Two Seniors, Lovers, Pilots, Sharing the Perils of Cancer 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. It shows how physician members of a group acted together against a vulnerable senior, denying her universally recognized and ordered treatment, and instead acted to bring about her death when she sought medical care for a modest medical problem. Only in America can such medical corruption and "medical homicide" occur with impunity and the usual public indifference! Glenda went to the hospital for shortness of breath caused by a fungus infection in the lungs. While in the hospital she developed an untreated pressure ulcer on her back. Almost every single requirement for treatment of pressure ulcers was denied to Glenda after she sought treatment for an unrelated treatable shortness-of-breath medical condition. That entry into the medical industry led to the painful pressure ulcer. She was then dosed with drugs that addressed the pain and worsened the initial treatable problem. Combined with doctor misconduct, Glenda was soon put to death with a morphine overdose. This is a documented and photographed example of what threatens, and sometimes kills, people seeking medical care in the United States today. Day-by-Day Documentation and Pictures of Physician Corruption And the Euthanasia of a Woman Named Glenda: A Warning to Everyone! This is a day-by-day picture and factual portrait of the euthanasia of a lady named Glenda, involving the complicity of nearly a dozen doctors in California, two skilled nursing facilities, engaging in blatant fraud, knowingly sending a smiling and active senior to her death! And protected by California regulators! There are multiple purposes for this site. This site is in two parts. The first part is about the life of a great lady, Glenda, and seeks to keep her memory alive. The second part is about her suffering and premature death at the hands of rogue physicians and management personnel in America's medical industry. It is information people must know if they 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. The 30,000 reported deaths from medical mistakes in hospitals is only part of the story. Discover the life and tragedy suffered by a great lady as she sought help from physicians in California's medical industry. Glenda sought help for a relatively modest medical shortness-of-breath problem and quickly became victimized in a medical care horror story. In less than a month, two preventable deaths occurred in a literal Greek tragedy. Short Summary Seeking medical help for a treatable shortness of breath condition to physicians-induced death within a short time reveals the unrecognized callousness by rogue physicians and enablers in America's medical business. A quick summary follows: Failure by John Muir hospital physicians to treat a pressure ulcer on Glenda’s back that developed while she was a patient from January 5, 2012 to January 14, 2012. What happened thereafter were medical frauds after hospital physicians ordered pulmonary rehabilitation treatment for Glenda as Manor Care skilled nursing facility (SNF) in Walnut Creek, California. Up to that point, the problems inflicted upon Glenda consisted of physicians' errors. Fraudulent admission of Glenda as a patient for pulmonary rehabilitation treatment by Manor Care managements and physicians. Manor Care had no such medical unit, and apparently admitted Glenda to avoid the transfer of patients by the hospital that constituted the bulk of the SNF's business. Manor Care managements and physician then had to engage in additional fraudulent actions to remove Glenda before Medicare and California regulators discovered Glenda in a facility for which payment was made for pulmonary rehabilitation when the facility had no such medical unit. Fraudulent actions taken by Manor Care management and physicians to remove Glenda before Medicare and California regulators discovered what had occurred. The following actions against Glenda were then taken: First falsely telling Glenda, suffering great pain from the untreated pressure ulcer, that she was not capable of improving her shortness-of-breath problem , that the false prognosis was made by non-qualified non-pulmonary personnel, that her planned discharge was to protect itself from sanctions; and made to cover up for the fraudulent admission on false pretenses. Withholding treatment for the pressure ulcer on her back, which would have extended Glenda’s stay at Manor Care, increasing the risk of sanctions by Medicare and California regulators. Covering up for the untreated and painful pressure ulcer by round-the-clock dosing with morphine and related drugs that were not to be used on patients with pulmonary problems. Encouraging Glenda to disregard my objections to the denial of treatment and mistreatment, relying upon the suicidal side effects of the Ativan drug given to Glenda; her great pain from the untreated pressure ulcer; Glenda’s slack of knowledge of the fraud being perpetrated against her. These medically corrupt acts were being aided and abetted by: Glenda’s primary care physician, Vona Lorenzana, who knew of these problems and covered up for them, signed a Certification of Terminal Illness form stating that Glenda had less than six