, the “clan,” spoke of their love for Glenda. Members of the Rossmoor Quilters also attended. Following the services at Hull’s, the funeral vehicles went to the Alamo-Lafayette cemetery in Lafayette, California, where graveside services were conducted. From Glenda's family, there appeared at the funeral services two of the sons, Martin from Tulsa, Oklahoma, and Mike from New Jersey. Missing was Bruce, who was found dead after being informed of his mother's death. Glenda's daughter, Lisa Kinney, living closer than any of Glenda’s other children, did not appear. Following the funeral services, many then went to the home of my daughter and her husband, Jerry Stadtler, in Danville, California.
Glenda is buried at the Alamo-Lafayette Cemetery in Lafayette, California. In the background were condominiums on land I once owned until coming under multiple attack tos silence my exposure of corruption in areas high in the federal government that were associated with several major national events. Details in various book I wrote, including History of Aviation Disasters: 1950 to 9/11, and Defrauding America. Hospice of the East Bay Grief Counseling Ironically after causing Glenda’s death through a morphine overdose, Hospice of the East Bay management sent me notices of bereavement services they offered. As with all their postings and notices, they request financial donations to pay for their employees, such as India-trained Dr. Smita Chandra and Dr. Jan Spencer.
Researching Bruce’s Death
After the funeral services had occurred, and between periods of grief, I started looking over the emails that Bruce had sent to me,
and also the emails on Glenda’s computer between Bruce and his mother. Bruce died either from grief, or he committed suicide with an overdose of his various pain medications. I didn’t think grief over Glenda’s death would itself result in death. I felt that Bruce probably committed suicide when he heard of his mother’s death. He loved her very much and his life centered on her. He called Glenda once or more a day from his Minnesota home. I tried to find some clue by looking at the hundreds of emails that he sent me, and also the emails between him and his mother on Glenda’s computer. They all showed a deep love for his mother and discussion of personal matters. Bruce lived alone in Minnesota. He had multiple sclerosis (MS), and was often in pain, I felt the need for almost daily communication to improve Bruce's spirits. Bruce's emails repeatedly thanked me for providing care for his mother and extending her life. A few of Bruce’s emails to me showing his concerns are shown here: January 21, 2012. Email from Bruce: You two can end the great love story where you two lived it! [Referring to Glenda returning home.] (Another at 10:37 PM) Rodney, I can only imagine how hard this is for YOU.
January 22, 2012 from Bruce) Thanks for keeping us updated. I know this is hard on you. Hopefully she can get over this pneumonia, and it will bring back the fight in her! Hang in there Rodney! I know this is SUCH a hard time for you, and there is no need to make it more complicated and stressful. Thanks to you and the “Stich” Clan for making her as comfortable as possible! She knows I love her, and hopefully will be able to speak better.
January 24, 2012 from Bruce: I have never stopped believing Mom can beat this. Something is left inside her to fight. You have my deepest sympathies. I know this is very hard on you, but without you, she would have died a long time ago. That I know. Spring is coming, and that would give me a chance to come see her! I hope she can hold on till then, and longer. I found by examining the emails from Bruce that Glenda's daughter, Lisa Kinney, was making ugly statements about me. They disturbed him. He forwarded a few of them to me. He suggested I stop sending her periodic updates on Glenda’s condition.
January 26, 2012 from Bruce, advising me not to continue giving his sister updates: I would SUGGEST NOT including my sister “Lisa's e-mail address in this fight. [Unknown to me, Glenda's daughter had been criticizing me for years—while I was taking care of her mother.]
Another January 26, 2012 from Bruce, forwarding an email to him from Glenda's daughter, Lisa: From Lisa Kinney: Subject: Fwd: Re: Pompous, maudlin, arrogant asshole .. The man is insane. HE is unfairly and gratuitously alienating her health care providers to satisfy a selfish wish that has very, very, very little to do with her. He's a moron who thinks he is a genius. Nothing more to say here. Lisa. [These comments were made while I was taking care of her mother during very difficult times.]
From email@example.com to Lisa Kinney: Subject: Re: Hi Lisa: How much time have you spent in her hospital room holding her hand? But if she makes it another year, it would be considered “Torture to You”? God Bless Sis. January 26, 2012. From Lisa Kinney to Bruce Guilinger, Martin Guilinger, and Mike Guilinger: Subject: Re: A crisis against Glen-
da. This man is criminally delusional! He's the one who needs to be stopped. Lisa. [Sent at the time I was seeking to transfer Glenda to a pulmonary rehabilitation facility and delaying the discharge by Manor Care personnel to hospice.] Glenda's Explanation of Her Daughter's Personality Problems Glenda sent two emails to my daughter, Stephanie, the first one on August 16, 2011, seeking to explain her daughter's problems: Lisa was very aware of her anti-social tendencies and didn't want to work in a physician's office, choosing clinical trials for the drug company Gilead in Foster City. Then last Thanksgiving, she moved to Seattle to work for Seattle Genetics. Lisa has a type of autism that makes it difficult for her to carry on conversations, an anti-social problem that she has and has been totally aware of for years. When she was small, she would walk to school alone, although others would want to walk with her. We moved a lot, and she would usually have only one friend. CHAPTER SIXTEEN
Doctor Euthanasia Through Morphine Overdose
It is well known in the medical community that morphine and morphine-containing drugs decreases a person's breathing capabilities and results in death. One internet article warning against the consequences of giving morphine related drugs to patients with COPD breathing problems contained the following warnings: One of morphine's main adverse effects is slowing down the respiratory rate, i.e., respiratory depression. If the dosage of morphine is too high for what the patient is accustomed to, the respiratory depression can become severe and actually stop the breathing periodically for a few seconds or many seconds.
This pattern of breathing where the patient stops breathing (skipping breaths) and then starts breathing again is termed “apnea.” Apnea commonly occurs as a result of the terminal illness and the dying process, when certain metabolic changes occur in the patient's body. If the breathing is stopped completely without restarting, the patient dies. (http://www.hospicepatients.org/no-prn-morphine-copd.html.) “Morphine suppresses the patient's drive to breath and creates the appearance of inadequate breathing. It also sedates the patient and creates noisy breathing as the tongue relaxes back in the throat. To use morphine for treatment for shortness of breath is lethal.” http://seniors.kaiserpapers.org/hos.html. For any doctor to give Glenda round-the-clock morphine drugs in Glenda’s modest breathing condition would be criminal, and apply to those doctors and other medical personnel who knew what was being done and remained quiet about it. In Glenda’s case, the morphine related drugs would not have been even a matter of consideration if the pressure ulcer on Glenda’s back had been treated. But to have done that would have delayed the removal of Glenda from Manor Care, and that risked exposing Manor Care’s fraud. Routine Physician-Ordered Euthanasia (Homicide!) in the United States Medical Industry At a later date, I started researching and finding articles on the deliberate killing of patients by physicians in America’s medical industry that is virtually unknown by the normally uninformed American public.
http://www.hospicepatients.org/euth-acct-three.html. “Note: the following is the account given by a daughter showing how her mother was medically killed by a hospice, its medical director and its nurses: involuntary euthanasia.” Morphine contraindicated for patients with COPD: http://www.hospicepatients.org/no-prn-morphine-copd.html.
“Morphine can seriously interfere with a patient's ability to breathe. In fact, anyone who is given a dosage of morphine which is much higher than they are accustomed to, may stop breathing. Hospice Patients Alliance received many, many reports from families about patients with COPD who were given morphine in dosages higher than they were accustomed to receiving, ... who died shortly after getting those morphine dosages. Most of those patients were given these dosages of morphine by nurses in the hospice setting. In all the cases reported, the physician had ordered that the morphine might be given “as needed” or “PRN” within a certain range and at a certain frequency of time intervals between doses given.” Incredible Freedom of Medical Personnel to Commit Euthanasia or Homicide A person, including physicians, can commit homicide by commission of an act, or by omission of any act, or by affirmatively doing a lethal act or by omitting to do an act that is necessary to preserve another's life. For a fatal omission to be considered a crime, the omitter must have had a legal duty to act, and the victim’s death must result from a breach of that duty. But so far, in the United States, very few prosecutors have filed criminal charges. Doctor death panels have therefore flourished. Legal duties may arise in various ways. There is the legal duty of parents to provide medical care for a child. A legal duty arises by contract, such as a medical insurance or in a HMO. In Glenda’s case, all of the doctors played a role in denying Glenda universally recognized medical treatment. It was a violation of a contractual duty for Manor Care admission personnel and physician-in-charge to deny to Glenda the pulmonary rehabilitation treatment that had been ordered and for which they accepted Glenda into that skilled nursing facility. That outright fraud was then followed by other violations, all of which were part of a series of events that led to Glenda’s death. These violations included:
Refusal to provide treatment for the painful pressure ulcer over her spine. Overdosing with morphine and morphine-related drugs that are contraindicated for COPD patients and were used in place of professional treatment for her pressure ulcer. To have treated the pressure ulcer would have delayed them need to remove Glenda after the fraudulent admission, increasing the risk that their prior fraudulent admission for a treatment they did not have would be discovered by federal and state regulators. The deliberate withholding of vital information from Glenda that caused her to accept hospice when she did not have a terminal illness with a short life expectancy and instead should have had treatment for the treatable medical conditions. The withholding of information from me, Glenda’s family and caregiver. The encouragement of Glenda to deny to me the decision to block her transfer to hospice. The refusal by key people at Manor Care to recognize my appeal of her discharge from Manor Care and transfer to hospice.
Breach of Duties by Kindred SNF Personnel Kindred admission and other management personnel breached a duty to Glenda. Duty as a public skilled nursing facility to admit a patient that had an outstanding order to receive pulmonary rehabilitation, for which payment would be made, when there was no other skilled nursing facility in the area with that treatment, and knowing that Glenda would be forced into a premature death at a hospice facility where the expected survival was seven to ten days.
Breach of Duties by Physicians Certifying Glenda Would
Die within Six Months from Esophageal Cancer The two physicians who stated Glenda would die of esophageal cancer within six month breached their legal duty to her, resulting in Glenda’s death: They fabricated a medical condition to support their hospice determination. The cancer was in remission; the cancer was not the subject of her recent medical treatment; her oncologist was not involved in the recent hospitalization for shortness of breath and pressure ulcer. They covered up for the frauds perpetrated upon Glenda by Manor Care management and physicians.
Breach of Duties by Multiple Physicians of the John Muir Physician Group The physicians breached their duty to Glenda; Covered up for the fraud by the management of Manor Care. Engaged in, or covered up, for the denial of pulmonary rehabilitation. Engaged in, or covered up, for the denial of treatment for the painful pressure ulcer. Engaged in, or covered up, for the drugging of Glenda with drugs harmful to patients with pulmonary deficiencies.
Breach of Duties by Hospice of the East Bay And Its Bruns House Hospice Management personnel at Hospice of the East Bay breached their duty to Glenda: Knew about most of the wrongful acts described within these pages. Knew that Glenda had two treatable medical conditions for which she had been in the hospital and skilled nursing facil-
ities, neither of which indicated a terminal illness with a less than six month survival. They overdosed Glenda with morphine that knowingly would cause her death.
Sampling of cases: 1 See People v. Burden, 140 Cal. Rptr. 282, 289-92 (Ct. App. 1977); see also Commonwealth v. Hall, 78 N.E.2d 644, 647 (Mass. 1948); Territory v. Manton, 19 P. 387, 392-93 (Mont. 1888); Biddle v. Commonwealth, 141 S.E.2d 710, 714-15 (Va. 1965) (collecting numerous cases and treatises). See generally WAYNE R. LAFAVE & AUSTIN W. SCOTT, JR., CRIMINAL LAW 202-12 (2d ed. 1986); JOSHUA DRESSLER, UNDERSTANDING CRIMINAL LAW 89 (2d ed. 1995) (providing an overview of liability by omission). Morphine overdose and euthanasia, or homicide, is common in hospice situations. One of many articles on this subject was by the Hospice Patients Alliance. Excerpts from that article follows. Allowing PRN Orders for Morphine May Result in Untimely Death for COPD Patients Morphine is an opioid medication often used to relieve severe pain in cancer and some other diseases. When prescribed by a physician appropriately for relief of pain, it is a blessing to those whose symptoms are relieved, and to the families of those patients who had suffered watching their loved one in agony. Patients in hospice who have diseases without severe pain may not need morphine for comfort. Some take other analgesics and some take none. But patients who have Chronic Obstructive Pulmonary Disease or “COPD” may especially be sensitive to the adverse effects of morphine. COPD patients have breathing difficulties and anxiety which can sometimes be lessened by very small dosages of a sedative and/or a very small dosage of morphine. However, given in too high a dose, morphine can seriously interfere with a patient's ability to breathe. In fact, any-
one who is given a dosage of morphine which is much higher than they are accustomed to, may stop breathing. One of morphine's main adverse effects is slowing down the respiratory rate, i.e., respiratory depression. If the dosage of morphine is too high for what the patient is accustomed to, the respiratory depression can become severe and actually stop the breathing periodically for a few seconds or many seconds. If the breathing is stopped completely without restarting, the patient dies. Because COPD patients have compromised breathing already, ... very inefficient breathing, overly high doses of morphine can quickly cause these patients to stop breathing. Hospice Patients Alliance has received many, many reports from families about patients with COPD who were given morphine in dosages higher than they were accustomed to receiving, ... who died shortly after getting those morphine dosages. Most of these patients were given these dosages of morphine by nurses in the hospice setting. In all the cases reported, the physician had ordered that the morphine might be given “as needed” or “PRN” within a certain range and at a certain frequency of time intervals between doses given. Giving a medication “as needed” requires a careful assessment of the patient's vital signs, pain level and need for the medication being considered. But in the case of COPD patients, the need for extra vigilance in determining the appropriate dosage is very urgent. Pharmacy and drug references, such as the Physicians Desk Reference and morphine package inserts warn about the dangers of giving too high dosages of morphine to COPD patients. The package inserts and the Physicians Desk Reference even write that morphine is “contraindicated” in general for COPD patients. However, when a patient is truly terminal, some of the rules of prescribing medications are adjusted to meet the needs of the patient. In the terminal COPD patient, morphine is sometimes ordered by the physician to be given in very small dosages.
If the physician orders the morphine to be given on a PRN or “as needed” basis, when the patient has COPD, and allows a shorter frequency of administration than that needed for the previous dosage to “wear off” or be metabolized, the concentration of morphine actually in the patient's blood may increase beyond a therapeutic level, causing severe adverse effects, even respiratory shutdown. If you have a loved one with COPD in a hospice care setting and if you are concerned that he may be euthanized before his natural time of passing on, then it is wise to request that the physician NOT write a PRN order for morphine. If you have concerns that your loved one may be medically killed or euthanized in a hospice setting, you should discuss these concerns with the physician and request that PRN orders for morphine not be used. If the physician refuses to do so, you may be able to determine whether the physician is sympathetic to your concerns about euthanasia or not. If you believe the physician is determined to euthanize your loved one, involuntarily, or without your knowledge, then you always have the right to change physicians or to change hospices. Any time that you have concrete evidence that a nurse or physician is acting to euthanize your loved one, the patient, or the patient's representative may act to change the physician and hospice to a setting that will provide true hospice care. Real hospice care is NOT about hastening the death of a patient. It is about providing relief from distressing symptoms, supporting the patient and letting them know that they are valued and loved. Hospice patients necessarily choose not to try to cure the terminal illness, because all efforts to cure the disease are believed to have failed and further efforts are believed to be of no use in curing the disease, i.e., the physician has determined that no efforts would succeed in any case. That does NOT mean that treatment for a urinary or respiratory infection is to be withheld, or that food and water are to be withheld if the patient can absorb them. Withholding food and water is a form of euthanasia for the patient who is not already
actively dying! Withholding appropriate treatment for an infection when the patient is not actively dying is also a form of euthanasia! Giving overly high dosages of morphine to a COPD patient, or a patient with another terminal illness, is a form of euthanasia. By being alert, discussing your concerns with the physician and hospice staff and acting promptly to prevent overly high dosages of morphine from being administered, you can save your loved one from an untimely death. Removing your loved one from a setting that is bent on euthanizing your loved one may be the only way to save them from being medical killed. Surveys and research into the attitudes and practices of physicians and nurses reveals that a significant percentage of nurses and physicians believe that euthanasia is acceptable. If you don't agree, then you must act to protect your loved one. The best protection is to know what medications are being given, what effect the medications have, what dosages are being given (by being there if possible when they are given) and knowing why the medications are being given. PRN orders for morphine may be totally inappropriate for COPD patients who do NOT have severe pain! ----------------Hospice personnel had to know the symptoms of morphine overdose. The fact they did not use the standard morphine antidote, naloxone or Narcan, indicates the morphine overdose was deliberate! CHAPTER SEVENTEEN
Prevalence of Medical Homicide In America’s Medical Industry
Medical homicide can occur from denial of medical treatment and many articles have been written about this subject. In Glenda’s case, there were multiple documented corrupt acts leading to medical homicide.
Rampant Physician Misconduct That Meet Definition of Criminal Conduct The need for, and the laws permitting, criminal prosecutions of HMO denial of care decisions are described in numerous articles found on the Internet. An article about criminal prosecution for denial of medical treatment by HMO medical groups was written by law professor John A. Humbach, J.D. summa cum laude, Ohio State University (1966), at Pace University School of Law, White Plains, New York. His article was about the criminal aspect of denying medical treatment when there is a responsibility to act. Excerpts of his article, Health Matrix, Vol. 11:147, follows: Homicide can be committed by commission or by omission— by affirmatively doing a lethal act or by omitting to do an act that is necessary to preserve another's life. There is, however, an important legal difference between the two. In order for a fatal omission to be considered a crime, the omitter must have had a legal duty to act,2 and the victim’s death must result from a breach of that duty.3 Such legal duties may arise in various ways. 4 For example, a legal duty to provide care is imposed on the parents or legal guardian of a child.5 Such a legal duty may also be created by contract, for example when a person agrees to provide care for another.6 Consider the following case: 1 See People v. Burden, 140 Cal. Rptr. 282, 289-92 (Ct. App. 1977); see also Commonwealth v. Hall, 78 N.E.2d 644, 647 (Mass. 1948); Territory v. Manton, 19 P. 387, 392-93 (Mont. 1888); Biddle v. Commonwealth, 141 S.E.2d 710, 714-15 (Va. 1965) (collecting numerous cases and treatises). See generally WAYNE R. LAFAVE & AUSTIN W. SCOTT, JR., CRIMINAL LAW 202-12 (2d ed. 1986); JOSHUA DRESSLER, UNDERSTANDING CRIMINAL LAW 89 (2d ed. 1995) (providing an overview of liability by omission). 2 See, e.g., Jones v. United States, 308 F.2d 307, 311 (D.C. Cir. 1962) (requiring proof of the legal duty); Albright v. State, 280 So. 2d 186, 190-91 (Ala. Crim. App. 1973) (upholding demurrer to indictment that failed to allege the status relationship giv-
ing rise to the duty); People v. Oliver, 258 Cal. Rptr. 138, 142 (Ct. App. 1989) (noting that there is no legal duty to render aid in absence of a special relationship); see also MODEL PENAL CODE §§ 2.01(1), (3)(b) (Official Draft 1962) (commenting that “a duty to perform the omitted act is otherwise imposed by law”). 3 See DRESSLER, supra note 1, at 86-89; see also Pope v. State, 396 A.2d 1054 (Md. 1979); People v. Beardsley, 113 N.W. 1128, 1129 (Mich. 1907) (stating that “the duty neglected must be a legal duty, and not a mere moral obligation. It must be a duty imposed by law or by contract, and the omission to perform the duty must be the immediate and direct cause of death”). 4 See Jones, 308 F.2d at 310 (describing “at least four situations in which the failure to act may constitute breach of a legal duty,” namely, a statutory duty of care, a status relationship to another, a contractual duty of care, and a voluntary assumption of care while secluding the victim); see also DRESSLER, supra note 1, at 89-91 (describing legal duties arising from statutory duty, status relationship, and contractual obligations). 5 See, e.g., Jones, 308 F.2d at 310-11; People v. Burden, 140 Cal. Rptr. 282 (Ct. App. 1977) (sustaining a murder charge based on a parent’s failure to feed an infant); People v. Abraham, 629 N.E.2d 148, 153-54 (Ill. App. Ct. 1993) (sustaining convictions for murder and aggravated battery based on parent’s failure to take affirmative action to protect children from an abusive live-in boyfriend); Commonwealth v. Twitchell, 617 N.E.2d 609, 613 (Mass. 1993); State v. Norman, 808 P.2d 1159 (Wash. Ct. App. 1991) (upholding manslaughter conviction for parent who failed to perform legal duty to care for his son). 6 See People v. Montecino, 152 P.2d 5, 13 (Cal. Dist. Ct. App. 1944) (finding that the legal duty to care for another may be created by contract or moral duty); People v. Flayhart, 523 N.Y.S.2d 225 (App. Div.) (holding that guardians were guilty of criminal negligence for failing to care for the retarded brother decedent), aff’d, 553 N.E.2d 657 (1988); Commonwealth v.
