Troubled Endings

For-profit hospice care provider Vitas Healthcare sacrifices patient needs for the bottom line

Backoff, a former Vitas rep, contends that there has been no pressure from upper management to increase numbers of patients since she became general manager in June 2002.

Barbara Rourke's deterioration began about two years ago, when she developed a nervous condition. Local doctors claimed she had Alzheimer's disease, but she exhibited no problems with her memory. Her daughter, Candi Rollins, and other family members doubted the diagnosis, so they took her to an Alzheimer's specialist in Massachusetts who quickly ruled out that disease. Upon her return to Pompano Beach, her husband -- Rollins' stepfather -- suffered a severe heart attack but was kept alive on a life-support machine. In the meantime, a psychiatric doctor prescribed anti-anxiety drugs for Rourke, who continued to visit her husband in the hospital and walk for exercise. During one of those walks in February 2002, she slipped and fell, and Rollins took her to the hospital to "rule out a hip fracture," she says. "I explained to them that she never had any medical problems but was taking these psych drugs and was being treated by a doctor and that he had said she shouldn't stop taking them."

Colby Katz
Barbara Rourke was "failing to thrive," according to doctors, and began receiving hospice care from Vitas Healthcare last September
Colby Katz
Barbara Rourke was "failing to thrive," according to doctors, and began receiving hospice care from Vitas Healthcare last September

The hospital, however, did not give her the drugs, Rollins says, and five days later, she "looked like a prisoner of war and couldn't even nod her head." Eventually she was transferred to a rehabilitation facility, but Rollins and her husband, Joe Moran, contend that little therapy ever took place. Rourke also didn't get assistance eating unless family members were there, Rollins says, so her mother lost weight. She says Rourke would "eat like a horse" when she or Moran fed her.

"They starve a patient, and then they insert a feeding tube," Moran complains. "That's another justification for Medicare to pay more. She begged me to take her home at night."

In September, the rehab's doctor recommended a hospice consultation for Rourke because she was "failing to thrive." During that consultation, the Vitas nurse declared that Rourke would need to lose weight.

"We were confused," Rollins says. "But we knew we wanted to get her out of that place." The nurse said that Rourke qualified for home hospice care and that someone else at Vitas would contact them in a short while. They heard nothing for two days. Vitas advised her to wait until she had a hospital bed at home before bringing her mom there.

Moreover, Vitas managers said they thought Rourke should receive hospice care in one of its inpatient facilities. "They called me into their office to try and discourage me from taking her home," Rollins says. "They wanted me to put her in one of their places, the reason being was that I could go to jail in a heartbeat, that [the Department of Children and Families] doesn't mess around. If my mother got one bedsore -- and she already had bedsores from that facility -- I would be charged with neglect. I was scared. They said they were going to be checking, and if anything looked suspicious or neglectful, that I'd be going to jail."

The medical equipment finally arrived on a Friday afternoon, a week after they'd requested it. When they went to the rehab facility to meet with a Vitas employee later that day, the woman told them, "You're not taking your mother anywhere. I have plans, and it's too late. I waited all day for you."

Rollins explained that they had been awaiting delivery of the equipment, but the woman left. Undaunted, the couple drove their mother home that night. They then called Vitas to request a nurse be sent over, as was required. The nurse arrived at 11:30 p.m. "She was upset because it was a late Friday night," Rollins says. "She went into the kitchen, never going in to meet my mother, to check her vital signs, nothing." The visit ended, Rollins claims, with the nurse asking in a loud voice, "What do you want from Vitas?" She left, saying another nurse would be "right behind me."

About 3 a.m., they heard a knock on the door that turned out to be a delivery man from the pharmacy with which Vitas does business. He spoke no English and handed them a bag full of drugs. "I called Vitas and asked what I should do with this bag of drugs," Rollins says. "The guy said, 'Give it to the nurse that's there. '" There was, of course, no nurse.

Nurses started showing up the next day, but the Vitas doctor, Jay Peitzer, who Vitas promised would be there within 48 hours, didn't show up for three weeks, Rollins says. Some of the drugs delivered the previous night were prescribed by Peitzer, Rollins says, even though he'd never examined Rourke. She called steadily, requesting a visit from the doctor.

When Peitzer finally showed up, the meeting was tetchy. "He said, 'You're labeled "The Angry Daughter. "' He walks into my mother's room, and she's in bed, awake, and he never acknowledged that she was there, that she was a person." He did say that she'd had a "rocky time" thus far but that the family should put that all behind them. "We're going to have a good relationship," he said, according to Rollins. He continued: "I'm going to be the one signing your mother's death certificate. Which brings me to my next question: What do you want me to put on your mother's death certificate? Because I don't even know what's wrong with her." Rollins says her mother heard all of this and became agitated.

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