months to live and would die from esophageal cancer. Tests showed the cancer that was diagnosed four years earlier was in remission; none of the treatment during that hospitalization was for cancer. Physician Dr. Jay Spencer of the Hospice of the East Bay, signed a Certification of Terminal Illness, supporting her fellow colleague in the clubby culture of the John Muir Physicians Group. She had no prior contact with Glenda Facilitating Glenda’s discharge from Manor Care into Bruns House hospice, a unit of Hospice of the East Bay, Spencer held that Glenda had only seven to ten days to live. (Bruns House hospital had an admission requirement that hospice patients have an estimated life remaining of seven to ten days.) Glenda was not eligible for hospice. She had one treatable medical condition when she went to John Muir hospital, where an order was made for Glenda to have pulmonary rehabilitation treatment—that was fraudulently denied to her by Manor Care management and physicians. The second treatable medical condition was the pressure ulcer on Glenda’s back that developed in the hospital and at Manor Care skilled nursing facility. The final coup de grâce occurred to Glenda within hours of her arrival at Bruns House hospice with a massive overdose of morphine: Glenda’s smiling and active appearance the afternoon of her arrival was quickly changed to comatose, gasping for breath—signs of morphine overdose. “She was dead hours later. The physician in charge of ordering Glenda’s morphine at Bruns House hospice was India-trained Dr. Smita Chandra, another doctor on the staff of Hospice of the East bay. It was this same doctor that within 24 hours of Glenda’s arrival at Manor Care commenced the scheme to discharge Glenda without receiving the pulmonary rehabilitation training. With Glenda’s death, the fraudulent conduct by Manor Care management and physicians was seemingly covered up. Aiding and abetting the above medical corruption were a list of people and groups that revealed a level of corruption in America’s medical industry that would equal corruption in almost any other of America’s endless areas of corruption. The sequence of medical corruption was pictured as the events took place. Hours between a Lively Glenda And Euthanasia in America's Medical Business January 31, 2012: 6 PM Multiple Physician Misconduct and Complicity: Hours Later: a comatose and dead Glenda!! Remain Blissfully Indifferent, And You or a Loved One May Suffer the Same Fate As Many Others! The death panels are here and have been here for years, with the usual cover-ups. You or your loved one can easily suffer the fate that Glenda suffered. Damn it! Show some outrage!! Read on to understand some of the ways in which this medically-approved homicide functions in America's medical business. Same culture, cover-ups, and public obsession with trivia as in the last 50 years of American tragedies! Cover-up is the standard American reaction to incendiary information affecting key people in the community. If the public knew, the reaction could have major impact upon the ongoing establishment. "Gone Without a Case: Suspicious Elder Deaths Rarely Investigated:" http://www.propublica.org/article/gone-without-a-case-suspicious-elder-deaths-rarely-investigated?key=0. Glenda Guilinger (Stich) (Jan 24, 1933 to Feb. 1, 2012) The following details are for people wanting a more serious understanding of facts, capable of understanding the facts, and capable of showing outrage. Especially for more sophisticated seekers of knowledge on major misconduct adversely affecting people throughout the United States. Glenda Guilinger and Rodney Stich were licensed pilots and lovers since 1995. They had an event-filled unusual life. At the age of 17 in Oklahoma, Glenda was voted beauty queen in high school, and at that age became a licensed pilot. She saved her lunch money to pay for flying lessons at the airport in Seminole, Oklahoma. Her parents learned about her flying activities when a local newspaper ran a story about a young woman who had just received her pilot license. This was highly unusual at that time. You just did not see young women who were willing to take such extraordinary measures to achieve their life-long dream.....flying. 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. She also played supporting roles in the complex activities in which Rodney was involved. These activities are described in part at www.defraudingamerica.com and further described in his many books (that are listed at amazon.com and other sites). Their lives changed in early 2008 when Glenda was diagnosed with Stage IV esophagus cancer, with a survival prognosis of less than one year. That first year was very rough for Glenda, and Rodney discovered the enormous responsibilities of a caregiver for someone with a medically eventful illness. Glenda not only survived that first year, but survived three additional years. As 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. Where formerly Glenda had no breathing problems while she and Rodney flew small aircraft at 14,000 altitude, such as over the Grand Canyon and the Sierras, the altitude started affecting Glenda in early 2011 at Reno's 4500 feet elevation. (Glenda was an avid slot machine player.) On