Pestinikas, 617 A.2d 1339, 1344 (Pa. Super. Ct. 1991) (holding defendant guilty of murder for agreeing to provide for a 92year old and then letting him starve to death, knowing he had no other way to get food); Davis v. Commonwealth, 335 S.E.2d 375, 378 (Va. 1985) (holding that defendant accepted sole responsibility for the total care of her mother and that she had a legal duty to provide the care). If an HMO breaches a legal duty to one of its subscribers by wrongfully denying treatment benefits that would, if timely provided, have preserved the subscriber’s life; the subscriber dies as a result. [Is it not murder?] There has been a deliberate breach of a legal duty to provide essential care. In both cases, the lethal omission was inspired by a motive to secure a financial advantage, even at the expense of human life. In both cases, someone has died due to the breach of duty. 7 See sources cited supra notes 1-6; see also Pinkerton v. State, 784 P.2d 671, 677 (Alaska Ct. App. 1989); People v. Stanciel, 606 N.E.2d 1201, 1211 (Ill. 1992) (noting that parents have an affirmative duty to protect their children from threat of murder and holding that neglect of this duty imposes liability by reason of accountability); State v. Wyatt, 482 S.E.2d 147, 153 (W.Va. 1996) (finding that “knowing failure to take reasonable steps” to prevent deprivation that resulted in a child’s death constitutes murder). There may, of course, also be salient factual differences between the two cases. For example, medical patients who are so ill that they die from lack of treatment are often so close to death that they would soon die anyway, even with all possible care. By contrast, the case of the avaricious uncle seems to presuppose that the young nephew had a long life ahead of him, provided only that he was saved from drowning. This is, however, a difference without a legal distinction.
Criminal liability for causing death is not relieved by the victim’s pre-existing health condition, or the fact that the victim was going to die anyway. 8 “Life at best is but of short duration”9 and, given the inevitability of eventual death, the law is clear that “murder is never more than shortening of life,”10 even if only by a day.11 It is, moreover, always a characteristic of omission-homicide cases that there are other causes of death than the omission alone. What makes fatal omissions into crimes is, precisely, the defendant’s wrongful failure to avert such other causes. The HMO’s duty is contractual and is subject to stipulated exceptions while the uncle’s duty is rooted in a status relationship and is relatively unconditional. However, despite these differences in the origin and scope of the legal duty, once it is shown that the duty has in fact been breached, the cases would seem legally the same. That is, assuming the HMO breached its contractual duty by refusing to authorize timely care, the HMO and its decision making personnel would seem to be in exactly the same legal position as the avaricious uncle—criminally liable for the death. 8 See People v. Morgan, 79 Cal. Rptr. 911, 913-14 (Ct. App. 1969) (holding appellant guilty of murder for causing the victim to die of a heart attack); State v. Malley, 366 P.2d 868, 873 (Mont. 1961) (allowing conviction if the “spark of life is extinguished by a wrongful act”); cf. Barber v. Superior Court, 195 Cal. Rptr. 484, 487 (Ct. App. 1983) (referring to superior court judge’s conclusion that homicide is the shortening of life since everyone sooner or later will die). 9 State v. Smith, 34 N.W. 597, 601-02 (Iowa 1887). 10 People v. Phillips, 414 P.2d 353, 358 (Cal. 1966). 11 See People v. Moan, 4 P.2d 545, 548 (Cal. 1884) (stating that it is homicide even if the victim has “a tenure upon life that cannot possibly continue for a day”) that results.12 Deathby-omission should be the same thing legally no matter who happens to be the omitter.
To my knowledge, no HMO entity or personnel have ever yet been criminally prosecuted for wrongful delay or denial of treatment authorization. It may, however, be only a matter of time before such prosecutions are attempted. Already there is a growing interest in civil actions for the harms that ensue when people, relying on HMOs, suffer or die because benefits are denied.13 There is, moreover, considerable disquiet about the federal limitations on HMO liability that were enacted by Congress in the Employee’s Retirement Income Security Act (ERISA).14 However, the ERISA exemptions do not apply to criminal laws.15 In many cases, criminal prosecutions may therefore be the only effective avenues of redress. In any case, criminal sanctions may actually work better than mere civil damages to motivate HMOs to authorize the medical treatments that their subscribers are contractually entitled to. One of the biggest disadvantages of allowing civil damages against HMOs is that the companies can simply shift the burdens of those “penalties” back to the subscribers, in the form of higher premiums. For the HMO, the amounts paid out as damages in lawsuits become just another cost of doing business. As a result, civil damages for wrongful treatment denials may actually work against the interests of the HMO’s subscribers and patients, increasing premiums and diverting scarce resources away from medical care into judgments and lawyers’ fees. 12 See infra Parts III and IV. 13 For a prediction that “HMOs may replace big tobacco companies as the prime target of the nation's trial lawyers,” see David G. Savage, Cost-Cutting Consequences: An HMO Liability Case is Being Closely Watched by the Lawyers Who Targeted Tobacco Companies, A.B.A. J., Feb. 2000, at 30. See also Chad Bowman, Special Report: Health Care Outlook 2000, 68 U.S.L.W. 2411, 2411-12 (2000) (observing that “the common law is evolving to allow patients to receive compensation for injuries caused by HMOs” and that “liability protection for managed care continues to be the battleground for the coming year”); Richard A. Hinden & Douglas L. Elden, Liability Issues for Managed Care Entities, 14 SETON HALL LEGIS. J. 1
(1990) (discussing potential liability for HMOs and PPOs with regard to provider selection and utilization management); Linda V. Tiano, The Legal Implications of HMO Cost Containment Measures, 14 SETON HALL LEGIS. J. 79 (1990) (describing liability theories that can arise when HMOs deny benefits causing patients’ injury or death). 14 See 29 U.S.C. § 1144(a) (1994) (stating that, with certain exceptions, laws relating to any employee benefit plan are superseded by ERISA). 15 See 29 U.S.C. § 1144(b)(4) (1994) (specifying that ERISA does not supersede “any generally applicable criminal law of a State”). When people subscribe to HMOs, what they are primarily seeking is quality medical care, as needed, not a right to get cash “compensation” after the fact, when life-or-death treatments have been denied.16 Money is a poor recompense for a permanently impaired quality of life or the loss of life itself. It little serves the person denied benefits, or his surviving family and loved ones, to let an HMO get off with merely paying damages, which it can pass on to subscribers, instead of delivering the benefits it has promised in its contract.17 The legal agreements that people make with HMOs are no ordinary commercial contracts. The due performance of these agreements can be vital to life itself. As long as HMOs are able to shift the costs of their breaches, it may never be possible to minimize the number of wrongful HMO denials. The only way to prevent HMOs from shifting the penalties for wrongful denials is to impose a cost on wrongful denials that the HMO cannot shift. This is, of course, the classic function of the criminal law—to impose costs on bad behavior that offenders cannot shift. A civil defendant may shift the cost of a monetary judgment, but a criminal defendant cannot “shift” a prison sentence. Although criminal punishment is a dramatic response to administrative errancy, the fact remains that it is the response prescribed by law for cases where people’s conduct proves deadly
or causes serious bodily harm.18 In the social debate about the role of HMOs, our nation’s commitment to criminal punishment as a tool of social policy must be recognized as part of the background. In any case, the deterrent impact of criminal penalties can scarcely be doubted: A potential for criminal prosecutions would give HMO decision-makers a strong incentive to treat subscribers right, avoiding delays and unwarranted denials of treatment authorization. In addition, with prosecutions a possibility, the public could feel much more secure against wrongful medical care denials in any situation where the patient’s life might be shortened or health seriously compromised. 16 “In choosing a health plan, consumers say that quality of care is their greatest concern . . . .” Report to Congressional Requesters, Consumer Health Care Information: Many Quality Commission Disclosure Recommendations Are Not Current Practice, GAO Rep. No. GAO/HEHS 98-137, at 18 (Apr. 30, 1998) (report of Bernice Steinhardt, Director, Health Serv. Quality & Pub. Health Issues). 17 As stated piquantly by Oliver Wendell Holmes, the idea “stinks in the nostrils” that a person who makes a promise need feel no compulsion to perform, provided the person is willing to pay legal damages. O. W. Holmes, Jr., The Path of the Law, in PHILOSOPHY OF LAW 169, 171 (Joel Feinberg & Hyman Gross eds., 5th ed. 1995). 18 Indeed, 38 states and the federal government currently prescribe the death penalty for lethal conduct under certain aggravating circumstances, such as when multiple victims occur. See State By State Death Penalty Information (visited Nov. 3, 2000) http://www.deathpenaltyinfo.org/firstpage.html. (Death Penalty Information Center.) In sum, while there are many possible approaches to the regulation of HMOs,19 the most straightforward approach may be simply to enforce the rules we already have, the existing rules of criminal law, the rules to which our society turns routinely to address a wide range of harmful activities. First, the criminal
law has the advantage of subjecting wrongful treatment denials to a penalty that cannot be shifted back to subscribers. Second, the criminal law is not superseded by ERISA, so the current federal barriers to civil lawsuits would not stand in the way. Third, as will be described below,20 criminal prosecutions offer advantages with respect to proof. Medical decisions and judgments are necessarily discretionary, and it may be almost impossible for a civil plaintiff to demonstrate in an individual case that economic considerations played a role, much less an improper role, in an HMO’s decision to deny benefits..21 In a criminal prosecution, by contrast, the needed evidence can be obtained by such well-tested prosecutorial techniques as, for example, offering leniency to subordinates in exchange for testimony against their superiors, the individuals directly responsible for forming HMO policies. Finally, as will also be outlined below, the criminal law on lethal and other injurious activities is rather clear. The only real questions seem to be factual. Did the HMO refuse to authorize treatment benefits in a situation where there was a legal duty to approve and provide them promptly? Were the HMO’s decision-makers aware of the risks imposed 19 See John V. Jacobi, Canaries in the Coal Mine: The Chronically Ill in Managed Care, 9 HEALTH MATRIX 79, 106-26 (1999) (summarizing a variety of proposed and enacted regulatory measures). It is doubtful, however, that regulatory measures can have much effect since they are “always a step behind the latest business practice,” while HMO cost containment methods “are simply too complex and subtle to be easily addressed by rigid regulations.” Id. at 120. 20 See infra Part IV.C. 21 “Even in those few cases in which there have been legal claims [against HMOs], lawyers find that obtaining critical information from a plan is akin to getting gold bars out of Fort
Knox.” The Menace of Managed Care: A Guide to How Avoidance, Denial and Control Can Result in Patient Harm, Before the Subcomm. on Health & Env’t of the House Comm. on Commerce, 105th Cong. (Oct. 28, 1997) [hereinafter Menace of Managed Care] (prepared statement of Linda Peeno, M.D.), available in LEXIS ( Fed. News Serv.). Was the patient’s life shortened or health impaired as a result? This article will, in Part II, first provide a brief examination of the economic pressures that market forces bring to bear on HMOs and their decision-making personnel. The objective is to show how the natural effect of normal market forces is to exert a constant pressure towards treatment delays and denials, particularly in the cases of elderly and chronically ill patients. Part III will provide an overview of the existing criminal law as it applies to situations in which death results because someone has violated a legal duty to provide medical treatment. In Part IV, the question of the requisite mental culpability will be discussed. Finally, after concluding that the criminal law provides, in its present state, a rather clear basis for homicide prosecutions of HMO personnel who authorize lethal treatment denials, a short Postscript will consider some further policy implications of HMO homicide prosecutions. II. The Problem of “Net-Negative” Patients In the past couple of decades, HMOs and other managed care firms have taken on a dominant role in the health care field, with for-profit HMOs now accounting for nearly two thirds of the total HMO market.22 Typically, these corporations have acquired the power to make essentially final decisions about who receives medical care, what kinds of care they receive, and when they can receive it.23 22 “Between 1985 and 1998 the proportion of HMO members enrolled in investor-owned plans increased from 26% to 62% . . . .” David U. Himmelstein et al., Quality of Care in InvestorOwned vs Not-for-Profit HMOs, 282 JAMA 159, 159 (1999). Half or more of privately insured Americans are enrolled in
HMOs. See John E. Ware, Jr. et al., Differences in 4-Year Health Outcomes for Elderly and Poor, Chronically Ill Patients Treated in HMO and Fee-for-Service Systems, 276 JAMA 1039, 1039 (1996); see also William H. Nelson, Customers Demand Managed Care, HEALTHCARE FIN. MGMT., Aug. 1995, at 38 (stating that “about 66 percent of insured Americans are enrolled in HMOs and other forms of managed care plans”). “The defining feature of an HMO is receipt of a fixed fee for each patient enrolled under the terms of a contract to provide specified health care if needed.” Pegram v. Herdrich, 530 U.S. 211, 120 S. Ct. 2143, 2149 (2000), discussed infra text accompanying notes 24-29. 23 See, e.g., Dozsa v. Crum & Forster Ins. Co., 716 F. Supp. 131, 134 (D. N.J. 1989) (noting that the Plan Administrator “retains ultimate authority to grant or withhold benefits”); Menace of Managed Care, supra note 21; Linda Peeno, Managed Care Ethics: The Close View (last modified May 30, 1996) A child is seriously ill. She will not live much longer if steps are not promptly taken. However, her parents’ HMO has denied approval for the treatment that she needs. According to her doctor, the treatment has a good chance of helping. It could extend her life by months or even years. The treatment is, however, expensive, more than her parents can pay. Also, the initial cost is just the beginning. As long as the child lives she will need expensive care. It is a burden that the HMO does not want to take. So, a few days from now—maybe less— she will lapse into unconsciousness and, soon after, she will pass away. Her parents ponder this and think: “We’ve paid premiums to that HMO for years. If she dies now, because of this denial, somebody ought to pay; the law should make somebody pay for letting our daughter die.” A Boston Globe article at www.boston.com (April 13, 2011) under the heading, “Woman who withheld son’s cancer drugs found guilty,” stated:
LaBrie’s attorney, Kevin James, said yesterday that the jury apparently did not understand the burden his client experienced in caring for an autistic son who developed cancer. He had also argued that social workers and doctors at Massachusetts General Hospital, where Jeremy was treated, should have done more to make sure she was fit to care for her child and administer the medications. “What we wanted to get across to the jury is the tremendous burden my client had to carry, as well as the fact that the support that should have been in place for her was not in place,’’ James said in an interview. James said he asked for the sentencing to be postponed at least until Friday in part so that he could gather evidence of support his client has received from many people who never met her, but who understand the difficulties of raising a developmentally disabled child with cancer. O'Keefe, LaBrie’s sister, said she understood jurors were required to follow the legal directives given to them, but that her sister never sought to hurt Jeremy. “It’s too hard for them to know what my sister was going through at that time,’’ O’Keefe said, holding back tears. “I don’t think my sister had any intentions of hurting Jeremy, ever. I never will believe that in my life, never.’’ Legal analysts said yesterday that the case was the most unusual since prosecutors brought manslaughter charges two decades ago against a couple who refused to authorize surgery for their toddler, who was suffering from a treatable bowel condition. The couple, David and Ginger Twitchell, then of Hyde Park, were Christian Scientists and believed the boy could be healed by spiritual treatment. He died within several days after his diagnosis in 1986. The state Supreme Judicial Court, in reviewing that case, determined in a landmark decision that parents have a legal duty to provide medical care for gravely ill children, regardless of religious faith.
