Literature Review

As hospitalists’ role grows, so do the ethical dilemmas Medscape; by Donavyn Coffey; 2/17/25 Margot Eves, JD, clinical ethicist for Cleveland Clinic, was called in for an emergency consult: A man in his early 50s was asking doctors to take him off the ventilator. Just 24 hours before, the man with chronic obstructive pulmonary disease (COPD) okayed the life-saving treatment. The hospitalist over his care expected him to come off the ventilator in a few days, but 24 hours was too soon. He wouldn’t survive. With head nods and in writing the patient signaled that he was fully aware — he understood this would end his life. Eves was called in to help weigh the options: Honor the patient’s wishes or help him survive. These kinds of ethical dilemmas have become common to the burgeoning hospitalist profession. ....

Former hospice physician alleges retaliation against nonprofit healthcare provider Northern California Record; by Northern California Record State Court; 1/23/25 In a gripping legal battle that raises questions about medical ethics and employee rights, a former hospice physician has filed a lawsuit against his previous employer, alleging wrongful termination and retaliation. The complaint was lodged by Kamaldip Ghei in the Superior Court of California, County of San Francisco, on January 10, 2025, targeting Sutter Visiting Nurse Association and Hospice dba Sutter Care at Home. ... Ghei claims he was wrongfully terminated after raising concerns about the organization's practices regarding patient care. Specifically, he alleges that he was pressured to keep patients in hospice care even when it was not medically justified. ...

North Augusta hospice nurse arrested after allegedly using fake prescriptions Aiken Standard, Aiken, SC; by Matthew Christian; 1/22/25 A North Augusta hospice nurse has been arrested after allegedly acquiring prescription drugs with fake prescriptions. South Carolina Bureau of Drug Control agents arrested Amy Elizabeth Strand, 44, on Jan. 17, according to an Aiken County Sheriff's Office booking report. Strand obtained lorazepam 2 mg tablets from the North Augusta Kroger on June 22, 2024, Agent B.A. Stafford said in a warrant. ... To get the pills, Strand called in a fake prescription in the name of a patient under her care, Stafford continued. ... Strand has been charged with three counts of obtaining a controlled substance by fraud and one count of attempting to obtain a controlled substance by fraud. 

Santa Maria investment advisor pleads guilty to federal wire fraud chargeSannta Maria Times, Santa Maria, CA; by Dave Minsky; 1/2/25 A Santa Maria registered investment advisor pleaded guilty to a wire fraud charge after admitting to stealing $2.25 million from mostly elderly clients who put her in charge of their assets, according to a plea agreement filed in Los Angeles federal court earlier this month. ... Federal officials alleged that [Julie] Darrah’s scheme ran from November 2016 until about July 2023 and involved at least 11 victims who were mostly elderly, including some who were receiving end-of-life care. ... Prosecutors alleged Darrah would gain control of her clients’ assets in several ways, including making her the trustee of their trusts, having the victims executing standing letters of authorization that gave Darrah control of their accounts, making Darrah a signatory on their accounts and giving Darrah power of attorney over their property.

PBMs secretly profited from opioid crisis: New York Times Becker's Hospital Review; by Alexandra Murphy; 12/17/24 Pharmacy benefit managers were paid by drugmakers, including Purdue Pharma, to keep opioid prescriptions flowing even as overdose deaths soared across the U.S., according to an investigation by The New York Times. The Dec. 17 report highlighted how Express Scripts, CVS Caremark and Optum Rx, which control access to medications for millions of Americans, negotiated deals with opioid manufacturers to prevent restrictions on painkiller prescriptions in exchange for lucrative rebates. Between 2003 and 2012, Purdue Pharma paid PBMs roughly $400 million annually to avoid limits on opioid prescriptions, which included measures that could have curtailed overprescribing, such as requiring additional physician justifications or limiting the number of pills dispensed. Internal documents reviewed by the Times show how the PBMs repeatedly collaborated with opioid manufacturers to influence insurers' decisions and block restrictions.

Convicted trio jailed for elder abuse Inland News Today, Riverside, CA; 12/18/24 A 7-year prison sentence has been meted out for the neglect and abuse of six severely disabled residents at an unlicensed Riverside care facility. Ronnel Tiburcio was convicted of six counts of elder abuse likely to produce great bodily harm. Earlier, co-defendants Joel Ombao and registered nurse Nimfa Molina were handed jail sentences. Ombao owned several hospice companies, including the unlicensed Secure Hands board and care facility where the victims were housed. Ombao, his assistant Tiburcio, and registered nurse Molina, were responsible for operating the facility and caring for the residents. When investigators first checked out the care facility, residents were being housed in squalor. Many of them were emaciated and dehydrated.

'Egregious' and 'insulting': 23 leaders slam Anthem BCBS' recently reversed anesthesia pay policy Becker's ASC Review; by Patsy Newitt; 12/9/24Anthem Blue Cross Blue Shield has reversed its decision on a controversial anesthesia reimbursement policy update, which would have introduced a new reimbursement structure based on CMS physician work time values. Twenty-three anesthesiologists and certified registered nurse anesthetists connected with Becker's to discuss their thoughts. [Click on the title's link to read these powerful responses.]