January 5, 2012, one of Glenda's shortness of breath episodes caused Rodney to admit Glenda into John Muir hospital in Walnut Creek, California. A series of improper acts by physicians changed Glenda from a smiling and active person into one racked with pain and then a premature death. The events, described in part here, met the definition of a "Greek tragedy," compounded. Part of their cancer tragedies were dealing with, and suffering the consequences of, the cavalier physician attitudes, the indifference, and corrupt conniving conduct. This is another tentacle to the thousands of needless suffering and deaths every year from hospital and physician "errors," or plain arrogance and misconduct. Love Between Two Seniors: Pilots In 1994, corruption-exposing whistleblower Rodney Stich, met, and joined up with Glenda Guilinger, and started an 18-year love affair. Rodney jokingly referred to their initial meeting as occurring in front of the prune section at Safeway! At that time, Rodney had been under heavy attack from government and non-government sources seeking to halt his exposure of nation--effecting high-level corruption. (Details in book, History of Aviation Disasters: 1950 to 9/11.) From that moment on, these two lovers experienced 18 years of eventful living. The focus is on the last four years of Glenda's life as she fought an early 2008 Stage IV esophagus cancer. In early 2011, Glenda's then-three-difficult years of fighting cancer was joined by Rodney's diagnosis of Stage III kidney cancer, and their encounter of misconduct in the American medical field. Together, they battled elements in the medical field that are similar to the rampant misconduct in the United States. Glenda's obituary Glenda experienced a form of medical treatment abuse that precipitated a premature death, despite having medical coverage under Medicare, Healthnet PPO, and Champa insurance (all of which acted admirably). The joining up with Rodney Stich, a former naval aviator, airline pilot, and federal airline safety inspector, with Glenda, was followed by years of flying trips throughout the Southwest. Illness brought their flying activities to an end. This is primarily a story of Glenda and her awesome path through cancer. But it is also an indictment of the cavalier, indifferent, and possibly criminal conduct by certain physicians, and may be one of the reasons for the reported 30,000 deaths a year due to medical "errors." Glenda About to be "Widowed" Looking back at their good times together, from 1995 to 2001, Glenda and Rodney made yearly flying trips in small planes to Las Vegas, the length of the Grand Canyon, Sedona, and other scenic places. This came to a halt in 2001, when one of Stich's six coronary bypasses installed during open-heart-surgery in 1985 failed. That ended the flying. It also brought Stich a near-death scenario. With the failure of that bypass, Rodney suffered severe unstable angina for which medications and a nitro patch failed to provide relief. Several cardiologists at Rodney's health care provider, Kaiser Permanente, stated there was nothing they could do for him, that a stent or another open heart surgery were not feasible because his coronary vessels were too small. He then made arrangements with a funeral director and for Glenda to receive the assets that remained from his once sizeable estate. (See www.defraudingamerica.com/ for what happens to government agents who expose high level corruption associated with major national consequences.) Having been a pharmaceutical detail man years earlier, promoting sophisticated pharmaceuticals to physician specialists, he instinctively did research and discovered a non-invasive treatment that generates new blood vessels around blocked coronary arteries. The procedure was used worldwide and approved by Medicare and most insurance plans. It is almost totally unknown to most physicians. There is no profit for physicians to refer patients for the treatment and a strong incentive not to. It diverts profits for physicians and hospitals from stents and open heart surgery. Rodney managed to convince his Kaiser cardiologist (Dr. Christopher J. Forrest) to order a referral. That treatment was so successful that Rodney put up an internet site for other people whose severe pain or premature death could be avoided. www.heartsurvival.info. Note: Glenda and Rodney never formally married, for various reasons. Rodney's attempts to expose high-level corruption made him vulnerable for lawsuits, which could then impact Glenda's assets. The Long Difficult Road With Cancer In early 2008, Glenda, then a youthful 75, reported to her primary care physician, Dr. Vona Lorenzana (Walnut Creek, CA) difficulty in swallowing. This very caring and alert physician immediately referred Glenda to specialists, where the diagnosis was made of esophagus cancer. The tests revealed that Glenda had cancer of the esophagus and that it had already spread to other organs: Stage IV esophagus cancer. Glenda was then given the phone number of a surgeon and an oncologist on the handwritten note pad. No other instructions were given. Being new to the area of cancer treatment, Glenda and Rodney went to the surgeon whose name was on the slip of paper. He recommended surgical removal of the esophagus. At that point this writer then started researching the many cancer treatment sites on the internet. He found that surgical removal of the esophagus when the cancer had already spread beyond the esophagus 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 that would have made life more miserable for Glenda. But this discovery would be only the first of others as to the culture among some physicians in the medical field. Starting With an Oncologist The other name on the notepad paper was that of the Diablo Valley Oncology Center, and the oncologist, Dr. 