Boston attorney J.W. Carney Jr., of Carney & Bassil, said LaBrie’s case was troubling in that she was portrayed as a mother who was overwhelmed. He said the case should have also focused on the failure of LaBrie’s doctors to intervene quicker, once it became obvious that she was not administering medications. “It can be so overwhelming for a single parent to deal with a child who is autistic, nonverbal, and developmentally delayed,’’ he said. “It is cruel to add to that burden a diagnosis of cancer and a requirement that the mom administer medicine that will cause the child even more pain.” The attempted murder conviction carries a maximum penalty of 20 years in prison. Under state sentencing guidelines, LaBrie — who does not have a criminal record — could face up to 7 ½ years in prison, according to legal analysts. That determination will be made by Judge Richard Welch, who could consider outside factors. “A judge is authorized to go downward, with mitigating factors, or depart upward if there are aggravated factors,’’ Carney said. Boston-based defense attorney Randy Gioia added, “I think there are mitigating factors and aggravating factors in this case. One of the aggravating factors is you have a vulnerable victim with a disability in this case. That is one of the factors the judge is going to take under consideration.’’ Valencia can be reached at firstname.lastname@example.org; Ballou at email@example.com. Article at the following address: CHAPTER EIGHTEEN
Last in My Attempts To Fight Corruption
Starting in the mid-1960s, I was a key federal airline safety inspector, investigating and exposing criminal misconduct that enabled a long series of brutal airline disasters to occur. Later, my investiga-
tions expanded to other areas of corruption by key people in covert government operations. I foolishly chased “windmills.” With the endemic cover-ups existing in the United States, and the public’s blissful indifference, such efforts are self-destructing. The pockets of corruption and incompetence that I initially discovered as a federal airline safety inspector enabled to occur many deadly airline disasters over a period of many years. While I now grieve over one death, that of Glenda, the number of people brutally dying in those tragedies number into huge figures. At first, I was emotionally affected by the deaths that would not have happened were it not for the corrupt acts of specific people. I wrote about these deaths in the later edition of the not-for-profit book, History of Aviation Disasters: 1950 to 9/11. (The first edition had the title, Unfriendly Skies.) In subsequent years, with the help of large numbers of other former government agents and insiders, I started writing other books. These books consisted of information on corruption that they discovered in covert areas of government that caused or enabled to occur even worse national tragedies. For various reasons, no one responded to this insider documented information. In turn, I became targeted to silence me, and suffered years of attacks that caused me great personal and financial harm. Eventually, after many years, I was able to overcome the concern for these needless sufferings and deaths. If people in control of key government and non-government affairs in the United States—and the public—showed no interest in the continuing series of deaths caused or enabled by corruption, I lost any hope of changing this sordid drama. It no longer overwhelms me. In Glenda’s case, I’m renewing the hopeless fight for her. I’m fighting the pockets of corruption in the healthcare industry and will continue until my end comes. Since I joined the U.S. Navy a year prior to the Japanese attack upon Pearl Harbor, I’m obviously up there in age. Despite facing the same obstacles, cover-ups by mainstream media, cover-ups by lazy or complicit regulators, and indifference by
the public, I am determined to at least make the corruption responsible for Glenda’s suffering and premature death known. I have a web site devoted to Glenda that will be periodically updated: www.defraudingamerica.com/glenda.html. My Personal Contact with Pockets of Medical Corruption The horrors that Glenda experienced during her four-year battle with cancer and COPD, were experienced personally to some extent. In May of 2011, I was diagnosed with Stage III kidney cancer, a cancer for which cancer treatment drugs have even more severe side effects than the drugs used for esophagus cancer. The details of what I encountered as a member of Kaiser Permanente health plan shows problems in an HMO type plan. www.defraudingamerica.com/kaiserpermanente.html. There is a reason for the reported 30,000-plus medical-error deaths a year in hospitals. Medically-related deaths outside of hospitals are not defined, but the thug-like physician misconduct that made Glenda's last days on earth so brutal should be an eye-opener even for the most naive among the masses! I was determined to try to get an investigation into the criminal aspects of what was done to Glenda. Also, to at least make this information available to the public, even if they remained blissfully unconcerned that it doesn’t affect them personally. For them, I say, “Dream on”! I have notified medical review and government oversight personnel of the corruption, realizing that their prior cover-ups made them enablers of what was done to Glenda. Continued cover-up of the guilty could be expected. I had 40 years of experience in that area. I notified Glenda's oncologist, Dr. Michael P. Sherman, of Glenda's death. February 3, 2012. No response. A subsequent letter requesting important information also went without a response. The only one of Glenda's physicians that responded after Glenda's death was Glenda's primary care physician, Vona Lorenzana. But I
would soon learn that it was Glenda’s primary care physician that put the final nail in Glenda’s coffin. Addressing Dr. Lorenzana’s Sham Certification of Terminal Illness “Death Decree” I sent a March 22, 2012, fax to Dr. Lorenzana stating the sham nature of her Certification of Terminal Illness, stating facts and offering her the chance to correct my charges. That letter stated: I am putting this letter on the internet with my interpretation of your conduct, and will change my report if you provide facts that indicate otherwise. The following is my interpretation of the evidence, which I am presenting to different government entities: 1. You were the primary physician needed to issue and sign the certification of terminal illness (CTI) on January 31, 2012, that Glenda had less than six months to live and would die of esophageal cancer and that you would act as attending physician while Glenda was at Bruns House hospice. 2. You implied by your Certification of terminal illness that: The medical condition for which Glenda was in Manor Care (shortness of breath) was untreatable and that she would die of that medical condition within six months. That the pulmonary rehabilitation treatment ordered by John Muir hospital to improve her pulmonary shortness of breath had been given to Glenda. The pulmonary rehabilitation treatment was not effective, and that Glenda’s condition had worsened to where her death from the shortness of breath condition would occur any time within six months. That there were no irregularities or fraud in the medical care for Glenda while at Manor Care that contributed to the expected death within six months. That the drugs given to Glenda at Manor Care did not worsen her breathing problem.
That the intense pain from the ulcer/wound/bed sore was not treatable. That Glenda was made fully aware of the above irregularities, and knew that she had been fraudulently denied the pulmonary rehabilitation treatment; fraudulently held to have a pulmonary condition that could not be improved upon; and that the only decision for her was to accept palliative treatment and die. It would be a criminal offense to sign a certification of terminal illness if any of the above conditions existed; if the medical conditions were in fact treatable and did not indicate a fatal ending within six months. The esophageal cancer that your Certification of Terminal Illness stated as Glenda’s expected cause of death appears nowhere on any of the medical records pertaining to Glenda’s recent hospitalization.
3. That the statutory, regulatory, and case law requirements for hospice had been met for you to legally sign the Certification of Terminal Illness. 4. You certified that you read the medical reports relating to her medical problems for which she first sought treatment on January 5, 2012, at John Muir hospital, where physicians ordered Glenda to be treated at a pulmonary rehabilitation unit. 5. Glenda was sent to Manor Care Rossmoor Parkway on January 14, 2012, for that treatment. You knew that Manor Care did not have a pulmonary rehabilitation unit and that treatment was never provided to Glenda. 6. That Manor Care fraudulently accepted Glenda for that treatment when Manor Care’s key source of patients, John Muir hospital, notified Manor Care that Glenda was to be transferred to their facility for treatment (that they did not have). 7. I notified you by faxes of serious medical problems including medical misconduct that was causing Glenda to needlessly suf-
fer pain, and deprive Glenda of the medical treatment and pulmonary rehabilitation, that was ordered by John Muir hospital physicians. 8. I stated to you in several faxes serious misconduct that was adversely affecting Glenda’s medical condition, including those dated January 11, 2012; January 16, 2012; January 20, 2012; and January 26, 2012. 9. You did nothing about the medical misconduct being inflicted upon a patient that you had oversight responsibilities as her primary care physician. Worse, you became complicit through covering for these medical crimes that could be expected to have fatal consequences.
10. You then insured Glenda’s premature death by covering up for these medical crimes by falsely signing the Certification of Terminal illness, omitting information about denial of ordered medical treatment and the medical misconduct occurring while Glenda was at Manor Care. 11. When I notified you that Manor Care was discharging Glenda on the sham argument that her pulmonary condition did not show any improvement, you falsely stated that this was an insurance problem. You knew, or should have known, that it was not an insurance matter, that Medicare and Healthnet PPO would pay for the pulmonary rehabilitation treatment that Manor Care was withholding from Glenda, that Manor Care had fraudulently accepted Glenda agreeing to provide such treatment, when Manor Care had no such facilities and that the fraudulent acceptance was probably to continue an uninterrupted flow of patients from John Muir hospital. 12. Under your primary care physician responsibilities, you knew when you heard that Glenda was being transferred from John Muir hospital to Manor Care for pulmonary rehabilitation that Manor Care did not have such medical facilities and arranged for prompt transfer to a skilled nursing facility that did have: the Kindred SNF located about 300 feet from your office. 13. That as a result of your actions, Glenda was dead within a mat-
ter of hours. Glenda arrived at Bruns House hospice, smiling, doing her crossword puzzles, reading the newspaper, and on the telephone. But within hours, she was dead! 14. It appears that your clubbiness with the physicians involved in the medical misconduct against Glenda gravely affected your responsibilities to her. 15. You were aware of all of the above, and the following facts, from what I brought to your attention and partly from your examination of the records. History of Glenda’s Medical Problem And the Medical Frauds Known to You: 16. On January 5, 2012, I brought Glenda Guilinger to John Muir hospital in Walnut Creek because of shortness of breath. John Muir hospital physicians reported that Glenda had fluid on her lungs and a possible fungus infection—which she previously had a year or two earlier. 17. John Muir hospital physicians determined that Glenda’s shortness of breath could be improved with pulmonary rehabilitation treatment. They ordered that this treatment be given to Glenda at a skilled nursing facility (SNF). 18. John Muir hospital personnel selected Manor Care Rossmoor Parkway to provide the pulmonary rehabilitation treatment. She was transported there on January 14, 2012. 19. Prior to that transfer, Laura Stengel, Admissions Director at Manor Care, during two separate discussions with three different people, stated that Manor Care did not have a pulmonary rehabilitation program or pulmonary specialist, and would not accept Glenda as a patient. 20. When John Muir hospital personnel, a major source of Manor Care’s business, notified Manor Care that they were sending Glenda to their facility for pulmonary rehabilitation treatment—Manor Care management remained silent about not being able to provide that treatment for Glenda.
21. Manor Care’s nearby competitor in the skilled nursing facility business did have a pulmonary rehabilitation unit. Their facilities were about 300 feet from your office building. Kindred’s admission personnel had earlier stated to me and my daughter that Kindred did have a pulmonary rehabilitation unit. They showed us the room Glenda would be in and confirmed that they would accept her. However, this transfer was cancelled after Kindred admission personnel called the case manager at John Muir hospital to arrange for transfer and was told that Glenda was already being transferred to Manor Care. 22. By accepting Glenda for pulmonary rehabilitation treatment, when Manor Care had no such program or pulmonary specialist, Manor Care risked being cited by Medicare and California regulators, possibly for fraud. 23. That risk of being exposed was quickly addressed by Manor Care personnel, including you in your position as chief physician. Within 24 hours of receiving Glenda, Manor Care personnel notified Glenda that she would have to leave and that she was not capable of having her breathing problems improved upon. 24. Dr. Smita Chandra, one of your associates at 1220 Rossmoor Parkway, was the first to state to Glenda, on January 15, 2012, the day after arriving at Manor Care, that Glenda was not capable of having her shortness of breath improved and that she would be shortly removed from Manor Care. That was of course a deliberate lie to get Manor Care out of the predicament that Manor Care got themselves into by fraudulently accepting Glenda when John Muir hospital notified Manor Care that they were having Glenda transported to Manor Care for pulmonary rehabilitation treatment. 25. My January 16, 2012, letter to Manor Care addressing Indiatrained Dr. Chandra’s misconduct to an ailing patient that included: Withholding from a senior patient the fraudulent accepting of a patient transfer from John Muir hospital under an order for pulmonary rehabilitation treatment
when Manor Care had no such program. Attempting to cover up for that first fraudulent act by immediately stating to an ill patient that she would be evicted from Manor Care and that she was not capable of having her breathing problems improved upon. That was a lie: Glenda didn’t yet have the ordered pulmonary rehabilitation treatment and there was no way that you could contradict the physicians at John Muir hospital that stated she could have her breathing improved; and for argument, even if there had been such a program—which there wasn’t, 24 hours since arriving at Manor Care could not have enabled anyone from making such judgment. Obviously, your cruel statement to Glenda, who was leading an active life and who wanted to live, created great stress and anxiety upon the woman.
26. The harmful round-the-clock dosing of Glenda with drugs, some of which had published warnings not to be used on patients with pulmonary breathing problems, and others worsened her breathing problems and created other medical problems. Sampling of these drugs included: Morphine sulfate; Duramorph; Norco; Oxycodone HCL round the clock, accumulating in the body, all of which depresses lung function, with each dose being cumulative. (Published strong warnings state these drugs are contraindicated in patients with breathing difficulty.) Haloperidol Lactate (Published side effect includes shortness of breath and swelling of the mouth, resulting in difficulty swallowing—which Glenda experienced.) Protonix/Pantoprazole (Published side effects included difficulty breathing, bone pain, swelling, allergic reaction causing swelling of the airways—which Glenda experienced.) Diltiazem (Published side effects include difficulty in
breathing, swelling of the mouth, and hoarseness— which Glenda experienced.) Metoprolol Succinate (Published warning side effects include breathing problems, shortness of breath, swelling of the mouth, hoarseness, mental depression, and musculoskeletal pain—which Glenda experienced.) Digoxin (Published warning side effects include difficulty breathing, swelling of the mouth, depression, change and irregular heartbeat—which Glenda experienced.) Bisacodyl (Published warning side effects include difficulty breathing and swelling of the mouth—which Glenda experienced.) Ativan/Lorazepam. (Published warning side effects include strong warnings not to give to patients with COPD breathing problems, especially to seniors; depression, dryness of the mouth; swelling of the throat; delusions—which Glenda experienced.) Prednisone. (Published warning side effects include breathing difficulties, shortness of breath, depression, water retention, irregular heartbeat, increased blood pressure, hinders wound healing, pain in back—which Glenda experienced.)
27. Various events interfered with Manor Care’s efforts to evict Glenda. On January 21, 2012, Glenda’s oxygen level plummeted. This could be due to the failure to provide the John Muir hospital ordered pulmonary rehabilitation treatment, and compounded by the misuse of round-the-clock drugs that worsened the breathing difficulties. Glenda was rushed to the nearest hospital, Kaiser Permanente. Similar to John Muir hospital reports, no terminal illness was stated. As her oxygen level improved, she was discharged to Manor Care on January 23, 2012. This improvement may have been due to removal from the breathing-impairment drugs given to Glenda at Manor
Care. 28. On January 24, 2012, Glenda was transported to John Muir hospital for the thoracentesis procedure to remove the fluid on her lungs that was first discovered nearly three weeks earlier when she was admitted to the hospital for shortness of breath. Manor Care records reported that Glenda showed improvement in her breathing after that procedure was done. 29. That delayed thoracentesis procedure was done by Glenda’s pulmonary doctor, Iranian Dr. Ramin Khashayar, after I reported to the medical board of California that he had abandoned his patient at a life-critical period. 30. While at Manor Care, Glenda experienced increasing pain from a wound/bed sore/ulcer on her back. Instead of obtaining medical care from a wound specialist, you and other Manor Care physicians ordered round-the-clock morphine and morphinecontaining drugs to be given to Glenda. Those drugs were known to worsen a person’s breathing capabilities, especially among seniors. 31. Highlights of the life-affecting abuse of Glenda, and the role you played by ignoring your responsibilities to intervene—and then to order the sham Certification of Terminal illness— include the following: Fraudulent admission of Glenda into Manor Care for an ordered medical treatment that Manor Care knew it did not have. Fraudulent attempts to evict Glenda from Manor Care by Manor Care physicians, within 24 hours of her arrival, using the sham argument that Glenda did not display an ability to improve her pulmonary function. That attempt was vocalized by Dr. Smita Chandra, who acted under your supervision. Refusal to transfer Glenda to a SNF that had the pulmonary rehabilitation treatment, including Manor Care’s nearby competitor, Kindred SNF.
Refusal to obtain a wound specialist to treat Glenda’s worsening wound/ulcer/bed sore on her back, and then dosing her with round-the-clock morphine and morphine related drugs that worsened her breathing problems. Compounding the harm to Glenda’s breathing problem with round-the-clock dosing with drugs, some that were not to be used on COPD patients, or elderly patients, and some that caused anxiety, worsening Glenda’s anxiety arising from all the other wrongs inflicted upon her by physicians.
32. Further cause for Glenda’s anxiety was the misconduct by pulmonary specialist, Dr. Ramin Khashayar. He repeatedly refused my requests to examine Glenda, and during one phone call accused me of blackmailing him for complaining to the Medical Board of California. He refused to treat Glenda unless I signed a statement that the facts in my complaint were false. Dr. Khashayar compounded that by having a letter delivered to Glenda complaining about my conduct [seeking to have him attend his seriously ill patient], and forced Glenda to sign that she received the letter complaining of these matters. That misconduct occurred while Glenda was lying at Manor Care, in pain, and waiting to be evicted, compounding her anxiety. 33. Possibly to insure that these medical frauds by multiple physicians went unaddressed, Manor Care management and physicians refused to respond to my faxes asking for information about Glenda’s treatment, despite the fact that I had been arranging and overseeing her medical care for the prior four years; I had power of attorney over her medical care and authorized to be kept informed; and I was her partner for the past 18 years. 34. Shortly before Glenda’s removal from Manor Care, as I sought to transfer Glenda to nearby Kindred SNF, where the pulmonary rehabilitation facility did exist, Manor Care personnel falsely stated that Glenda was not capable of showing pulmonary improvement. Based upon this false information, Kindred
refused to accept Glenda. This rejection, added to the medical abuses already inflicted upon Glenda, causing her to just give up and want to die. 35. The complicity of two physicians was needed to remove Glenda from Manor Care. This was done on January 31, 2012. These two physicians included yourself, and the routine off—theshelf statement by Dr. Jan Spencer, a physician consultant at Hospice of the East Bay, who cavalierly stated nothing to support her short off-the-shelf one sentence death decree. 36. You knowingly signed a certification of terminal illness falsely stating that Glenda had less than six months to live, and that her death would come from esophageal cancer. Several falsehoods arose with those two certifications : There were no reports in any of the medical facilities that cared for Glenda between January 5, 2012, and January 31, 2012, addressing Glenda’s underlying cancer. The reports throughout that period focused on Glenda’s shortness of breath. John Muir hospital physicians held that Glenda’s breathing problems could be helped by pulmonary rehabilitation treatment (which Manor Care physicians denied to Glenda). The certification of terminal illness had to cover up for the prior misconduct inflicted upon Glenda, including what has already been stated. Glenda was diagnosed four years earlier with Stage IV esophagus cancer. Treatment had put that cancer in remission; her oncologists had scheduled Taxol cancer treatment for Glenda prior to her shortness of breath problem and had planned to start that as soon as Glenda returned home; and there was no involvement of her oncologist in Glenda’s medical treatment or any contacts throughout the period from January 5, 2012, to January 31, 2012. Neither you nor your rubber stamp accomplice signing
the certification of terminal illness, with death from esophageal cancer, were cancer specialists. 37. Your certification contradicted everything written by physicians at John Muir Hospital and Kaiser Permanente hospital during the prior several weeks of treatment. 38. The facts indicate that you and your “rubber-stamp accomplice” fabricated the certification of terminal illness, which assisted in covering up for the major medical misconduct occurring while Glenda was at Manor Care. 39. You allowed, or encouraged, Glenda to abandon the pulmonary rehabilitation treatment that unknown to her, she never received, and instead go to Bruns House hospice, a unit of Hospice of the East Bay. 40. You knew that the John Muir order for Glenda to receive pulmonary rehabilitation still existed, that she had never received that treatment, and the nearby Kindred SNF had that treatment. Instead of arranging for Glenda to receive that fraudulently denied treatment, by deception, cover-up, and omission, you sentenced Glenda to a premature death by your sham Certification of Terminal Illness. 41. You made no effort to inform Glenda of these matters when in desperation she decided to give up the available medical treatment that was unknown to hers. Instead, you covered up for the medical crimes and became complicit. 42. You played major roles in denying to Glenda the pulmonary rehabilitation that could have extended her life, and resulted in her premature death. 43. Glenda’s son, Make Guilinger, upon hearing of Glenda’s death, either committed suicide or her death caused his death. 44. If your conduct did play a role in Glenda’s death, it would arguably also have played a role in the death of her son, Bruce. 45. The evidence indicates that Glenda didn’t die of any illness.