A healthcare system’s moral bankruptcy goes viral MedCity News; by Neal K. Shah; 12/5/24 Brian Thompson's murder was chilling, but the social media response of this tragedy was equally shocking, if eye-opening. It shows a massive collapse of public trust in our healthcare system, a system so broken that it bankrupts families, denies life-saving care, and treats death as an acceptable cost of doing business. When UnitedHealthcare CEO Brian Thompson was gunned down outside a Manhattan hotel ..., something chilling happened: thousands of Americans responded not with horror, but with dark jokes and scathing comments about the health insurance industry. People shared stories of being denied coverage by the company and drew parallels comparing the CEO’s death to the ways they’ve been mistreated by America’s healthcare system. ... The tragedy of Thompson’s death is compounded by a cruel irony: He was rushed to Mount Sinai  — a healthcare system whose hospitals UnitedHealth removed from its network only a few months ago, leaving thousands of patients scrambling. Even in death, he couldn’t escape the byzantine system his company helped create.

A moral code: Ethical dilemmas in medicine — three physicians face crossroads in patient care MedPage Today; podcast by Genevieve Friedman, Perspectives Editor; 10/25/24 We are back for another episode of our medical podcast, which we hope isn't really a podcast about medicine, but a podcast about life, death, dilemma, the challenges, and sometimes the joys of medicine. ... Now, medicine is complicated because a lot of times there aren't hard and fast rules ... One treatment isn't always right or wrong for someone. One surgery isn't always successful or unsuccessful, and one diagnosis isn't always correct. Decisions aren't black and white, they're varying shades of gray. So we come up with principles to help handle this -- codes if you will. But even those get a bit marred by complexity at times. As you'll hear in this episode of Anamnesis with the theme of "A Moral Code: Ethical Dilemmas in Medicine," one of our biggest codes is "do no harm." But what is harm? Who decides what harm is, what happens if we disagree?

How physicians can navigate ethical conflicts when caring for patients Physician's Weekly; 10/14/24 ... According to the president of The Physicians Foundation, Gary Price, MD, ethics in medical care are particularly complicated regarding end-of-life choices. While decades ago, a patient’s primary care provider (PCP) would have been involved in that patient’s hospitalized care and their end-of-life decisions within the hospital, the fragmented nature of today’s healthcare system has all but eliminated PCPs from involvement in hospitalized patient care. As such, patients often make end-of-life decisions based on the guidance of doctors with whom they have no pre-existing relationship. Other factors that blur ethical lines in healthcare, adds Dr. Price, are the new state of healthcare ownership and financing. Dr. Price mentions, for instance, conflicts of interest due to the US’s biggest employer of physicians, Optum, being a subsidiary of the same company that owns UnitedHealthcare. This situation allows for an insurer who controls reimbursement and who could, as the physician’s employer, influence decisions made regarding patient care. Sadly, this influence largely comes from financial concern instead of concern for the patient’s best health outcomes. 

Texas families take on Houston-based solar company in arbitration case CBS News Texas; by Andrea Lucia, Lexi Salazar, and Mike Lozano; 9/24/24 In February, the CBS News Texas I-Team revealed a pattern of complaints against Sunnova Energy, accusing it of preying on the sick and elderly by getting them to sign long-term payment plans for solar panels they can't afford. ... Joshua resident Cynthia Hampton was featured in the I-Team's February report about Sunnova. Hampton believed her late father, who was receiving in-home hospice care, was tricked into signing a contract with Sunnova, leaving his children to settle the debt after his death. ... Mark Alexander believes the company's practices violate the Deceptive Trade Practices Act and that the company has committed breach of warranty and fraud. ... In an emailed statement to the I-Team, Sunnova wrote in part: "Nothing is more important to us as a company than customer service. ... 

AI shouldn't decide who dies. It's neither human nor humane Fox News; by John Paul Kolcun and Anthony Digiorgio; 9/20/24 [Opinion] As we write this, PubMed ... indexes 4,018 publications with the keyword "ChatGPT." Indeed, researchers have been using AI and large-language models (LLMs) for everything from reading pathology slides to answering patient messages. However, a recent paper in the Journal of the American Medical Association suggests that AI can act as a surrogate in end-of-life discussions. This goes too far. The authors of the paper propose creating an AI "chatbot" to speak for an otherwise incapacitated patient. To quote, "Combining individual-level behavioral data—inputs such as social media posts, church attendance, donations, travel records, and historical health care decisions—AI could learn what is important to patients and predict what they might choose in a specific circumstance." Then, the AI could express in conversant language what that patient "would have wanted," to inform end-of-life decisions. We are both neurosurgeons who routinely have these end-of-life conversations with patients’ families, as we care for those with traumatic brain injuries, strokes and brain tumors. These gut-wrenching experiences are a common, challenging and rewarding part of our job. Our experience teaches us how to connect and bond with families as we guide them through a life-changing ordeal. In some cases, we shed tears together as they navigate their emotional journey and determine what their loved one would tell us to do if they could speak. 

Hiring manager fired for refusing to post 'ghost jobs' is now sharing how to recognize them Upworthy; by Jacalyn Wetzel; 9/18/24 There doesn't seem to be a shortage in job openings but there does seem to be an abundance of people looking for work for months without finding gainful employment. According to Ceros Whaley, a former hiring manager at an unnamed company, the problem is that unsuspecting hopeful employees are unknowingly applying for "ghost jobs." Whaley shares that part of his job as a hiring manager was to create "ghost jobs," which are simply fake job listings. He explains that these job listings were not created to find more qualified people to fill positions but to "encourage" current employees to improve their performance. Whaley says that he got into a little bit of a kerfuffle with his higher manager over the company continuing the ghost job ruse. By the time the man reached his tolerance level for posting fake jobs, he had already posted over 300 ghost jobs on sites like Indeed, Monster and other hiring sites. But Whaley shares that he found his morals and just couldn't continue the practice. ... [The] frustrated former employee … did a follow up video sharing how to spot ghost jobs and how to avoid them while you're job hunting. [Click on the title’s link to view.]