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 Glenda could feed liquid food directly into the stomach. Medical supply companies delivered food and a feeding pump to the residence, but no one took the effort to describe how to use it. Several problems for which this writer sought help from Diablo Valley Oncology, which were not responded to, created a new-death condition for Glenda. That near-death experience brought on by the cavalier indifference of Diablo Valley Oncology caused Stich to request urgent help from the executive offices of John Muir Hospital. They established treatment for Glenda with Contra Costa Oncology's Dr. Michael Sherman. There then followed months of radiation treatment at the John Muir Hospital campus at Concord, California. That failure of the Diablo Valley Oncology group to respond, and a prior problem, caused cancer treatment to be changed to the Contra Costa Oncology group in Walnut Creek. The treatment there was generally good, but a common problem was experienced of physicians refusing to respond to the caregiver responsible for arranging medical treatment. Rodney, caring for Glenda who slept most of the time, possibly due to the effect of the cancer drugs, was not aware of the problem. If the cancer experience was not a new experience, he might have detected the problem earlier. It wasn't until Glenda's dehydrated appearance was obvious that Stich rushed her to the emergency section of John Muir Hospital in Walnut Creek. For the first year the 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. The first year was very hard on Glenda, and on her life companion and caregiver. Seeking additional guidance, Rodney 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. Sherman's selection of oncology drugs appeared to stabilize Glenda's cancer. The normal life expectancy of someone diagnosed with Stage IV esophagus cancer is one year. Glenda went way beyond that. The surgeon that inserted the feeding tube directly into Glenda's stomach stated 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. Rodney and Glenda then planned to again visit Stanford where physicians reopened Glenda's esophagus's that had previously closed. But before this came about, the esophagus did reopen, about a year after it had closed and Glenda thereafter was able to eat and drink normally. Cancer treatment continued for several years, with repeated treatment at Contra Costa Oncology with infusions of cancer drugs, CT scans, PET scans, blood tests. It never ended, and was a nearly daily occurrence for almost four years. Glenda's cancer tests showed the cancer in remission while taking the cancer drug Taxol, by infusion. But in early 2011, that low-profit generic cancer drug was unavailable in the United States, like many other low-cost, low-profit cancer drugs. There was no shortage of high profit drugs such as Cialis or Viagra! Also, government licensed pharmacies in Canada had no shortage of that and other life-affecting cancer drugs, but members of Congress made it a crime for doctors to obtain the cancer drugs from that source. See www.defraudingamerica.com/medical_care_minefield.html for more information on this matter. The Enormous Load for Caregivers The first year of Glenda's cancerous life was an endless series of tragic moments, pain, near-death experiences, constant trips to hospitals and other medical faculties. Anyone going through something like that urgently needs a loving person there all the time. Without that, the suffering and premature death is sure to occur. After surviving the first year, Glenda suffered less, but still needed a full time caring caregiver. The miseries of cancer and COPD would eventually return with a vengeance. Glenda's Distant Biological Family 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 became confined to a wheel chair. In 1997 he did make it to Las Vegas where he then joined Glenda and this writer with a flying trip throughout the southwest in a two-engine Beech aircraft, including flying the length of the Grand Canyon. Bruce, living alone, worshipped Glenda. He would send this writer emails almost daily discussing personal matters, his love for his mother, and his appreciation for this writer's care for Glenda during a very difficult four years of cancer-related difficult periods. A few of his comments sent during the past four years was reflected by the following comments: January 14, 2012. I cannot think PAST what you have done for Glenda, have done to "SURVIVE" together Glenda's daughter, Lisa Kinney, lived near Seattle and worked for a pharmaceutical company, Genetics, answering questions sent in by physicians. The company's site states it