She was put to death! The records and personal observation strongly indicates Glenda would be alive today but for the joint misconduct of multiple physicians and your final certification to rid yourselves of the woman defrauded out of her life! 46. If a group of physicians had set out to bring about Glenda’s death, starting with Glenda’s arrival at Manor Care on January 14, 2012, the physician misconduct inflicted upon Glenda could be expected to result in success: Glenda’s death within about two weeks. Rodney Stich cc: Medical Board of California Complicit Enablers at Medical Board of California The copy sent to the Medical Board of California was a waste of time, but I wanted the record to show their continued cover-up of these corrupt acts by physicians over whom they had oversight responsibility. It was their culture of cover-up that made the corrupt culture possible―and the resulting deaths. Fax to Second CTI Physician, Dr. Jan Spencer I also sent a March 22, 2012, fax to Dr. Jan Spencer to Hospice of the East Bay, the second physician signing what amounted to a death decree for Glenda. As a consulting physician for Hospice of the East Bay, of which Bruns House hospice facility was a unit, she knew that admission was limited to people with an estimated remaining life of ten days. No one looking at Glenda, or her medical records, could arrive at that estimate. It appears that’s Dr. Spencer was protecting the rear ends of the other physicians that had used Glenda in a bizarre medical game. The following was my letter to her: To Dr. Spencer: I am providing details to government entities and putting the details on the Internet about your role in events leading to the highly suspicious death of Glenda Guilinger associated with your signing of a Certification of Terminal Illness. If you disagree with my in-
terpretation of the facts, let me know in writing and I will consider changing it. You have a responsibility to provide information on events that deprived Glenda of medical treatment for the medical problem that brought her to the hospital and then Manor Care, and eventual death within hours of arriving at Bruns House, a unit of Hospice of the East Bay, where you are a medical consultant. The responsibility to provide me with information arises in part from my position as trustee over the estate of Glenda Guilinger; the power of attorney for me to make medical decisions while Glenda was alive; her caregiver during the last four years of her life and illness; and partner for 18 years. Two deaths were made possible by your final act of preparing a Certification of Terminal Illness. Based upon the facts, I view that certification as a sham—a sham that resulted in two immediate deaths! Your certification of terminal illness (CTI) stated that Glenda had less than six months to live and would die of esophageal cancer. That diagnosis was without support. None of the physicians at John Muir or Kaiser Permanent hospitals, who had treated Glenda for the sole reason she was there—shortness of breath—made any mention of esophageal cancer or provided any treatment for it. That applied also to Manor Care SNF where Glenda was sent for treatment to improve her shortness of breath through pulmonary rehabilitation treatment—that she never received! On February 2, 2012, you apparently signed a certification of terminal illness for Glenda Guilinger, stating that she had less than six months to live, and that her death would be caused by esophageal cancer. The copy provided to me by your employer, Hospice of the East Bay, lacked a signature. That Certification of Terminal Illness document was dated February 2, 2012, the day after Glenda Guilinger’s highly suspicious and unnatural death in Bruns House hospice. Your extremely brief Certification of Terminal Illness stated: This is to certify that the above named patient has a
prognosis of six (6) months or less, if the illness runs its normal course. Effective 1/31/12, I recommend this patient be admitted to hospice services. Terminal Diagnosis* metastatic esophageal cancer. (*single diagnosis most likely limiting the life expectancy). 78 yo woman with metastatic esophageal cancer and history of DMII and CAD who died on 2/1/12. Attestation: I confirm that this narrative is based on my review of the patient’s medical record and/or examination of the patient. Jan Spencer, MD Hospice Physician 2/2/12. Legal requirements arising from statutory, regulatory, and case law requires that a physician preparing a Certification of Terminal Illness (CTI) prepare a detailed narrative supporting that certification. Your CTI did not have any narrative; only unsupported statements. Your CTI didn’t have any medical reports attached (assuming your Hospice of the East Bay employer provided me all the reports pertaining to Glenda that were in their possession and upon which you made your impending-death certification).
Your CTI report stated that it was “based on my review of the patient’s medical record and/or examination of the patient.” What was it? A review of the records? Or an examination of the patient? Your wording avoids stating what you based your early deathwithin-six-month decision upon! It was similar to using an off-theshelf form for some multiple minor office matters. You implied by your Certification of terminal illness that” The medical condition for which Glenda was in Manor Care skilled nursing facility (shortness of breath) was untreatable and that she would die of that medical condition within six months. That the pulmonary rehabilitation treatment ordered by John Muir hospital to improve that pulmonary shortness of breath had been given to Glenda. The pulmonary rehabilitation treatment was not effective, and
that Glenda’s condition had worsened to where her death from the shortness of breath condition would occur any time within six months. That there were no irregularities or fraud in the medical care for Glenda while at Manor Care that contributed to the expected death within six months. That the drugs given to Glenda at Manor Care did not worsen her breathing problem. That the intense pain from the ulcer/wound/bed sore was not treatable. That Glenda was made fully aware of the above irregularities, knew that she had been fraudulently denied the pulmonary rehabilitation treatment; fraudulently held to have a pulmonary condition that could not be improved upon; and the only decision for her was to accept palliative treatment and die. That the statutory, regulatory, and case law requirements for hospice had been met for you to legally sign the Certification of Terminal Illness.
All of the above were false. It would be a criminal offense to sign a certification of terminal illness if any of the above conditions existed; if the medical conditions were in fact treatable and did not indicate a fatal ending within six months. The esophageal cancer that your Certification of Terminal Illness stated as Glenda’s expected cause of death appears nowhere on any of the medical records that you could have viewed. You stated that esophageal cancer was “most likely limiting life expectancy.” That statement was false and you surely knew it: Glenda had lived for four years since her original diagnosis of Stage IV esophagus cancer, which was in apparent remission, and scheduled for additional curative or remission cancer therapy with the cancer-fighting drug, Taxol. Millions of people have cancer and continue living for years.
Not one of the medical facilities that had examined or cared for Glenda since her January 5, 2012, initial visit for shortness of breath made any reference to esophageal cancer as her current medical problem. Each of the physicians’ treatment was for pulmonary problems. Pulmonary problem was the reason for Glenda’s presence at Manor Care. Pulmonary rehabilitation treatment was ordered to improve upon Glenda’s breathing. The pulmonary rehabilitation ordered for Glenda was never given by Manor Care as they did not have such pulmonary treatment. Your reference to CAD and DMII had no relationship to Glenda’s hospitalization or terminal illness. Your report said nothing about Glenda’s primary problem: the shortness of breath and pain from the bed sore/wound/ulcer on her back.
Assuming your CTI was based on a physical examination, the most probable physical signs that you would have noticed would be: Shortness of breath. Pain from the bed sore/wound/ulcer on her back. You would not have seen any evidence of coronary artery disease (which most adults have). You would not have seen any evidence of diabetes (which had never been stated to Glenda and for which no medication had ever been prescribed). Neither of the CAD or diabetes mellitus II would be terminal and never made known to Glenda or her caregiver.
Esophageal cancer would not have been recognized (A condition she had been living with and was under control since Stage IV esophagus cancer was first diagnosed four years earlier).
If your CTI was based on an examination of the records available at Manor Care, they would have been the records from the January 5, 2012, hospitalization at John Muir hospital; the Kaiser Permanente hospital from January 21, 2012 to January 23, 2012, and Manor Care skilled nursing facility. These records would reveal that: Glenda’s initial hospitalization showed a treatable shortness of breath, and the order for pulmonary rehabilitation therapy. Glenda never received that pulmonary rehabilitation therapy. Manor Care had no such facility. There was no reference to any terminal medical condition. Quite the opposite, as shown by one John Muir hospital report that stated: “The patient was admitted to the hospital with shortness of breath. … The patient is to be discharged to a skilled nursing facility. … Clinically, she is doing relatively well. Asymptomatic on 2 L of oxygen. She looks comfortable without any shortness of breath or tachypnea.” History of Medical Misconduct Revealed By The Records You Would Have Examined On January 5, 2012, I brought Glenda Guilinger to John Muir hospital in Walnut Creek because of shortness of breath. John Muir hospital physicians reported that Glenda had fluid on her lungs and a possible fungus infection—which she previously had a year or two earlier. John Muir hospital physicians determined that Glenda’s shortness of breath could be improved with pulmonary rehabilitation treatment. They ordered that this treatment be given to Glenda at a skilled nursing facility (SNF). That sole and important treatment was never provided to Glenda! John Muir hospital personnel selected Manor Care Rossmoor
Parkway to provide the pulmonary rehabilitation treatment. She was transported there on January 14, 2012. Prior to that transfer, Laura Stengel, Admissions Director at Manor Care, during two separate discussions with three different people, stated that Manor Care did not have a pulmonary rehabilitation program or pulmonary specialist, and would not accept Glenda as a patient. When John Muir hospital personnel, a major source of Manor Care’s business, notified Manor Care that they were sending Glenda to their facility for pulmonary rehabilitation treatment—Manor Care management remained silent about not being able to provide that treatment for Glenda. Manor Care’s nearby competitor in the skilled nursing facility business did have a pulmonary rehabilitation unit. Their facilities were about 300 feet from your office building. Kindred’s admission personnel had earlier stated to me and my daughter that Kindred did have a pulmonary rehabilitation unit. They showed us the room Glenda would be in and confirmed that they would accept her. However, this transfer was cancelled after Kindred admission personnel called the case manager at John Muir hospital to arrange for transfer and was told that Glenda was already being transferred to Manor Care. By accepting Glenda for pulmonary rehabilitation treatment, when Manor Care had no such program or pulmonary specialist, Manor Care risked being cited by Medicare and California regulators, possibly for fraud. That risk of being exposed was quickly addressed by Manor Care personnel. Within 24 hours of receiving Glenda, Manor Care personnel notified Glenda that she would have to leave and that she was not capable of having her breathing problems improved upon. That was, of course, a lie and a hoax perpetrated upon an ailing senior by physicians expected to be honest about such life-affecting matters. Dr. Smita Chandra, one of your associates at Hospice of the
East Bay, was the first to state to Glenda, on January 15, 2012, the day after arriving at Manor Care, that Glenda was not capable of having her shortness of breath improved and that she would be shortly removed from Manor Care. That was of course a deliberate lie to get Manor Care out of the predicament that Manor Care got themselves into by fraudulently accepting Glenda when John Muir hospital notified Manor Care that they were having Glenda transported to Manor Care for pulmonary rehabilitation treatment. My January 16, 2012, letter to Manor Care addressing Indiatrained Dr. Chandra’s misconduct to an ailing patient that included: Withholding from a senior patient the fraudulent accepting of a patient transfer from John Muir hospital under an order for pulmonary rehabilitation treatment when Manor Care had no such program. Attempting to cover up for that first fraudulent act by immediately stating to an ill patient that she would be evicted from Manor Care and that she was not capable of having her breathing problems improved upon. That was a lie: Glenda didn’t yet have the ordered pulmonary rehabilitation treatment and there was no way that you could contradict the physicians at John Muir hospital that stated she could have her breathing improved; and for argument, even if there had been such a program—which there wasn’t, 24 hours since arriving at Manor Care could not have enabled anyone from making such judgment. Obviously, your cruel statement to Glenda, who was leading an active life and who wanted to live, created great stress and anxiety upon the woman.
The harmful round-the-clock dosing of Glenda with drugs, some of which had published warnings not to be used on patients with pulmonary breathing problems, and others worsened her breathing problems and created other medical problems. Sampling of these drugs included:
Morphine sulfate; Duramorph; Norco; Oxycodone HCL round the clock, accumulating in the body, all of which depresses lung function, with each dose being cumulative. (Published strong warnings state these drugs are contraindicated in patients with breathing difficulty.) Haloperidol Lactate (Published side effect includes shortness of breath and swelling of the mouth, resulting in difficulty swallowing—which Glenda experienced.) Protonix/Pantoprazole (Published side effects included difficulty breathing, bone pain, swelling, allergic reaction causing swelling of the airways—which Glenda experienced.) Diltiazem (Published side effects include difficulty in breathing, swelling of the mouth, and hoarseness— which Glenda experienced.) Metoprolol Succinate (Published warning side effects include breathing problems, shortness of breath, swelling of the mouth, hoarseness, mental depression, and musculoskeletal pain—which Glenda experienced.) Digoxin (Published warning side effects include difficulty breathing, swelling of the mouth, depression, change and irregular heartbeat—which Glenda experienced.) Bisacodyl (Published warning side effects include difficulty breathing and swelling of the mouth—which Glenda experienced.) Ativan/Lorazepam. (Published warning side effects include strong warnings not to give to patients with COPD breathing problems, especially to seniors; depression, dryness of the mouth; swelling of the throat; delusions—which Glenda experienced.) Prednisone. (Published warning side effects include
breathing difficulties, shortness of breath, depression, water retention, irregular heartbeat, increased blood pressure, hinders wound healing, pain in back—which Glenda experienced.) Various events interfered with Manor Care’s efforts to evict Glenda. On January 21, 2012, Glenda’s oxygen level plummeted. This could be due to the failure to provide the John Muir hospital ordered pulmonary rehabilitation treatment, and compounded by the misuse of round-the-clock drugs that worsened the breathing difficulties. Glenda was rushed to the nearest hospital, Kaiser Permanente. Similar to John Muir hospital reports, no terminal illness was stated. As her oxygen level improved, she was discharged to Manor Care on January 23, 2012. This improvement may have been due to removal from the breathing-impairment drugs given to Glenda at Manor Care. On January 24, 2012, Glenda was transported to John Muir hospital for the thoracentesis procedure to remove the fluid on her lungs that was first discovered nearly three weeks earlier when she was admitted to the hospital for shortness of breath. Manor Care records reported that Glenda showed improvement in her breathing after that procedure was done. That delayed thoracentesis procedure was done by Glenda’s pulmonary doctor, Iranian Dr. Ramin Khashayar, after I reported to the medical board of California that he had abandoned his patient at a life-critical period. While at Manor Care, Glenda experienced increasing pain from a wound/bed sore/ulcer on her back. Instead of obtaining medical care from a wound specialist, you and other Manor Care physicians ordered round-the-clock morphine and morphinecontaining drugs to be given to Glenda. Those drugs were known to worsen a person’s breathing capabilities, especially among seniors. Highlights of the life-affecting abuse of Glenda That Made Your Certification of Terminal illness A Deadly Sham:
Fraudulent admission of Glenda into Manor Care for an ordered medical treatment that Manor Care did not have. Denial of the very care ordered to improve Glenda’s breathing. Fraudulent attempts to evict Glenda from Manor Care by Manor Care physicians, within 24 hours of her arrival, using the sham argument that Glenda did not display an ability to improve her pulmonary function. That attempt was vocalized by Dr. Smita Chandra, who acted under your supervision. Refusal to transfer Glenda to a SNF that had the pulmonary rehabilitation treatment, including Manor Care’s nearby competitor, Kindred SNF. Refusal to obtain a wound specialist to treat Glenda’s worsening wound/ulcer/bed sore on her back, and then dosing her with round-the-clock morphine and morphine related drugs that worsened her breathing problems. Compounding the harm to Glenda’s breathing problem with round-the-clock dosing with drugs, some that were not to be used on COPD patients, or elderly patients, and some that caused anxiety, worsening Glenda’s anxiety arising from all the other wrongs inflicted upon her by physicians.
Further cause for Glenda’s anxiety was the misconduct by pulmonary specialist, Dr. Ramin Khashayar. He repeatedly refused my requests to examine Glenda, and during one phone call accused me of blackmailing him for complaining to the Medical Board of California. He refused to treat Glenda unless I signed a statement that the facts in my complaint were false. Dr. Khashayar compounded that by having a letter delivered to Glenda complaining about my conduct [seeking to have him attend his seriously ill patient], and forced Glenda to sign that
she received the letter complaining of these matters. That misconduct occurred while Glenda was lying at Manor Care, in pain, and waiting to be evicted, compounding her anxiety. Possibly to insure that these medical frauds by multiple physicians went unaddressed, Manor Care management and physicians refused to respond to my faxes asking for information about Glenda’s treatment, despite the fact that I had been arranging and overseeing her medical care for the prior four years; I had power of attorney over her medical care and authorized to be kept informed; and I was her partner for the past 18 years. Shortly before causing Glenda’s removal from Manor Care, as I sought to transfer Glenda to nearby Kindred SNF, where the pulmonary rehabilitation facility did exist, Manor Care personnel falsely stated that Glenda was not capable of showing pulmonary improvement. Based upon this false information, Kindred refused to accept Glenda. This rejection, added to the medical abuses already inflicted upon Glenda, causing her to just give up and want to die. The complicity of two physicians signing Certification of Terminal Illness was needed to remove Glenda from Manor Care. You signed a certification of terminal illness falsely stating that Glenda had less than six months to live, and that her death would come from esophageal cancer. Several falsehoods arose with those two certifications: There were no reports in any of the medical facilities that cared for Glenda between January 5, 2012, and January 31, 2012, addressing Glenda’s underlying cancer. The reports throughout that period focused on Glenda’s shortness of breath. John Muir hospital physicians held that Glenda’s breathing problems could be helped by pulmonary rehabilitation treatment (which Manor Care physicians denied to Glenda). The certification of terminal illness had to cover up for the prior misconduct inflicted upon Glenda, including
what has already been stated. Glenda was diagnosed four years earlier with Stage IV esophagus cancer. Treatment had put that cancer in remission; her oncologists had scheduled Taxol cancer treatment for Glenda prior to her shortness of breath problem and had planned to start that as soon as Glenda returned home; and there was no involvement of her oncologist in Glenda’s medical treatment or any contacts throughout the period from January 5, 2012, to January 31, 2012. Neither you nor your rubber stamp accomplice signing the certification of terminal illness, with death from esophageal cancer, were cancer specialists.