focused on pulmonary diseases. Glenda's son, Bruce, Las Vegas 1998 Glenda's Adopted Family Living near Rodney and Glenda was Rodney's daughter, Stephanie, and her husband, Jerry. They hosted almost monthly family events, attended by over a dozen members of the clan. They adopted Glenda, treated her like a queen, and contributed greatly to Glenda's life. The following is a picture taken showing Glenda looking good, until the change in cancer drugs when Taxol was unavailable. (June 2011) Glenda with the Stich Clan, May 15, 2011 RVing, Next Stage in Life Following Aviation With the end to their flying activities, they developed an interest in RVs, and purchased a used 27-foot Dolphin motor home. With that purchase, they took many short trips to campsites in Northern California, and especially those along the ocean, including nearby Bodega Bay. Cancer Became a Family Affliction In May 2011, Rodney, who had been caring for Glenda during the prior three years of esophagus cancer, received a diagnosis of Stage III kidney cancer. Cancer then became a dual family matter. Fortunately, when Rodney needed 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, Rodney was able to respond. Details of the difficulties that Glenda's caregiver encountered under a Kaiser Permanente HMO medical plan is detailed at Deadly denial of health care by Kaiser Permanente senior Medicare plan. It is a sobering wakeup call on the sordid side of America's health care, following the pattern of other known and unknown American scandals. Obstacle to Cancer Remission Status: America's Drug Shortage The cancer drug Taxol appeared to be keeping the 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 the cancer had spread to her lungs. From that point on, Glenda was rushed to the emergency section of the John Muir hospital in Walnut Creek, not for the cancer, but for breathing problems as the cancer that spread to the lungs worsened the COPD that she had for years. But even then, the cancer showed no further signs of spreading. Glenda's primary problem then was obtaining competent treatment from a pulmonary specialist. She chose a former Iranian doctor, Dr. Ramin Khashayar. The ugly politics of cancer drug shortages are described at www.defraudingamerica.com/medical_care_minefield.html. The Contra Costa Oncology center then had to substitute Taxotere cancer drug for Taxol. Taxotere caused an increase in undesirable symptoms for Glenda, and also spreading of the cancer to the lungs. Glenda already had limited lung function due to years of COPD. In late 2010 she developed a possibly chronic fungus infection of the lungs that appeared to be occurring in the San Francisco area. In November 2011, Glenda started having to use oxygen more frequently, but able to attend a Christmas party and a New Year's eve party hosted by Stephanie and Jerry Stadtler. Despite the need for using oxygen, Glenda had looked forward to warm weather and taking several trips, including a sea cruise to Alaska. But that would never happen. Stephanie-Rodney-Glenda Round Hill Country Club, Alamo, CA 12-9-11 Seven Weeks Remaining for Glenda! December 23, 2011 December 25, 2011 Hospital Admission for Breathing Problems On January 4, 2012, Rodney rushed Glenda to emergency at John Muir hospital in Walnut Creek, California because of a shortness-of-breath problem. Hospital doctors found an infection in the lungs for which an antibiotic was given. During the hospital stay, an x-ray showed fluid on the lungs for which drainage was scheduled. A January 5, 2012, hospital report blamed Glenda's shortness of breath on the following: "Moderate bilateral pleural effusions are noted." That was an easily correctable problem. Developing a Painful Bed Sore on Her Back While in the hospital during the January 4 to January 14 period, Glenda developed a painful bed sore or pressure ulcer. These pressure ulcers can be very painful and require medical personnel trained and experienced in wound care. This attention was not given. While Rodney's daughters, Patty and Stephanie, were visiting Glenda at John Muir hospital, one of the nurses expressed concern about the wound on Glenda's back that wasn't being given adequate treatment. The nurse's concern about the appearance of the pressure ulcer caused her to take a picture of it for the record. The required special care was never provided. Reverse of Proper Medical Attention |Given to Glenda's Pressure Ulcer Instead of providing recognized pressure ulcer treatment, hospital doctors gave Glenda morphine-type pain medications. That had two major problems. One, the pressure ulcer worsened. Two, morphine drugs decrease pulmonary function, the exact opposite of the medical treatment Glenda needed. Glenda's caregiver, Rodney Stich, was unaware of these problems because the hospital doctors repeatedly refused to respond to his telephone and fax requests. Glenda, fearful of antagonizing the doctors and losing what little care she was receiving from her physicians, didn't want Rodney causing any ripples. Hospital Physicians Issued Order For Pulmonary Rehabilitation Toward the end of Glenda's hospitalization, hospital physicians issued an order for Glenda to receive pulmonary rehabilitation treatment, which is standard to improve shortness of breath condition. Logistics of Treating COPD A pulmonary COPD exacerbation is a worsening of symptoms and described as “an event in the natural course of the disease characterized by a change in the patient's baseline symptoms and a change in medication and a pulmonary rehabilitation program by a physician specializing in pulmonary problems." A COPD exacerbation can easily be due to not following a pulmonary specialist’s instructions, a need to change medication, or a more qualified pulmonary specialist. Lack of competency by a physician, or one without a strong feeling to help a COPD patient, can easily bring about a preventable breathing crisis. People with COPD often have exacerbations, or temporary worsening of their symptoms. Glenda had breathing difficulties and hospital trips for years. These exacerbations can be caused by many different facts. A lung infection, improper use of an inhaler, failure to take prescribed drugs, failure to follow a doctor’s instructions, and may require either a change in drugs or entry in a common pulmonary rehabilitation program. It is important that a knowledgeable caregiver knows the treatment the doctor is providing. Some doctors are far behind on available treatments; some are too busy to either keep up or to focus on a particular patient during an otherwise busy schedule. Whether Glenda fell victim under one of these scenarios, in addition to the other problems, is unknown, since Rodney’s attempts to get this information repeatedly was ignored. Among the treatments to improve COPD or any other breathing problem includes the following: A pulmonary rehabilitation program, available at skilled nursing facilities and other facilities. Antimicrobials for possible infection, and requires treatment with antimicrobials, such as ampicillin, tetracycline, or a combination. Different types of bronchodilators are usually needed. These include Albuterol, Atrovent, Combivent, Spiriva, Tebutaline, Theophylline, Xopenex, Formoterol, or Salmetero. Many doctors won’t take the time, or don’t know about the various available products, or just have no initiative to try others, or think out of the box. Corticosteroids play a key role in improving COPD. They are beneficial in acute exacerbation of COPD and shorten the recovery time while improving lung function. Examples of these corticosteroids include Prednisone, Solumedrol, and Flovent. Weeks or months of treatment, variation of treatment, changing of physicians, are often necessary. And the informed patient, or caregiver, must be constantly informed of the treatment being prescribed and do internet research that many physicians have no time or interest to do, which is necessary to stay informed on current medical progress. Different skilled nursing facilities (SNF) specialize in different types of rehabilitation, so it is vitally important that a patient goes to one that has medical facilities focusing on that type of condition in order to obtain improvement in the condition. There is considered no cure for COPD but facilities that can usually bring about an improvement in breathing problems. Glenda at John Muir Hospital Continued Pain Caused Glenda to Want to Give Up The continued pain from the pressure ulcer on her back caused Glenda to think of giving up and going to hospice to die. Her desire was to be transferred to the nearby skilled nursing facility, Manor Care (Rossmoor Parkway in Walnut Creek, California. Rodney explained to Glenda that she could not be transferred to the Manor Care SNF unless she accepted the treatment hospital physicians were ordering. She then had a totally different outlook on life. She wanted treatment and she wanted to live! Glenda, Jan 13, 2012, John Muir Hospital Specialized Skilled Nursing Facilities (SNF) Different skilled nursing facilities focus on different types of rehabilitation. 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. In the Walnut Creek area, there were two major skilled nursing facilities: Manor Care (Rossmoor Parkway and Manor Care Walnut Creek and a medical care competitor, Kindred skilled nursing facility. But only one had a pulmonary rehabilitation unit. John Muir hospital had a sophisticated out-patient pulmonary rehabilitation unit and 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 would set in motion a series of medical frauds and quickly result in a double "Greek tragedy." Site referring to the pulmonary rehabilitation program that Manor Care did not have, but available at Kindred Rehabilitation facility (SNF). http://www.nhlbi.nih.gov/health/health-topics/topics/pulreh/. Prior to Glenda's Transfer to Manor Care, Admitting to Absence Of Pulmonary Rehabilitation Unit And Refusal to Accept Glenda Several days earlier, Rodney's daughter, Stephanie, and a sister from Texas, 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 Glenda's caregiver, Rodney, heard this, he and his daughter Stephanie, returned to Manor Care and discussed Glenda's admission with Laura Stengel to confirm that Manor Care would accept the transfer of Glenda from John Muir hospital. Stengel again stated that Manor Care did not have any COPD treatment nor pulmonary physicians and therefore would not accept Glenda. That occurred on January 13, 2012. Kindred SNF