Your certification contradict everything written by physicians at John Muir Hospital and Kaiser Permanente hospital during the prior several weeks of treatment. The facts indicate that you and your rubber-stamp accomplice fabricated the certification of terminal illness, which assisted in covering up for the major medical misconduct occurring while Glenda was at Manor Care. You allowed, or encouraged, Glenda to abandon the pulmonary rehabilitation treatment that unknown to her, she never received, and instead go to Bruns House hospice, a unit of Hospice of the East Bay. You knew that the John Muir order for Glenda to receive pulmonary rehabilitation still existed, that she had never received that treatment, and the nearby Kindred SNF had that treatment. Instead of arranging for Glenda to receive that fraudulently denied treatment, by deception, cover-up, and omission, you sentenced Glenda to a premature death by your sham Certification of Terminal Illness. You made no effort to inform Glenda of these matters when in desperation she decided to give up the available medical treat-
ment that was unknown to hers. Instead, you covered up for the medical crimes and became complicit. You played major roles in denying to Glenda the pulmonary rehabilitation that could have extended her life, and resulted in her premature death. I have a picture of Glenda on January 31, 2012, hours before she became comatose and died. She was smiling, doing crossword puzzles, reading the newspaper, and answering phone calls. Within hours of arriving at Bruns House, Glenda changed from a smiling and active patient to comatose, and dead. Her death was not from the relatively modest shortness of breath. Glenda’s son, Make Guilinger, upon hearing of Glenda’s death, apparently committed suicide immediately upon hearing of his mother’s death—another consequence of the sham Certification of Terminal Illness! The evidence indicates that Glenda didn’t die of any illness. She was put to death while at the Bruns House unit of Hospice of the East Bay—your employer! The records, personal observations, and almost daily photographs of Glenda, strongly indicates Glenda would be alive today but for the joint misconduct of multiple physicians. And that your final certification to rid themselves of the woman they defrauded out of her life! If a group of physicians had set out to bring about Glenda’s death, starting with Glenda’s arrival at Manor Care on January 14, 2012, the physician misconduct inflicted upon Glenda could be expected to result in success. Glenda was put to death within about two weeks. Sincerely, Rodney Stich Bizarre Reason Justifying Physician euthanasia (homicide) For Anyone Exceeding Average Life Expectancy! Dr. Jan Spencer provided a sole response to my questions through a March 15, 2012 fax from Hospice of the East Bay. The response
justified putting to death anyone exceeding the average life expectancy: “Dr. Spencer stated that Glenda had ... far outlived her life expectancy. This doctor was revealing the thinking of others complicit in Glenda’s demise. Anyone who is alive past the average life expectancy, and there are millions, can be put to death according to the mentality shown here! My age at this writing in 2012 is 89, far beyond the life expectancy. Under Dr. Spencer’s care, I could be put to death and it be justified on the basis I already lived many years beyond life expectancy! That includes you or your loved ones! Dr. Spencer Certifying to Death Within Seven to Ten Days It was the unwritten practice of Hospice of the East Bay, of which Dr. Jan Spencer was on the board, that candidates for its Bruns House hospice must have a life expectancy of only seven to ten days. As a physician consultant on the board of the Hospice of the East Bay, of which Bruns House hospice was a unit, Spencer was also certifying that Glenda had only seven to ten days to live. That was an admission requirement for going to Bruns House. Glenda’s appearance, medical record, and actions obviously didn’t meet that requirement. But something was done to Glenda within hours of arrival at Bruns House to where that sham certification was made to be true! Top Medical Journal Reported Doctor Euthanasia Common An article in the prestigious Journal of American Medical Association (JAMA) reported that doctor euthanasia is clearly done without patient knowledge or permission: JAMA at http://jama.amaassn.org 1998 and search from the JAMA site for the following article:
Aug 12;280 (6):507-13 entitled “The practice of euthanasia and physician-assisted suicide in the United States: adherence to proposed safeguards and effects on physicians.” written by Emanuel EJ, Daniels ER, Fairclough DL, Clarridge BR done at the Center for Outcomes and Policy Research, Division of Cancer Epidemiology and Control, Dana-Farber Cancer Institute, Boston, Mass 02115, USA. In the Archives of Internal Mediciine—AMA, a similar article reports the practice of doctor euthanasia (homicide) between the United States and the Netherlands. Vol. 160 No. 1, January 10, 2000, “Attitudes and Practices Concerning the End of Life - A Comparison Between Physicians From the United States and From the Netherlands” (by Dick L. Willems, MD, PhD; Elisabeth R. Daniels; Gerrit van der Wal, PhD; Paul J. van der Maas, PhD; Ezekiel J. Emanuel, PhD). -------------------------Law Relating to Criminal Fraud in Physician Certification of Terminal Illness Cases An internet article by Loren Jacobson, a partner at Waters & Kraus, LLP, in the firm's Dallas office focused on fraud in a physician's certification of terminal illness. Her law practice focuses on qui tam (whistleblower) cases and appellate matters. (http://www.myquitamlawsuit.com/index.aspx?id=jacobson.) September 12, 2011 What Distinguishes Medical Judgment from Fraud? Many qui tam cases involve decisions by physicians—a decision to certify a patient as eligible for hospice, a decision to order services that are allegedly medically unnecessary, a decision to code a procedure a certain way. In all of these circumstances, defendants will argue that allegations that such conduct is fraudulent are not actionable because differences in scientific opinion, methodology, and judgments cannot support claims under the False Claims Act.
Recently, the U.S. Attorney’s office debunked such arguments in a Statement of Interest filed in U.S. ex rel. Wall v. Vista Hospice Care, Inc., Case No. 3-07-cv-0604 (N.D. Tex.). In the Statement of Interest, the Government argued that where a physician acts with deliberate indifference or reckless disregard of objective facts, a fraud claim can lie. Specifically, in the hospice context, if a physician certifies a patient for hospice care without sufficient information to make the certification or with deliberate indifference or reckless disregard for whether the patient actually meets the objective criteria for such certification, the certification and claims for payment of that patient’s hospice care are false. As the Government noted: Hospice care provided to a patient who does not meet objective medical criteria for terminal illness can be false or fraudulent under the FCA. A defendant cannot defeat FCA allegations simply due to the existence of a physician certification of terminal illness when there is evidence that the provider knew or should have known such a patient was not terminally ill. This reasoning has equal force in the other circumstances described above: where there are allegations that a physician ordered unnecessary procedures or services, or deliberately upcoded procedures, so long as there is a good faith allegation that the physician knowingly acted in direct contradiction to objective facts, an FCA claim should lie. The key is to be able to show that the physician’s conduct is not being challenged as erroneous, but as fraudulent. Loren Jacobson is a partner at Waters & Kraus, LLP, in the firm's Dallas office. Her practice focuses on qui tam (whistleblower) cases and appellate matters. Another related article at http://EzineArticles.com/4358159, titled, “Fraud against Medicare, and criminal homicide,” stated: Hospice fraud in South Carolina and the United States is an increasing problem as the number of hospice patients has ex-
ploded over the past few years. From 2004 to 2008, the number of patients receiving hospice care in the United States grew almost 40% to nearly 1.5 million, and of the 2.5 million people who died in 2008, nearly one million were hospice patients. While most hospice health care organizations provide appropriate and ethical treatment for their hospice patients, because hospice eligibility under Medicare and Medicaid involves clinical judgments which may result in the payments of large sums of money from the federal government, there are tremendous opportunities for fraudulent practices and false billing claims by unscrupulous hospice care providers. As recent federal hospice fraud enforcement actions have demonstrated, the number of health care companies and individuals who are willing to try to defraud the Medicare and Medicaid hospice benefits programs is on the rise. Murder of Seniors Eluded/Ignored by Regulators A Frontline NPR article stated that: “ProPublica and PBS Frontline have identified more than three-dozen cases in which the alleged neglect, abuse or even murder of seniors eluded authorities. But for the intervention of whistleblowers, concerned relatives and others, the truth about these deaths might never have come to light.” http://www.propublica.org/article/gone-without-a-casesuspicious-elder-deaths-rarely-investigated. Signing Off Without Seeing the Body In many states, laws are so lax that doctors can sign off on death certificates without having seen a patient in months or actually viewing the body. As a result, even obvious signs of abuse have gone unnoticed by authorities in some instances. Take the case of William Neff, a diminutive 83-year-old who passed away in an assisted-living facility in Bucks County, Pa. A World War II veteran, Neff suffered from advanced Alzheimer's disease, which had tangled the delicate fibers within his brain cells, limiting his speech.
After Neff died on Sept. 11, 2000, a doctor employed by the facility signed his death certificate, citing a “failure to thrive” due to “dementia” as the reason for his demise. The physician, Anne Whalen, would later testify that she hadn't seen Neff for 13 days before his death. She wasn't at the assisted-living home when he died and never saw his corpse. Sampling of related sites: http://www.jonchristianryter.com/2009/091101.html. http://www.jonchristianryter.com/2009/090830.html. http://www.jonchristianryter.com/News_Blurbs/blurbs.html http://www.jonchristianryter.com/Video/2011/110321.html. “Gone Without a Case: Suspicious Elder Deaths Rarely Investigated.” http://www.propublica.org/article/gonewithout-a-case-suspicious-elder-deaths-rarely-investigated. http://www.dailymail.co.uk/news/article-1219853/Myhusband-beaten-cancer-doctors-wrongly-told-returned-letdie.html. http://lonestarwatchdog.blogspot.com/2012/02/hospiceeugenics-with-smile-and.html. --------------------------The Certificate of Death—and the stated cause of death for Glenda, was signed by Dr. Spencer. She wrote as the immediate cause of Glenda’s death: Cause of Death: Immediate Cause. Final disease or condition resulting in death: ESOPHAGEAL CANCER. And for “significant conditions contributing to death …” she wrote: “DIABETES TYPE II, CORONARY ARTERY DISEASE.” These were fabricated sham statements. o There were no sign of the cancer in recent scans and blood tests done just prior to seeking treatment for shortness of breath (which was diagnosed as resulting from a fungus infection). o Glenda was never diagnosed or treated for diabetes or
put on a restricted diet to control any diabetes. o Glenda was not being treated for coronary artery disease. o None of the medical treatment involved in the recent medical care related to these fabricated causes of death. Another statement on the Certificate of Death was puzzling. It was the name of Dr. Guy Micco from the University of California in Berkeley. He was named the “attending physician” at Bruns House at the time of Glenda’s death. The India-trained Dr. Smita Chandra was the doctor attending Glenda at Bruns House and determining the morphine dosage she would receive—that quickly brought about Glenda’s death. My faxes to Dr. Micco seeking information about his role in these matters relating to Glenda went unanswered. Except that Virginia Bruski, vice president at Hospice of the East Bay, responded and stated that Dr. Micco would not respond to my questions. Apparently Micco was also on the payroll of Hospice of the East Bay, adding to their Drs. Chandra and Spencer that played major roles in conduct leading to Glenda’s death. Glenda didn’t have a chance to survive the huge numbers of wrongful acts and multiple medical personnel acting against her chance of remaining alive! CHAPTER NINETEEN
Hospice: the Good, the Bad, And the Deadly
The hospice industry’s public relations portrays hospice in glowing terms, leaving the public with a pie-in-the-sky image of a medical option that has benefits for some, and great perils for others. Where a person is near death, and there is no realistic hope for a cure or remission, hospice then should be considered.
Real hospice care is not about hastening the death of a patient. It is about providing relief from distressing symptoms, supporting the patient and letting them know that they are valued and loved. Excerpts from one article at www.hospicepatients.org stated: Hospice Patients Alliance has received many, many reports from families about patients with COPD who were given morphine in dosages higher than they were accustomed to receiving, ... who died shortly after getting those morphine dosages. Most of these patients were given these dosages of morphine by nurses in the hospice setting. In all the cases reported, the physician had ordered that the morphine might be given “as needed” or “PRN” within a certain range and at a certain frequency of time intervals between doses given. [http://www.hospicepatients.org/no-prn-morphine-copd.html] The Hospice Patients Alliance was formed in August of 1998 as a nonprofit charitable organization and is a 501(c)(3) corporation serving the general public throughout the United States. We were formed by experienced hospice staff and other health care professionals who saw that hospices were not always complying with the standards of care, and in fact, were in some cases, violating the rights of patients and families and exploiting them for financial gain, or not providing adequate care to control pain or other distressing symptoms during the end of life period. ... [Laws Against Medical Killing] Having received numerous complaints for more than a decade, HPA is warning the public that a form of stealth euthanasia is quietly being introduced throughout the health care system in which the misuse of terminal sedation and other methods of imposing death are used without an actual legalization of euthanasia or assisted-suicide. The misuse of terminal sedation is the Third Way to end life within a health care setting and bypasses laws against medical killing. An article by the Catholic Hospice Group warned: “By admitting these folks to hospice, they are denied access to routine medical and rehabilitative care that they need to extend
and improve their lives,” said Cristen Krebs, executive director of Catholic Hospice of Pittsburgh, a non-profit. “A vulnerable and voiceless population is preyed upon for money.” Other Internet Sites for This Subject www.defraudingamerica.com/hospice.html.
An article about deliberate killing of patients in hospice: http://www.hospicepatients.org/questionable-death.html. http://www.hospicepatients.org/atty-resource.html. Misconduct reported by Hospice Patients Alliance: http://www.hospicepatients.org/hospic1.html. Mother Killed by Hospice with Morphine Overdose: http://www.hospicepatients.org/euth-acct-three.html. See hospice death in Texas. Terri Schindler Schiavo. http://www.hospicepatients.org/terrischindler-schiavo-docs-links-page.html. Report of overdosing: http://www.hospicepatients.org/hospicenurse-observes-euthanasia.html.
The Hospice Patients Alliance, Inc. is a non-profit 501(c)(3) charity acting to preserve the original hospice mission, promoting quality end-of-life services and offers free information and assistance to hospice patients, families and caregivers nationwide. For more information, visit Hospice Patients Alliance online or call  8669127. Enter here for Information and News On Involuntary Euthanasia, Hospice Medical Killings, Case Histories, And Much more!
Two Daughters Report Mother Killed Due To Negligence Of Hospice Nurses (Morphine Overdosage - Improperly Set Pump) http://www.hospicepatients.org/negligent-death-d-t-morphinepump-overdosage.html. It is easy to falsify records for hospice. http://hospiceuncovered.blogspot.com/. “Thursday, January 14, 2010 Hospice And What They Will Not Tell You. What Hospice and sometimes your OWN relatives will not tell you, when signing
your love one into Hospice. My mom, passed away, in 2009, her death was hastened while in the care of (Vitas-HOSPICE) (Pembroke Pines Florida). Unfortunately, animals have much louder advocates for inhumane treatment against them (although they’re not human). Why is the abuse of animals a much more sensitive issue in America, and more important than inhuman treatment of real human beings? Specifically, the terminal, the sick, and the elderly. These groups of people are targeted and funneled into Hospice (the silent killer) to cut Medicare cost. The public has a right to know the truth about the (silent) practices used by the Hospice Organizations working in and through, our Hospitals, and Nursing Homes working in conjunction with Medicare. Medicare’s sole agenda is to cut cost by any means necessary. Medicare’s idea of cutting cost is referring your love ones (the elderly, the terminal, and sick) to Hospice. Where the patient supply of medication is cut off. All except the morphine/methadone used to administer a quiet, rapid exit into eternity (someone is saving on their water bill as well because they are dehydrating their patients and not turning to the I.V. drip). Other related sites:
http://ezinearticles.com/?Hospice-Fraud---A-Review-ForEmployees,-Whistleblowers,-Attorneys,-Lawyers-and-LawFirms&id=4358159. “A recent example of hospice fraud involving a South Carolina hospice is Southern Care, Inc., a hospice company that in 2009 paid $24.7 million to settle an FCA case. The defendant operated hospices in 14 other states, too, including Alabama, Georgia, Indiana, Iowa, Kansas, Louisiana, Michigan, Mississippi, Missouri, Ohio, Pennsylvania, Texas, Virginia and Wisconsin. The alleged frauds were that patients were not eligible for hospice, to wit, were not terminally ill, lack of documentation of terminal illnesses, and that the company marketed to potential patients with the promise of free medications, supplies, and the provision of home health aides.
Southern Care also entered into a 5-year Corporate Integrity Agreement with the OIG as part of the settlement. The qui tam relators received almost $5 million.” Fraud between nursing facilities and hospice: http://oig.hhs.gov/fraud/docs/alertsandbulletins/hospice.pdf Criminal charges arising from fraudulently certifying people as terminally ill. http://californiawatch.org/dailyreport/federal-justice-officialsaccuse-hospice-provider-medicare-fraud-14342.
National for-profit hospice Accused of Fraud A national for-profit hospice care company partially owned by a San Francisco private equity firm has been accused of bilking Medicare of millions of dollars, according to a legal complaint filed this week by the U.S. Department of Justice. In court documents, the government contends that since at least 2007, Texasbased AseraCare Hospice has fraudulently certified patients as terminally ill to illegally collect Medicare payments. “The United States alleges that AseraCare, through its reckless business practices, admitted and retained individuals who were not eligible to receive Medicare hospice benefits, because it was financially lucrative – and did so even after AseraCare’s auditor alerted AseraCare to troubling problems,” court documents state. “AseraCare misspent millions of Medicare dollars intended for Medicare recipients.” In its complaint, the government describes a corporate culture in which AseraCare employees were given heavy incentives to enroll and retain hospice patients – even if they don’t qualify – because hospice providers are paid per patient per day. Top performers were rewarded with prizes like massage chairs, while those who didn’t meet patient admission goals were disciplined. An internal audit stated in a December 2007 report that a reduction in the number of hospice patients led to layoffs. A Bloomberg story chronicles the plight of Janet Stubbs, who “didn’t know that her aunt, Doris Midge Appling, was admitted to
Hospice Care of Kansas during the company’s “Summer Sizzle” promotion drive, which paid employees as much as $100 a head for referrals.” For many who have experienced hospice as it was intended — palliative and comfort care for near-death patients and their families — it is shocking to learn that hospice care is promoted like the sale of used cars or mattresses. (http://fraudblawg.com/2011/12/13/bloomberg-exposes-medicarehospice-fraud-boom/)
Hospice patients alliance. (http://www.hospicepatients.org/euth-center.html.)
The Grief Inflicted Upon Loved Ones Not described here is the grief inflicted by these corrupt actions upon loved ones left behind, the bereavement that often seems endless. CHAPTER TWENTY
Unrecognized Death Panels
The term, “death panels”, became a political term in 2009 during political debates about federal health care legislation. Little did anyone know that such death “panels” already existed and resulted from the corrupt acts of certain doctors and medical personnel. That was clear with Glenda. One doctor, Doctor Jan Spencer of the Hospice of the East Bay, where Glenda was put to death with a morphine overdose, justified Glenda's death by stating Glenda had already lived beyond her expected lifetime. Death panels or doctors are more likely to be found in HMO type of medical plans where the doctor group receives a flat amount of money every month for a given member. Normally, in fee-forservice type of medical plans, there is an incentive by doctors and medical facilities to provide, not withhold, treatment.
In Glenda's case, she was in a fee-for-service medical plan. But the motivation to deny her treatment rose from the need to quickly discharge her out of a skilled nursing facility that had fraudulently accepted her transfer from John Muir hospital, a major source of their patients. Another name for death panels is withholding tests and withholding treatment. That is especially common in HMO type medical plans. There are many reports on the Internet of Kaiser Permanente doctors doing that. I became a victim of that rationing as a 40-year member of Kaiser Permanente health plan in the Walnut Creek, California area. I describe that at web site: www.defraudingamerica.com/kaiserpermanente.html. Too Old For Diagnostic Tests In my case, it started out by Kaiser Permanente primary care physicians refusing to order medical tests, CT scan in this case, for symptoms that turned out to be kidney cancer. One doctor admitted to me that at my age, Kaiser Permanente did not do such tests. That was stated to me while I was under contract for medical care for which Kaiser doctors were obligated to provide universally recognized tests and treatment. Filing appeals with Medicare are in most cases a waste of time. On May 1, 2011, I then went to a out-of-plan physician and described my symptoms. The doctor promptly ordered a CT scan that showed a kidney cancer that had spread from the right kidney throughout the related lymph node. The easily curable early stage kidney cancer was now a probable incurable one. Upon presenting the report to Kaiser doctors, they then pressed me to do nothing. That meant allowing the kidney cancer to spread throughout the body, abandoning the curative or remissionaffecting benefits of surgery and kidney cancer drugs. Kaiser doctors gave me various excuses for refusing to do surgery: I was too old and anyone taking aspirin for a coronary stent was high risk. I then presented them with medical reports showing these to be sham excuses. Kaiser doctors eventually agreed to surgery, but no rush. Meanwhile, the cancer was spreading.
The surgery was finally done. The universally recognized medical treatment following nephrectomy is periodic blood tests and scans. Three Kaiser cancer doctors refused to do them, stating they would not do anything until I personally experienced symptoms that would occur in the latter stages of cancer, long after the curative or remission-enabling cancer treatment had any effect. That would save the doctor group money since hospice would be about the only route to go. All of these death plan actions were inflicted upon me while I was caring for Glenda. Complaints to Medicare supported this corrupt denial of contractual health care. The same occurred when I complained to the Medical Board of California, and various medical groups. CHAPTER TWENTY ONE
The Guilty, the Complicit, And the Enablers
After the funeral services were over, I embarked upon an investigation to discover and document everything I could about the medical misconduct inflicted upon Glenda. The more I discovered, the more I was shocked at the pockets of arrogance and corruption and contempt for Glenda’s life. I requested all available records from the day I brought Glenda to John Muir hospital on January 5, 2012, the transfer to Manor Care, and then the transfer to the Hospice of the East Bay’s Bruns House, where Glenda died hours upon arrival. As in my prior efforts at attacking harm-enabling corruption, there were several motivating factors. One was to address the harm done to someone I loved very much: Glenda. Another was to try to remove this crud culture, to halt the harm to others. Another was my hatred for people that engage in corrupt conduct and those who cover up for it. Another reason, as I sometimes jokingly say, it is my Austrian background that forces me to take on these battles against harm-enabling corruption. It became obvious that this was far worse than the medical “errors” responsible for the reported tens of thousands of deaths a year.
This was fraud and criminal misconduct for which criminal investigations on the federal and state levels were required. But like the decades of thousands of criminal sexual assaults by Catholic priests, the criminal investigations would probably never occur. Like the church crimes, something about medical crimes appear to be off limits. The wrongful conduct against Glenda had been occurring at such a rapid pace, with an almost total withholding of medical information as the events were in progress. I was unaware of what was going on, and had to rely upon the assumption that universally recognized medical treatment was being honestly provided to Glenda. I had no reason to believe that conduct resembling a criminal operation was ongoing. I now started recognizing the arrogance of the medical personnel involved. It was conduct that I did not believe possible in the medical field. John Muir Hospital Carelessness The care by John Muir hospital personnel was generally good, though I fault the hospital doctors with failure to properly treat the pressure ulcers on Glenda’s back and transferring Glenda to Manor Care skilled nursing facility for pulmonary rehabilitation treatment that Manor Care did not have. Ordinarily this would be serious, but in consideration of what was done to Glenda after her transfer to Manor Care, the hospital shortcoming was far less serious. On May 9, 2012, I sent a fax to John Muir Hospital CEO, Dr. Calvin “Cal” Knight, stating that the hospital should take steps to disassociate the hospital with the medical facilities and doctors whose corrupt acts and culture resulted in Glenda’s death. The fax stated in part: As I examine more of the evidence of deliberate wrongdoing by doctors and management at facilities to which John Muir Hospital personnel transfer patients, which resulted in Glenda’s death, it becomes obvious that the hospital has a moral and legal responsibility to take certain actions to avoid approving of what was done and to protect patients in the future. John Muir Hospital has an otherwise excellent reputation for healthcare, and I appreciate the excellent care that the hospital pro-
vided to Glenda over the years. Let me briefly describe what was done to Glenda after the hospital treated her for a fungus infection in the lungs and then transferred her to Manor Care for pulmonary rehabilitation treatment. Manor Care admission personnel assured John Muir hospital that they would provide the treatment ordered by hospital physicians, when they did not have such a unit, and had no intention to provide it. On January 14, 2012, your hospital transferred Glenda to Manor Care Rossmoor Parkway for the sole purpose of receiving pulmonary rehabilitation treatment. Hospital personnel had earlier treated Glenda for a suspected fungus infection in the lungs, a condition for which she was treated about a year earlier. Manor Care admission personnel and physicians accepted Glenda for the treatment ordered by John Muir hospital physicians. In this manner they implied to hospital personnel and to Glenda that the specific treatment would be given. Manor Care did not have that type of treatment. Several days earlier, Manor Care admission director Laura Stengel stated on two different occasions to me and my daughter that Manor Care would not accept Glenda because of her need for COPD treatment. She clearly stated that they did not have such treatment or a pulmonary specialist. The absence of such treatment was also later stated to Glenda and me by Dr. Smita Chandra within 24 hours of Glenda’s arrival at Manor Care. By accepting Glenda for a specific treatment that they did not have, Manor Care admission personnel and physician-incharge, Dr. Martin Jimenez, committed fraud against John Muir Hospital; against Glenda; against the federal government by billing Medicare for a specific pulmonary treatment they did not have; and fraud against Healthnet insurance, who would be paying for treatment that was not being given. Manor Care management and physicians, and Dr. Smita Chandra, an employee of Hospice of the East Bay, sought to extricate themselves from their position of fraud in the following
manner: Within 24 hours of Glenda’s arrival at Manor Care, Dr. Chandra lied to Glenda, stating she was not capable of experiencing improvement in her shortness-of-breath condition and that she should select hospice and palliative care. Chandra was not a pulmonary specialist, and even if she had been, Glenda’s physical appearance would prevent any physician to reach such a decision. Chandra was promoting the business of her employer, Hospice of the East Bay. Chandra told Glenda she would have to leave the facility that had just accepted her the day before. After ten days of tests and observation, your hospital physicians felt that Glenda could have her occasional shortness-ofbreath improved upon. (Shortly prior to me taking Glenda to the hospital on January 5, 2012, for shortness-of-breath, Glenda was easily doing 20 minutes on the treadmill at a fairly good pace and was in no way a hospice candidate.) Glenda was obviously upset and distressed by Dr. Chandra’s comments. I complained to Dr. Chandra at that point that Glenda was at Manor Care for treatment, not hospice or palliative care! I then sent a fax to Manor Care complaining of this misconduct. A copy of that fax is at www.defraudingamerica.com/glenda.html. Under the direct supervision of physician-in-charge Dr. Jimenez, and other Manor Care personnel, other misconduct occurred to cover up for the fraudulent acceptance of Glenda for treatment it did not have. The untreated multiple pressure ulcers on Glenda’s back, which may have been infected with MRSA bacteria, were denied treatment by wound specialists while at Manor Care. To have provided that treatment would have delayed Glenda’s removal from Manor Care and increased the possibility that federal or state regulators or prosecutors would detect the fraud. Glenda was suffering pain from the multiple pressure ulcers. Manor Care’s withholding of treatment for the painful pressure ulcers was “addressed” by round-the-clock dosing with mor-
phine sulfate and morphine-related drugs. These drugs are widely recognized as not to be used on patients with impaired breathing and could cause death. That danger was knowingly inflicted upon Glenda. Among the other related medically wrongful acts was the repeated refusal to provide the person responsible for arranging Glenda’s medical care any details on her treatment. This kept me from discovering the extent of the fraud that would shortly lead to Glenda’s death. They also encouraged Glenda to transfer to hospice, and to deny me any role in opposing that sham tactic. Complicit in these medically corrupt acts against Glenda were two physicians signing that Glenda would die within six months from esophageal cancer. Glenda wasn’t at Manor Care for cancer treatment; her oncologist was not involved in her care at that time; recent scans and blood tests showed the cancer in remission; and the two physicians lacked the information to reach such conclusion. The two physicians were Dr. Jan Spencer, an employee of Hospice of the East Bay, with no contact with Glenda; and Dr. Lorenzana, far removed from Glenda’s cancer or COPD treatment. All of the involved physicians were members of the John Muir Physician Network. The final death decree was carried out within hours of Glenda’s arrival at Bruns House hospice, a unit of Hospice of the East Bay where Dr. Chandra and Dr. Jan Spencer were employed. Glenda arrived at Bruns House at 2 PM, Tuesday, January 31, 2012, the same day that Dr. Lorenzana signed the Declaration of Terminal Illness (that Certification of Terminal Illness still had the name Dr. Martin Jimenez on it, indicating the same doctor involved in multiple frauds against Glenda was initially sending Glenda to her death within a matter of hours!). I have photos of Glenda that evening, making phone calls, doing crossword puzzles, reading the newspaper. These pictures are on the Internet—where this letter will be posted. As I sat by Glenda’s bed at Bruns house, in walked the same
doctor, Smita Chandra, who had fraudulently stated to Glenda within 24 hours after her arrival from John Muir Hospital, that Glenda should select hospice, palliative care, and that Glenda had no chance of having her breathing improved! Chandra would now be in charge of ordering morphine for Glenda, a drug that would result in Glenda’s death within a matter of hours! When I returned to Bruns House hospice early the next morning, Glenda was comatose, gasping for breath. She died hours later! This was homicide that directly involved multiple physicians, and made complicit those doctors and regulators who knew of these blatant medically-corrupt actions and cowardly allowed Glenda to be put to death. Glenda’s son, Bruce, apparently committed suicide immediately upon learning of his mother’s death. Arguably, the doctors and other personnel whose corrupt acts led to his mother’s death could be prosecuted for homicide in Bruce’s death.
John Muir Hospital had an innocent role in these events by transferring Glenda: To a skilled nursing facility that did not have the treatment being ordered. To being cared for by doctors that engaged in medical fraud that led to Glenda’s expected death through a series of corrupt medical acts. To being cared for by doctors signing fraudulent certification of terminal illness forms, citing expected cause of death to esophageal cancer that had been in remission. Except for John Muir hospital personnel not providing the required care for Glenda’s multiple pressure ulcers and not insuring that Manor Care had the type of medical treatment for which they were transferring Glenda, the hospital generally provided excellent care. You now have a moral and legal problem. If John Muir hospital continues to do business with any of the physicians that engaged in what was done to Glenda, it is aiding and abetting, and subjecting other patients to the same culture that led to Glenda’s death.
If John Muir hospital allows any of the physicians directly implicated in the corrupt actions against Glenda, the same moral and legal offenses could be expected to continue, threatening the vulnerable patients. John Muir Hospital also has a responsibility to: Request California and federal criminal agencies to conduct an investigation into the probable criminal acts, including euthanasia or homicide. Even that step is subject to cover-up, as has occurred for years as this culture didn’t suddenly start with Glenda. My 50 years spent exposing fraud and corruption, starting as a federal agent, made me fully aware of this endemic culture. Request of California and federal medical oversights agencies to investigate. As in the past, they can be expected to cover up. But making a record has certain merit. Discontinue business relations with Manor Care. Discontinue hospital relationship with the doctors that engaged in a pattern of fraud. To do otherwise condones their conduct that resulted in two deaths.
A copy of this letter appears on the Internet. Your response, if any, will also be posted. --------------------Neither Dr. Knight nor anyone else from the hospital responded. Manor Care Admission Personnel and Doctors Were Primary Perpetrators of Glenda’s Suffering and Death Manor Care admission personnel and physician in charge, assisted by attending physician Smita Chandra from Hospice of the East Bay, were the originating and primary perpetrators in Glenda’s unnecessary suffering and denial of the ordered pulmonary treatment. Their misconduct reminded me of what could be expected of a corrupt medical enterprise.
Admission Personnel at Kindred Skilled Nursing Facility Became Complicit in Glenda’s Death Kindred skilled nursing facility became complicit when, as a public medical facility, they refused to accept Glenda when she had an outstanding and unfilled order for pulmonary rehabilitation treatment, for which payment would be made by Medicare and Healthnet PPO insurance. Their complicity was worsened by knowing that their refusal to accept Glenda would result in Glenda abandoning treatment and transfer to a hospice facility where survival was a matter of days. Coupe de Grace Against Glenda The two doctors signing the sham Certification of Terminal Illness documents provided the coup de grace ending the pattern of medical fraud against Glenda. Without their cooperation, the fraud and corruption by Manor Care personnel and Hospice of the East Bay doctor could not succeed. They falsely stated that Glenda would die within six months of esophageal cancer. Neither of them had cancer treatment backgrounds; neither treated Glenda for cancer, or her shortness of breath condition. Glenda’s cancer scans and blood tests showed the cancer, diagnosed four years earlier, was in remission; her oncologist had cancer remission therapy waiting for her upon her return from her shortness-of-breath treatment. He had no role in making that Certification of Terminal Illness diagnosis that was made by two highly unqualified doctors. Cavalier Preparation of Death Decree Prepared in haste, the original doctor’s name on the Certification of Terminal Illness form had the name, Dr. Martin Jimenez, on it, and then crossed out. They were in such a hurry to send Glenda to her death that they did not even redo the document. They simply added the name of Glenda’s primary physician, Dr. Vona Lorenzana. Dr. Lorenzana was not a cancer doctor, was not involved in Glenda’s cancer treatment, and from my experience, would not be capable of arriving at the statement of impending death that she made.
Hospice of the East Bay and Its Bruns House Hospice Facility Funded by grants and contributions, Hospice of the East Bay personnel, including two of its doctors, Smita Chandra and Jan Spencer, provided early, intermediate, and final blows ending Glenda’s life. Dr. Chandra assisted the fraud by Manor Care admission personnel by stating to Glenda, who had an order from John Muir hospital for pulmonary rehabilitation treatment, to instead choose hospice instead of treatment. That suggestion would provide another potential client for Chandra’s Hospice of the East Bay employer. Chandra would then be the physician overseeing the morphine dosing when Glenda arrived at Hospice of the East Bay’s Bruns House, where Glenda was put to death with morphine overdose within hours of her arrival. Dr. Jan Spencer, a colleague of Dr. Chandra at Hospice of the East Bay, who never attended Glenda and was not an oncologist, “signed” a sham Certification of Terminal Illness. Her statement that was provided to me was a brief off-the-shelf Certification of Terminal Illness form, dated the day after Glenda had been put to death. It was unsigned, and lacked the supporting details that are required by law. Putting to Death Anyone Exceeding Life Expectancy None of my faxes sent to Dr. Jan Spencer of the Hospice of the East Bay were ever answered by her. However, Virginia Bruski, Vice President of the Hospice of the East Bay, sent me a letter relaying the answer of Dr. Spencer. That message relayed from Dr. Spencer stated: “Dr. Spencer stated that Glenda had ... far outlived her life expectancy.” That was an admission showing the mentality of those doctors comprising America’s death panels at work! Obviously, this group is not too smart at covering up for themselves. Enablers
These actions reflected a culture that didn’t suddenly occur with the arrival of Glenda as a patient. They had to be of long standing, and known to others; including California and federal personnel in the oversights agencies. My experience with oversight agency personnel started as I was a federal airline safety inspector in the 1960s, and then greatly expanded to other government entities. Further, the many reliable reports on the tens of thousands of deaths every year due to medical errors are prima facie evidence that the regulators are refusing to meet their responsibilities. Showing the Death Panels in Action Through Medical Records, Documents, and Pictures I was determined to expose the perpetrators and the culture that surely affected people other than Glenda. Based upon my experiences starting in the mid-1960s when I first started exposing and reporting corruption with high numbers of fatalities associated with a series of fatal airline disasters, I expected to encounter the same culture of cover-up and blissful indifference. I reported the misconduct resulting in two deaths to people and groups that have medical oversight and criminal responsibilities. I also intended to make this information that affected everyone available on the Internet and through not-for-profit books. My initial internet site for Glenda became active in March 2012: www.defraudingamerica.com/Glenda.html. Sampling of People and Groups I Notified District attorney of Contra Costa County I sent detailed information to the district attorney for Contra Costa County, Mark A. Peterson, at Martinez, California (April 8, 2012) because of the criminal or homicidal nature of what was done to Glenda. Chief of Inspectors in his office, Paul Mulligan, acknowledged the seriousness of the matter and explained that such a matter required an investigation by an office with a larger staff. He then referred the matter to the State of California Attorney General, Kamala Harris. Mulligan’s email response (April 24, 2012) stated in part: First, I am sorry for the loss of your companion. I spoke to Special Agent Rosa Gonzales who is an investigator with the
California Department of Justice. She is assigned to the DOJ’s Pleasanton office. Her office phone is (925) 520-6406. I will forward a copy of your letter to her via this e-mail. Agent Gonzales said she will review this matter, and will discuss it with you. Hopefully she can offer some advice as to what should be done next. Thank you for bringing this matter to our attention. ------------------------The California Department of Justice agent never contacted me. The endemic cover-ups were like the decades of cover-ups of the criminal sexual crimes numbering thousands of cases that were covered up, protecting the powerful Catholic Church. My Direct Complaint to California Attorney General. I sent an April 4, 2012, fax to California attorney General Kamala Harris with precise details of what happened, and referred her to the additional information at the Glenda web site. She never responded, despite the involvement of two deaths and the probability that this culture would continue to have fatal consequences for others. I had initially sent information to the Sheriff of Contra Costa County, David Livingston, and then realized such a matter probably was not in his area of official responsibility. However, he replied, stating that he did look at my information. He showed concern, and acknowledged its seriousness. Complaint to the Inspector General in United States Department of Justice. I filed a complaint with the U.S. Department of Justice on April 18, 2012, on the basis of fraudulent billing of the federal government under Medicare by Manor Care management for pulmonary rehabilitation treatment that the skilled nursing facility did not have and did not provide. Also, for the criminal acts under Medicare that resulted in Glenda’s death. The April 26, 2012, response from the investigations division of the Office of the Inspector General stated that they forwarded the
matter to the Department of Health and Human Services in Washington. I never heard from that department. I faxed detailed information to California Government Edmund G. Brown on April 21, 2012. He had oversight responsibility for the criminal and medical agencies that were covering up for the medical corruption. No response. All of the physicians involved in the abuses against Glenda were members of the John Muir Physician Network, headed by Dr. Michael Kern. I never initiated any contact with him, but on his own he sent me letters making excuses for the perpetrators of the deadly offenses. I sent a letter with details to the California Department of Health and Public Services based on their responsibility over skilled nursing facilities, including Manor Care and Kindred SNFs. No response. Granddaddy of Medical Abuse/Fraud Cover-Ups: Medical Board of California There is a history of my reports to the Medical Board of California, before and after Glenda’s death. It related to repeated refusal by oncologists at Kaiser Permanente health plan to provide me universally recognized cancer treatment for which I had a health insurance contract. I made brief reference to that problem in earlier pages. Briefly, in early 2011, as a member of Kaiser Permanente Health Insurance Plan, Kaiser Permanente doctors refused to order tests when symptoms appeared that turned out to be kidney cancer. I then had to go to an out-of-plan doctor to get the CT scan. The report showed cancer in the right kidney that had already engulfed the entire right kidney lymph node. After Kaiser oncologists were given proof of the cancer, they refused to provide the universally recognized immediate treatment: surgical removal of the kidney and lymph node. . Kaiser oncologists and urologists said to wait until I personally experienced positive symptoms of the spreading cancer. That meant withholding the curative or remission-enabling benefits of cancer drugs for which
billions of dollars had been invested to develop. And then accept the only option left: pain relief, hospice! That was medically insane! Finally, after a two month delay, a Kaiser surgeon performed the surgery. During this delay, the cancer was spreading from the critical Stage III. It is universally recognized that immediate surgical removal be done. After surgery in a Stage III kidney cancer case with extension of the cancer to the lymph node, it is universally recognized that periodic scans and blood tests be done, starting at either three or no later than six months after surgery. This is so that prompt treatment can be done the moment that the expected kidney cancer metastasis occurs. Kaiser oncologists refused to do any of the recognized cancer treatment. Three different Kaiser oncologists, Drs. Aram Canin and Michael Russin in the Walnut Creek facility, and Dr. Jeanette Yu in the Oakland offices, all stated sham excuses for refusing to provide universally recognized post-nephrectomy cancer treatment. The conduct by these three oncologists were death decrees for me, insuring that I would suffer the pain and early death by denying to me the universally recognized treatment for which they were paid under my health plan. Dr. Russin’s excuse for denying me the routine scans was that anyone with only one kidney was at great risk from the dye used in scans. He conveniently withheld the fact that in those cases it is routine to do the scans without contrast dye. Failure to do routine scans allows the cancer to spread beyond the point where it can be either cured or put into remission and extending the person’s life. Kaiser oncologist Aram Canin excuse for denying the universal cancer care was that the adverse effects from cancer drugs was too severe, implying that the cancer should be allowed to metastasize to the hospice stage without the benefit of cancer drugs. Young and recently hired Kaiser oncologist Dr. Jeanette Yu used the denial-of-cancer-treatment excuse that cancer drugs do not extend a person’s life.
Their sham arguments constituted death decrees for me, violating my contractual right to standard cancer treatment for which I was legally entitled under my prepaid medical plan. There were criminal aspects related to medical homicide in their corrupt excuses denying me medical treatment for a serious cancer condition. Profit-Motivated Death Panels Kaiser doctors operate under a capitated compensation plan, whereby the doctor group receives a specific amount of money every year for each patient. Treatment for kidney cancer is especially expensive because almost all of the kidney cancer drugs are under patents and expensive. By denying me treatment to where the only option left for me is pain-relief, palliative care— hospice—the Kaiser doctor group provides a greater end-of yearbonus to the individual doctors. Glenda, herself having survived over three years at that time from Stage IV esophagus cancer, had already outlived the one-year normal survival rate through rigorous universally recognized cancer detection tests and treatment. It distressed her to see what Kaiser death panel doctors were doing to me. She took notes and made written reports of what the Kaiser doctors said as they denied me the cancer care for which they were paid. Approving this corrupt denial of standard cancer treatment was the Kaiser physician-in-charge of the Walnut Creek facility, Dr. Theodore Levin, and the entire Kaiser appeal group. Courageous Kaiser Doctor Contradicted the Death Panel Group Toward the end of 2011, Walnut Creek Kaiser oncologist Douglas Andrew Kaufman stated to me that I should have had the cancer detection tests months ago, and showed me medical studies supporting that standard, similar to what I had presented throughout the appeal process. He then ordered the tests. Despite all this, April 2012 reports from every level of the Kaiser “appeal” process stated that the conduct of the three oncologists that refused to conduct any of the recognized cancer detection tests were in compliance with recognized medical procedures. This was
an outright lie showing the culture among large numbers of doctors having life and death responsibilities! The denial of prepaid medical care, the conduct decreeing a premature death, and the blatant lying, were actions that I had never experienced in my 40 years of uncovering arrogance, corruption and related tragedies. Complicity by Medical Board of California In an April 17, 2012, letter to me, signed by Consumer Services Analyst Sharlene Smith, the Board approved the denial of prepaid medical care by the Kaiser oncologists and that their conduct did not depart “from the standard of practice of medicine.” In other words, the Medical Board of California approved the corrupt denial of prepaid care and the death decree culture among the Kaiser oncologists. They became accessory before and after the fact, and accomplices, all criminal offenses!
Accomplices in the Medical Fraud Against Glena Personnel involved in the Medical Board of California oversight procedures were notified in early January 2012 of the wrongful acts against Glenda. If they had started an investigation at that time, it is very possible that the medical outrages against Glenda would have changed, and she would not have been put to death by a combination of medical abuse and medical homicide! Under California law, complaints against physicians and investigations conducted by the Medical Board of California are withheld from the public. The practice of cover-up by personnel of the Medical Board of California is therefore kept secret. Complaints are “investigated” by doctors in the area where the doctor misconduct occurred. Decisions are made by peers of the doctors committing the misconduct. In Glenda’s case, the investigating office is Pleasant Hill, and involved doctors from the same group as those committing the medical misconduct, including the John Muir Physician Network. Public Pronouncements versus Reality
Information provided by the Medical Board of California for public consumption state, for instance: The law requires that the Medical Board of California ensures that physicians are practicing medicine within “the standard of practice in the medical community.” And the Board is given the authority to take action, such as suspension, revocation of the right to practice medicine, or issuing citations and requiring probation or monitoring. The Board assesses the “quality” of care for a given patient. The Board does not provide information on complaints against physicians. Only if the Board takes action against a physician are complaints made available to the public. The Board is required to investigate violations of the Business and Professions code. Gross negligence, incompetence, … The written investigative guidelines include the statement that the Medical Board will personally contact the complainant. This is an obvious investigative requirement since letters and records convey only part of the problem. I was never contacted. As of this writing, the Medical Board cover-up report has yet to be received. Blissful Unconcern, or Cowardice, Everywhere People throughout the medical community were made aware of the misconduct resulting in Glenda’s death. None responded with any anger. In the retirement community of Rossmoor in Walnut Creek, Dr. Clair Weenig, head of a medical group known as Medical Friends of Rossmoor, didn’t care enough to respond when I provided her the details of what was done to Glenda. That cover-up enabled others in that 9000-member retirement group to use the same doctors and the same medical facilities and be threatened with the same culture that defrauded Glenda, a Rossmoor resident, of her life. Despite this, the standard blissful indifference that is widespread in the United States.
Cover-Up by Head of John Muir Physician Network Many people and groups became complicit through active coverups or through silence. One example was the head of John Muir Physician Network, Dr. Michael Kern. Every doctor involved in the medical treatment of Glenda was a member of that group. In what must have been a misunderstanding, and without me having contacted him, he sent me an April 27, 2012, letter explaining that Glenda’s oncologist, Dr. Sherman had stayed in constant touch with the care being provided to Glenda while she was temporarily away from cancer care at John Muir hospital and Manor Care SNF. Dr. Kern’s letter raised an issue I had not considered. Part of my May 3, 2012, reply stated: To Dr. Kern: I received the impression from your April 27, 2012, letter that I was criticizing Dr. Sherman or thought there was some dissatisfaction with the cancer treatment provided to Glenda by him while Glenda was at John Muir hospital and Manor Care Rossmoor Parkway for a treatable shortness-of-breath medical condition. That was not so. Let me try to clarify that matter. I did not expect Dr. Sherman to be actively involved in the shortness-of-breath medical problem, that apparently resulted from a fungus infection in Glenda’s lungs, a problem she initially experienced or year or so earlier. Scans and blood tests shortly before Glenda’s initial problem with the shortness-of-breath showed no signs of any cancer. Glenda was scheduled to return to Contra Costa Oncology to resume Taxol treatment to effect continued remission of the cancer. Dr. Sherman’s prior treatment was probably responsible for Glenda’s beating the survivable odds when in early 2008 she was diagnosed with Stage IV esophagus cancer. I appreciate his treatment in the cancer area that kept Glenda alive far beyond the normal expected survival. And it looked like the end of quality of life was still in the distant for Glenda, thanks to his treatment. I was somewhat disappointed by his failure to respond at times, which prevented
me from asking for his help when I observed serious misconduct occurring after Glenda was transferred to Manor Care Rossmoor Parkway. I found no copies of any medical reports relating to Dr. Sherman or Contra Costa Oncology at either John Muir hospital or Manor Care, and did not expect to find any, since Glenda’s medical problem started with a fungusrelated shortness of breath and complicated by a developing pressure ulcer on her back. I would like to have copies of such reports if they exist. Now that you mentioned that Dr. Modarressi was following Glenda’s treatment during the period from January 5, 2012, to February 1, 2012. I wasn’t aware of that until you stated it in your letter. Questions arise. For instance, why nothing was said by Dr. Modarressi or Contra Costa Oncology when: John Muir hospital ordered pulmonary rehabilitation treatment for Glenda and transferred her to a skilled nursing facility that did not have such treatment. Manor Care accepted Glenda for that treatment, assuring John Muir hospital (and Glenda) that they would provide that treatment, when they did not have such a unit. That acceptance was apparently to keep the flow of patients being referred from the hospital to Manor Care. That fraudulent acceptance required a series of medical frauds to occur that could have—and did have—fatal consequences. Within 24 hours of Glenda’s fraudulent admission to Manor Care, their management and attending physicians immediately engaged in a series of fraudulent acts to remove Glenda from their facilities before federal and state regulators discovered what happened. First fraud upon this senior lady was to fraudulently state to her that her shortness of breath condition was not capable of being improved upon, and that she should settle for pal-
liative treatment. Also, that she had to leave the facility. The doctor stating that lie was India-trained Dr. Smita Chandra, from the Hospice of the East Bay, and a member of your group. But worse was yet to come from that doctor. Glenda developed a painful pressure ulcer on her back, over the spine. That dangerous medical condition required the attention of a wound specialist, and basic medical procedures that were never accomplished. To have provided that treatment would have required keeping Glenda at Manor Care. That, in turn, would increase the danger that the fraudulent acceptance of Glenda would be discovered by federal and state regulators. | In place of universally-recognized treatment for the pressure ulcer, Manor Care attending physicians, including the physician-in-charge, Martin Jimenez, gave Glenda roundthe-clock drugs that are not to be used on COPD patients, and other drugs that had significant side effects. Physicians involved in Glenda’s medical treatment repeatedly refused to respond to my faxes requesting information about Glenda’s condition and treatment. I was Glenda’s domestic partner for 18 years; I arranged for her intensive medical treatment for the past four years; I had power of attorney over her medical care; and I had years of prior experience in the medical community as a pharmaceutical company representative. It was necessary to withhold information from me in order to cover up for the ongoing frauds. Physicians and management at Manor Care took advantage of Glenda’s pain and mind-altering drugs to induce her to deny me any role in the attempt to appeal her discharge and oppose transfer to hospice. Glenda had two treatable medical conditions and not suitable or eligible for hospice. Two physicians accommodated Manor Care’s need to remove Glenda from Manor Care by discharging her to Hospice of the East Bay’s Bruns house. With no experience in oncology, no involvement in Glenda’s treatment, and fully
aware of the series of frauds inflicted upon Glenda, the doctors participated in preparing Certification of Terminal Illness, falsely certified that Glenda was expected to die within six months from esophageal cancer. Glenda had two treatable medical problems. One was the shortness of breath for which John Muir hospital physicians ordered pulmonary rehabilitation treatment that was fraudulently withheld from her. The second was the untreated pressure ulcer that developed during her stay at John Muir hospital and worsened at Manor Care Rossmoor Parkway. No treatment was directed at esophageal cancer and none was required. It was in remission and Glenda was scheduled to start on a series of Taxol infusions. Making the certification of Terminal Illness by Dr. Jan Spencer of Hospice of the East Bay even a worse offense, the unwritten admission requirement for Bruns House was that the patient has only seven to ten days of life remaining. Glenda arrived at Bruns House hospice, being transferred from Manor Care, at 2 pm on January 31, the day of the Certification of Terminal Illness preparations. All afternoon she was smiling, talking on the phone, reading newspapers, and doing crossword puzzles. Glenda had no idea of the frauds inflicted upon her by doctors and management at two skilled nursing facilities: Manor Care Rossmoor Parkway and Kindred. The physician put in charge of ordering morphine for Glenda’s pain from the untreated pressure ulcer was Dr. Smita Chandra, of the Hospice of the East Bay. Chandra was the same doctor who fraudulently stated to Glenda within 24 hours of her arrival at Manor Care that she was not capable of having her shortness-of-breath improved upon-and that Glenda should select palliative care. Hours later, Glenda was comatose, gasping for breath, and then died. Death by medical homicide, with multiple enablers!!
An oncologist, even though not a specialist in the two treatable medical problems affecting Glenda, the medical misconduct and criminal frauds, and danger to Glenda’s life, should have been immediately recognized, and action taken. You, as head of the John Muir Physician Network, have a moral and legal duty to report and bring about an investigation by an outside group. Failure to do that makes you one of many enablers, allows the guilty to remain unpunished, and for others to suffer and be put to death by this culture. It is also a sad example of life in America when an 89-year-old senior has to fight to prevent his partner from being criminally mistreated by a series of physicians, put to death, and then have to fight by himself to circumvent the series of enablers in the federal and states oversight bodies, physician groups, and others. ---------------------Letters that I sent to other doctors involved with Glenda’s treatment went unanswered. India-trained Dr. Smita Chandra, Jan Spencer, and others never replied. My letters to involved doctors and other medical personnel, and other information not in this book, can be found at the following web site: www.defraudingamerica.com/glenda.html. Atrocious Medical Misconduct Kept from General Public Outrageous medical misconduct rarely gets printed in the media; something like the thousands of sexual crimes committed by Catholic priests went unreported by medical personnel for decades. Surgeons Preying Upon Their Patients In October 2002, 40 FBI agents raided doctors’ offices at the Redding Medical Center Hospital in Redding, California, operated by Tenet Healthcare Corporation, after evidence surfaced that certain heart surgeons were performing open-heart surgery on patients that had no heart problems. The income from open-heart surgery was so lucrative that they performed this massive invasive surgery on people that did not have any heart problems.
The surgeons involved included Fidel Realyvasquez, Kent Brusett, Chae Hyun Moon, and Ricardo Javier Moreno-Cabral. The evidence first came to light when one patient, Father John Corapi, a Catholic priest, who Moon scheduled for triple bypass surgery, went to another doctor for a second opinion, and it was discovered that he had no heart problems whatsoever. U.S. Attorney Michael Hirst, after prosecuting the case, stated: The evidence shows these doctors ran a high turnover, high volume surgery mill. While the evidence did not establish beyond a reasonable doubt that the doctors intended to perform unnecessary heart surgeries, the evidence was convincing that the doctors showed a reckless disregard for whether those surgeries were necessary or in their patient’s best interests. All of the doctors paid settlements to the patients of many millions of dollars, along with Tenet Healthcare Corporation. In addition, there were over 600 civil lawsuits filed. Pharmaceutical Companies Withholding Evidence of Deadly Consequences On May 10, 2007, Purdue Pharma, and three of its executives pled guilty to criminal charges that they had deliberately made false statements to the government, withholding evidence of deadly consequences from the use of the drug, OxyContin. The false claims made by the company, and the withholding of the deadly side effects, enabled the company’s sales of OxyContin to exceed $1 billion a year. For pleading guilty, the company agreed to pay $634.5 million in fines and other payments to resolve the criminal charge of misbranding the product, which was a fraction of the profits made from the drug. The three company executives that pled guilty were a lawyer, the president, and another company executive. Chief executive Michael Friedman, general counsel Howard Udell, and chief medical officer Paul Goldenheim, all of whom pled guilty, were ordered to pay fines of $7.5 million to $19 million. Many people became addicted to the drug after taking it for a short time, information that the company kept from doctors, patients, and the government oversight agency. Despite the fact that many
people were sent to prison for possession or distribution of the drug, none of the executives were ordered to serve any prison time. David Siesko of a consulting firm on insurance and riskmanagement matters, Siesko Partners, stated: It’s a very grim day for the pharmaceutical industry. The level of executives involved in guilty pleas and misrepresentations is just chilling on the industry when you think of how things will start to move forward. Also pleading guilty to criminal charges in May of 2007 was Bristol-Myers Squibb for making false statements to the government relating to the company’s efforts to preserve a lucrative monopoly for the anti-clotting drug, Plavix. Kickbacks to Encourage Prescription Writing Many forms of kickbacks exist to encourage doctors to prescribe certain tests or to prescribe drugs. With drugs, the kickbacks encourage doctors to prescribe the more expensive drugs under patent protection than equally effective generic versions. Or, to prescribe drugs that aren’t necessary. A New York Times editorial (May 14, 2007) addressed a small portion of this problem. Under the headline, The Danger in Drug Kickbacks, the article stated: The explosion in the use of three anti-anemia drugs to treat cancer and kidney patients illustrates much that is wrong in the American pharmaceutical marketplace. Thanks to big payoffs to doctors, and reckless promotional ads permitted by lax regulators, the drugs have reached blockbuster status. Now we learn that the dosage levels routinely injected or given intravenously in doctors’ offices and dialysis centers may be harmful to patients. Wide use of the medicines, Aranesp and Epogen, from Amgen; and Procrit, from Johnson & Johnson, has been propelled by the two companies paying out hundreds of millions of dollars in so-called rebates. Doctors typically buy the drugs from the companies, get reimbursed for much of the cost by Medicare and private insurers, and on top of that get these rebates based on the amount they have purchased.
For high-volume providers, the profits can be substantial. One group of six cancer doctors in the Pacific Northwest earned a profit of about $1.8 million last year thanks to rebates from Amgen, while a large chain of dialysis centers gets an estimated 25 percent of its revenue, and a higher percentage of its profits, from the anemia drugs. It seems likely that these financial incentives have led to wider use and the prescribing of higher doses than medically desirable. Obviously, the oversight personnel are either incompetent, lazy, or knowingly complicit or enablers, combined with the usual media and congressional cover-ups. Cover-Up by California Department of Justice Employees Months after I sent a complaint to the California Department of Justice, an agent called me (May 14, 2012) and stated they were not proceeding on my complaint on the basis that the death certificate issued by one of the doctors stated Glenda died from esophageal cancer. That death certificate stating Glenda died of esophageal cancer was signed by Hospice of the East Bay’s Dr. Jan Spencer, complicated by Diabetes Type II and coronary artery disease. Glenda was never diagnosed or treated for diabetes, nor coronary artery disease. The cancer diagnosed four years earlier was in remission. Dr. Spencer’s death certificate protected her colleagues at Bruns House, Dr. Chandra, and the Manor Care participants. Prior to that call, no one had ever contacted me about the information I had. When two people are dead from alleged series of corrupt actions, the most elementary investigative action requires contact the person closest to the action. That would be me. Since I was a former federal agent, probably with far more investigative experience that most of their employees had, that would be even more reason to not only contact me but make me parts of the investigation work. Department of Justice personnel had never conducted the most basic investigative requirements and sought to support their coverup—also known as obstruction of justice—by use of the doctor's death certificate.
After that agent, Rosa Gonzales, made that ridiculous statement, I explained the problem with that thinking, since the doctor certifying Glenda’s death was involved in the medical misconduct that resulted in her death, and any coroner report would simply repeat what the doctor stated. I then requested that Gonzales put that decision in writing, which he stated he would do. On May 17, 2012, I sent an email to California Department of Justice agent Rosa Gonzales, addressing the cover-up excuse he had given to me during the earlier phone call, and reminded him to send me the decision in writing that the California Justice Department was not investigating the events leading up to two deaths because of the doctor report that Glenda died from esophageal cancer. Facts relating to death certificates: A combination PBS Frontline and ProPublica investigation revealed the sordid facts of deaths that often go unpunished, uninvestigated, and unsupported or sham coroner reports on the actual cause of death. Excerpts from their report follows: For more than a year, ProPublica, in concert with other news organizations, has scrutinized the nation's coroner and medical examiner offices , which are responsible for probing sudden and unusual fatalities. We found that these agencies—hampered by chronic underfunding, a shortage of trained doctors and a lack of national standards—have sometimes helped to send innocent people to prison and allowed killers to walk free. An investigation by ProPublica, in concert with other news organizations, investigating the nation’s coroner and medical examiner offices discovered that those agencies lacked competency, lacked national standards, and a shortage of trained doctors; and that the results were that sometimes innocent people were sent to prison on their testimony, or killers went unpunished. [Effects upon Deaths of Older People] When it comes to the elderly, the system errs by omission. If a senior … dies under suspicious circumstances, there's no guarantee anyone will ever investigate. Catherine Hawes, a Texas A&M
health-policy researcher who has studied elder abuse for the U.S. Department of Justice, described the issue as “a hidden national scandal.” Because of gaps in government data, it's impossible to say how many suspicious cases have been written off as natural fatalities. However, the limited evidence available points to a significant problem: When investigators in one jurisdiction comprehensively reviewed deaths of older people, they discovered scores of cases in which elders suffered mistreatment. An array of systemic flaws has led to case after case being overlooked: When treating physicians report that a death is natural, coroners and medical examiners almost never investigate. But doctors often get it wrong. In one 2008 study, nearly half the doctors surveyed failed to identify the correct cause of death for an elderly patient with a brain injury caused by a fall. In most states, doctors can fill out a death certificate without ever seeing the body. That explains how a Pennsylvania physician said her 83-year-old patient had died of natural causes when, in fact, he'd been beaten to death by an aide. The doctor never saw the 16-inch bruise that covered the man's left side. Autopsies of seniors have become increasingly rare even as the population age 65 or older has grown. Between 1972 and 2007, a government analysis  found, the share of U.S. autopsies performed on seniors dropped from 37 percent to 17 percent. Dr. Michael Dobersen, a forensic pathologist and the coroner for Arapahoe County, Colo., said he worries about suspicious deaths in nursing homes. “Sometimes, if I don't want to sleep at night, I think about all the cases that we miss,” Dobersen said. “I'm afraid we're not looking very hard.” In a handful of locales, coroners and medical examiners have begun to view older Americans as a vulnerable population whose deaths require extra attention. Some counties have formed elder
death review teams that bring special expertise to cases of possible abuse or neglect. In Arkansas, thanks to one crusading coroner, state law requires the review of all nursing-home fatalities, including those blamed on natural causes. But those efforts are the exception. In most places, little is being done to ensure that suspicious senior deaths are being investigated. “We're where child abuse was 30 years ago,” said Dr. Kathryn Locatell, a geriatrician who specializes in diagnosing elder abuse. “I think its ageism—I think it boils down to that one word. We don't value old people. We don't want to think about ourselves getting old.” Across the country, state laws rely on doctors to separate extraordinary fatalities from routine ones, principally by what they record on death certificates. When a doctor encounters an unusual fatality—a death that may have been caused by homicide or suicide or accident—the physician must report it to the coroner or medical examiner for further investigation. The investigative work can be as minimal as gathering clues from the place where a body was found, or as extensive as a full autopsy—the dissection and evaluation of a corpse to pinpoint the precise reason for death. In Shepter's case, Pormir, the nursing-home doctor, checked off a small box on the death certificate indicating that he never contacted the county coroner. There was no autopsy. The laws assume physicians like Pormir will report deaths accurately and fully, flagging suspicious cases. In reality, though, death certificates are frequently erroneous or incomplete, academic research has shown. A study published last year in The American Journal of Forensic Medicine and Pathology found that nearly half of 371 Florida death certificates surveyed had errors in them. Doctors without training in forensics often have trouble determining which cases should be referred to a coroner or medical examiner. In a 2008 study, 225 physicians were asked to determine what killed an elderly man who had fallen and suffered a severe head injury. Just over half of the doctors correctly identified bleeding of
the brain as the primary cause of death. Nearly two-thirds did-
n't list the fall as a contributing factor.
“I knew people were going to get it wrong, but it was a surprise just how poorly people did,” said Dr. Marian Betz, who led the study and teaches medicine at the University of Colorado. Robert Anderson, chief of mortality statistics for the Centers for Disease Control and Prevention, said some doctors don't grasp the significance of death certificates. “I've had instances where the physician just doesn't understand the importance of what they're writing down,” said Anderson, who trains doctors in how to certify deaths. “I'm appalled when I hear that.” CHAPTER TWENTY TWO
Criteria for Doctor Conduct To be Criminal Acts
The following information is provided to help understand the type of acts that are criminal under federal and similar state criminal statutes. Many criminal acts are not prosecuted, but should be. Catholic priests have been committing thousands of sexual crimes against vulnerable children, worldwide, for decades. It is only after a few media sources finally publicized the crimes that certain prosecutors started to perform their duty, in isolated cases. And even then, reference is to sexual abuses, not the sexual crimes that they were. The same culture of silence exists related to the crimes of doctors against their patients. When lawsuits have been filed against these crimes by doctors, media personnel generally continue the coverup. It is a crime to cover up for a crime. Euthanasia and Physician-Assisted Death If a person kills another person the killing is considered a homicide. It does not matter if the other person is about to die or is ter-
minally ill and has just a short time to live. Euthanasia is generally considered a criminal act and rarely prosecuted. This must change. Medical Manslaughter Legally, medical manslaughter is no different from gross negligence manslaughter. Medical manslaughter refers to medically qualified individuals who perform acts within the medical duties when the act, or the omission of acts, occurs. Constituting Criminal Acts An article written by John A. Humbach, Professor of Law, Pace University School of Law, referred to a case where a child is seriously ill and would die if steps were not promptly taken. The doctor in that case approved the treatments but the HMO refused. Premiums were paid to the HMO for health care but to save money, the HMO refused to provide the treatment. Humbach wrote: “When people deliberately do things that are almost certain to cause death, and someone dies as a result, prosecutions for homicide are normally appropriate.” Homicide can be committed by commission or by omission— by affirmatively doing a lethal act or by omitting to do an act that is necessary to preserve another's life. In order for a fatal omission to be considered a crime, the omitter must have had a legal duty to act, such as a physician or a medical provider. The victim’s death must result from a failure to perform that duty. See People v. Burden, 140 Cal. Rptr. 282, 289-92 (Ct. App. 1977); see also Commonwealth v. Hall, 78 N.E.2d 644, 647 (Mass. 1948); Territory v. Manton, 19 P. 387, 392-93 (Mont. 1888); Biddle v. Commonwealth, 141 S.E.2d 710, 714-15 (Va. 1965) (collecting numerous cases and treatises). See generally WAYNE R. LAFAVE & AUSTIN W. SCOTT, JR., CRIMINAL LAW 202-12 (2d ed. 1986); JOSHUA DRESSLER, UNDERSTANDING CRIMINAL LAW 89 (2d ed. 1995) (providing an overview of liability by omission). A person is guilty of murder if he or she intentionally or knowingly causes the death of another human being, engages in conduct that manifests a depraved indifference to the value of human life and causes death.
In Dressler, supra note 1, at 86-89; see also Pope v. State, 396 A.2d 1054 (Md. 1979); People v. Beardsley, 113 N.W. 1128, 1129 (Mich. 1907) (stating that “the duty neglected must be a legal duty, and not a mere moral obligation. It must be a duty imposed by law or by contract, and the omission to perform the duty must be the immediate and direct cause of death.” In Jones v. United States, 308 F.2d 307, 311 (D.C. Cir. 1962); People v. Burden, 140 Cal. Rptr. 282 (Ct. App. 1977) (sustaining a murder charge based on a parent’s failure to feed an infant); People v. Abraham, 629 N.E.2d 148, 153-54 (Ill. App. Ct. 1993) (sustaining convictions for murder and aggravated battery based on parent’s failure to take affirmative action to protect children from an abusive live-in boyfriend); Commonwealth v. Twitchell, 617 N.E.2d 609, 613 (Mass. 1993); State v. Norman, 808 P.2d 1159 (Wash. Ct. App. 1991) (upholding manslaughter conviction for parent who failed to perform legal duty to care for his son). Criminal liability for causing death is not relieved by the victim’s pre-existing health condition, or the fact that the victim was going to die anyway. 8 “Life at best is but of short duration”9 and, given the inevitability of eventual death, the law is clear that “[m]urder is never more than shortening of life,”10 even if only by a day.11 It is, moreover, always a characteristic of omission-homicide cases that there are other causes of death than the omission alone. What makes fatal omissions into crimes is, precisely, the defendant’s wrongful failure to avert such other causes. In cases directly involving doctors, reference was made to certain doctors in HMO health plans: The HMO’s duty is contractual and is subject to stipulated exceptions while the uncle’s duty is rooted in a status relationship and is relatively unconditional. However, despite these differences in the origin and scope of the legal duty, once it is shown that the duty has in fact been breached, the cases would seem legally the same. That is, assuming the HMO breached its contractual duty by refusing to authorize timely care, the HMO
and its decision making personnel would seem to be in exactly the same legal position as the avaricious uncle—criminally liable for the death. See People v. Morgan, 79 Cal. Rptr. 911, 913-14 (Ct. App. 1969) (holding appellant guilty of murder for causing the victim to die of a heart attack); State v. Malley, 366 P.2d 868, 873 (Mont. 1961) (allowing conviction if the “spark of life is extinguished by a wrongful act”); cf. Barber v. Superior Court, 195 Cal. Rptr. 484, 487 (Ct. App. 1983) (referring to superior court judge’s conclusion that homicide is the shortening of life since everyone sooner or later will die). In People v. Moan, 4 P.2d 545, 548 (Cal. 1884) (stating that it is homicide even if the victim has “a tenure upon life that cannot possibly continue for a day”). To my knowledge, no HMO entity or personnel have ever yet been criminally prosecuted for wrongful delay or denial of treatment authorization. It may, however, be only a matter of time before such prosecutions are attempted. Already there is a growing interest in civil actions for the harms that ensue when people, relying on HMOs, suffer or die because benefits are denied.13 There is, moreover, considerable disquiet about the federal limitations on HMO liability that were enacted by Congress in the Employee’s Retirement Income Security Act (ERISA).14 However, the ERISA exemptions do not apply to criminal laws.15 In many cases, criminal prosecutions may therefore be the only effective avenues of redress. In any case, criminal sanctions may actually work better than mere civil damages to motivate HMOs [or doctors] to authorize the medical treatments that their subscribers are contractually entitled to. One of the biggest disadvantages of allowing civil damages against HMOs is that the companies can simply shift the burdens of those “penalties” back to the subscribers, in the form of higher premiums. For the HMO, the amounts paid out as damages in lawsuits become just another cost of doing business. As a result, civil damages for wrongful treatment denials may actually work against the interests of the HMO’s sub-
scribers and patients, increasing premiums and diverting scarce resources away from medical care into judgments and lawyers’ fees. When people subscribe to HMOs, what they are primarily seeking is quality medical care, as needed, not a right to get cash “compensation” after the fact, when life-or-death treatments have been denied.16 Money is a poor recompense for a permanently impaired quality of life or the loss of life itself. It little serves the person denied benefits, or his surviving family and loved ones, to let an HMO get off with merely paying damages, which it can pass on to subscribers, instead of delivering the benefits it has promised in its contract.17 [Life and Death Medical Contracts] The legal agreements that people make with HMOs are no ordinary commercial contracts. The due performance of these agreements can be vital to life itself. As long as HMOs are able to shift the costs of their breaches, it may never be possible to minimize the number of wrongful HMO denials. The only way to prevent HMOs from shifting the penalties for wrongful denials is to impose a cost on wrongful denials that the HMO cannot shift. This is, of course, the classic function of the criminal law—to impose costs on bad behavior that offenders cannot shift. A civil defendant may shift the cost of a monetary judgment, but a criminal defendant cannot “shift” a prison sentence. Although criminal punishment is a dramatic response to administrative errancy, the fact remains that it is the response prescribed by law for cases where people’s conduct proves deadly or causes serious bodily harm.18 In the social debate about the role of HMOs, our nation’s commitment to criminal punishment as a tool of social policy must be recognized as part of the background. In any case, the deterrent impact of criminal penalties can scarcely be doubted: A potential for criminal prosecutions would give HMO decision-makers a strong incentive to treat subscribers right, avoiding delays and unwarranted denials of treatment authorization. In addition, with prosecutions a possibility, the public could feel much more secure against
wrongful medical care denials in any situation where the patient’s life might be shortened or health seriously compromised. In sum, while there are many possible approaches to the regulation of HMOs [or any doctor under any other medical plan],19 the most straightforward approach may be simply to enforce the rules we already have, the existing rules of criminal law, the rules to which our society turns routinely to address a wide range of harmful activities. First, the criminal law has the advantage of subjecting wrongful treatment denials to a penalty that cannot be shifted back to subscribers. Second, the criminal law is not superseded by ERISA, so the current federal barriers to civil lawsuits would not stand in the way. Third, as will be described below,20 criminal prosecutions offer advantages with respect to proof. Medical decisions and judgments are necessarily discretionary, and it may be almost impossible for a civil plaintiff to demonstrate in an individual case that economic considerations played a role, much less an improper role, in an HMO’s decision to deny benefits.21 In a criminal prosecution, by contrast, the needed evidence can be obtained by such well-tested prosecutorial techniques as, for example, offering leniency to subordinates in exchange for testimony against their superiors, the individuals directly responsible for forming HMO policies. Finally, as will also be outlined below, the criminal law on lethal and other injurious activities is rather clear. The only real questions seem to be factual. Did the HMO refuse to authorize treatment benefits in a situation where there was a legal duty to approve and provide them promptly? Were the HMO’s decision-makers aware of the risks imposed? -----------------Michael Jackson Doctor Held Guilty for Criminal Act for Careless Use of Drug In the murder trial against the personal physician of Michael Jackson, the conviction was based upon the doctor’s careless use of the drug propofol to treat Jackson’s chronic insomnia. That doctor, a
medical professional, was criminally charged for a standard of care deviation, and charged with involuntary manslaughter. By the careless prescription of propofol, the doctor’s acts were judged criminally negligent and a gross deviation from applicable standard of care, resulting in the death of another person. The doctor was found guilty because he prescribed a commonly used drug. Now, compare the guilt of Michael Jackson’s doctor with what a series of closely associated doctors and medical facilities did to Glenda. Should they also be charged with murder or homicide? If they aren’t, what incentive is there for this culture not happening to you or a loved one any time you seek medical treatment? Compare that standard with what was done by a group of doctors and medical facility management personnel to Glenda. Or what Kaiser Permanent death panel doctors sought to do to me by denying universally recognized cancer treatments. A person, including physicians, can commit homicide by commission of an act, or by omission of any act—by affirmatively doing a lethal act or by omitting to do an act that is necessary to preserve another's life.1 For a fatal omission to be considered a crime, the omitter must have had a legal duty to act,2 and the victim’s death must result from a breach of that duty. Federal Criminal Statutes Consider the following federal crimes that are found under various statutes in most states: Title 18 U.S.C. § 2. Principals. (a) Whoever commits an offense against the United States or aids, abets, counsels, commands, induces or procures its commission, is punishable as a principal. (b) Whoever willfully causes an act to be done which if directly performed by him or another would be an offense against the United States, is punishable as a principal. Note: The legislative intent to punish as a principal not only one who directly commits an offense and one who “aids, abets, counsels, commands, induces or procures” another to commit an offense, but also anyone who causes the doing of an act
which if done by him directly would render him guilty of an offense against the United States. Case law decisions: Rothenburg v. United States, 1918, 38 S.Ct. 18, 245 U.S. 480, 62 L.Ed. 414, and United States v. Giles, 1937, 57 S.Ct. 340, 300 U.S. 41, 81 L.Ed. 493. Title 18 U.S.C. § 3. Accessory after the fact. Whoever, knowing that an offense against the United States had been committed, receives, relieves, comforts or assists the offender in order to hinder or prevent his apprehension, trial or punishment, is an accessory after the fact. Title 18 U.S.C. § 4. Misprision of felony. “Whoever, having knowledge of the actual commission of a felony cognizable by a court of the United States, conceals and does not as soon as possible make known the same to some judge or other person in civil or military authority under the United States, shall be fined not more than $500 or imprisoned not more than three years, or both.” Title 18 U.S.C. § 34. Penalty when death results. Whoever is convicted of any crime prohibited by this chapter, which has resulted in the death of any person, shall be subject also to the death penalty or to imprisonment. Title 18 U.S.C. § 241. Conspiracy against rights of citizens. If two or more persons conspire to injure, oppress, threaten, or intimidate any citizen in the free exercise or enjoyment of any right or privilege secured to him by the Constitution or laws of the United States, or because of his having so exercised the same; ... They shall be fined ... or imprisoned ... or … Title 18 U.S.C. § 371. Conspiracy to commit offense or to defraud United States. If two or more persons conspire either to commit any offense against the United States, or to defraud the United States, or any agency thereof, in any manner or for any purpose, and one or more of such persons do any act to effect the object of the conspiracy, each shall be fined ... or imprisoned ... CHAPTER TWENTY THREE
Sampling of Glenda in Happier Times
Glenda at Bodega Bay
Bridge Across Colorado River
Glenda loved flying above the clouds.
Afterword to The Glenda Medical Tragedy
At this writing, I still grieve for Glenda. I think I am getting over her death, and then when I review the details leading up to her death, or see the pictures of her dying, of gasping for breath from the morphine overdose, the grieving and anger starts all over again.
I try to tell myself that this is life, and that people die. But Glenda wasn’t meant to die. She had beaten the odds and was cancer-free after four years. She looked to return home and return to an active life. For me, thinking of how people in positions of trust engaged in outright fraud to bring misery and death upon this fine lady, I’m determined to continue doing what is probably a hopeless task seeking to expose and bring about changes in the corrupt elements within America’s healthcare industry. My unusual background as a government insider close to corrupt conduct that enabled to occur a long line of preventable airline crashes and deaths, and then with the help of the dozens of other former government agents and insiders expose still other areas of corruption responsible for even more deaths, have left me with an “acceptance” of fraud-related deaths and tragedies. In the beginning, the corruption and the resulting deaths affected me emotionally, and drove me to take never-before taken actions seeking to expose and halt the tragedies. But after experiencing cover-ups and indifference everywhere I turned, and lack of outrage by the people I made aware of these matters, my emotions cooled down. I was still mad, and still fought it. But after years of cover-ups and public indifference I looked at it as the public itself, their indifference and obsession with trivia, brought the tragedies down upon themselves. Over the years, fortified with information from many insiders, the deaths in other areas of corruption no longer disturbed me. With tens of thousands of deaths of people in foreign countries being killed by America’s constant invasions of other countries, and the heavy public support for what were essentially murders of innocents, the idea of death seemed to lose meaning. Renewed Outrage over the Corruption Bringing about Glenda’s Death Now, with the corruption embedded in the healthcare industry that has existed for years, I have one last project before my life ends. That is to expose the corrupt elements in America’s healthcare field that is responsible for probably thousands of deaths a year—
and that of Glenda. That includes the many enablers, with oversight responsibilities: media personnel; members of Congress; and others. Based upon the past 40 years of doing this, I have no chance of affecting change. I face the problem of Glenda’s death being simply one in tens of thousands a year from corrupt acts and corrupt culture. But like the impossible dream, and Don Quixote, I plug on, mindless of the futility. For Glenda, I have to do it. I have so little time left.
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