Rodney and Stephanie then went to another skilled nursing facility nearby, Kindred SNF. The admission personnel bragged about their special pulmonary rehabilitation unit and pulmonary physician, and showed a room that Glenda could be transferred to immediately. Rodney 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. Hospital Reports Showed Treatable Pulmonary Condition On January 13, 2012, John Muir hospital physicians prepared a final report before transferring Glenda to Manor Care SNF for pulmonary rehabilitation. That final report indicated Glenda was doing well. The following is a relevant section 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.] The mid-January 2012 hospital report did not indicate any near-terminal COPD or other medical condition. No contact or coordination was made with Glenda's caregiver during her stay at John Muir Hospital, or in the final decision to send her to Manor Care. John Muir hospital personnel transferred Glenda to Manor Care SNF for pulmonary rehabilitation despite the fact that Manor Care did not have any COPD rehabilitation or pulmonary qualified physicians. John Muir hospital personnel should have known that Manor Care had no facilities for pulmonary COPD care. They were also deliberately kept uninformed by Manor Care, possibly to avoid John Muir sending clients to Manor Care's nearby competitor, and thereby losing future income. Manor Care 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. Manor Care Accepting Glenda's Transfer Knowing They Lacked the Required Pulmonary Rehabilitation Facilities When Manor Care's primary source of patients—and income—John Muir hospital, called and said they were transferring Glenda to their facility, Manor Care's physicians and management accepted Glenda. If they had not, their primary supplier of patients would have sent Glenda to Manor Care's closest competitor, Kindred SNF. On January 14, 2012, Glenda arrived at Manor Care. She was delighted, had a smile on her face, and now wanted to live. Glenda was still suffering from pain but feeling good because she expected to now receive treatment. She didn't know that Manor Care did not have a pulmonary rehabilitation facility or pulmonary doctor. Medicare would soon question her presence at Manor Care for pulmonary rehabilitation, when in fact, Manor Care does not even offer this form of rehabilitation. Glenda would not be showing any improvement which would risk losing Medicare approval. Glenda also had other problems affecting her breathing. The fluid was still on her lungs, which had been there since her initial arrival at John Muir hospital. Possibly the difficult to cure fungus infection needed additional treatment. Manor Care was not the place for treating these medical conditions. Glenda continued to suffer pain from the wound on her back which was not being adequately addressed. Once she called Rodney on the phone pleading for him to get Manor Care personnel to provide pain medication. She also complained of the high temperature in the room. People suffering from breathing problems need a cooler room. There was a total absence of the type of care needed by COPD patients. Glenda Jan 15, 2012 Manor Care, Looking and Feeling Good— And Wanting to Live Glenda January 15, 2012 Manor Care, with the Stich Clan Manor Care's Immediate Decision To Discharge Glenda Glenda was at Manor Care less than 24 hours when a physician, Dr. Smita Chandra, came into the room while Rodney 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 would be discharged, and started talking palliative care. 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. 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 has set her heart on. Rodney was outraged at this blunt talk to a frail lady within 24 hours of her arrival! He 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. Rodney protested that Glenda was looking for treatment, not palliative care. Rodney 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. Rodney stated that he resented the doctor causing a confrontation in front of a very frail patient; that this may be the practice in India, but totally unacceptable here in the United States. Glenda was grief stricken. Rodney faxed his objections to Manor Care (January 16, 2012) about the immediate dismissal plans before Glenda had any pulmonary rehabilitation. As with every other communication request, including information about the treatment Manor Care doctors were providing to Glenda, none were ever answered. The probable reason was that Manor Care had engaged in fraud when they admitted Glenda for treatment that they were not qualified to give, and now had to engage in a cover-up. In most cases, the physicians and management people, in the medical industry would have gotten away with it. But Rodney had spent over 50 years, starting as a federal airline safety inspector, investigating and exposing fraud, and also have several years experience in the medical field as a pharmaceutical detail representative. Manor Care personnel had engaged in fraud, and now were trying to extricate themselves from the consequences, with Glenda paying the consequences. Manor Care Rossmoor Parkway: 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. And then, within 24 hours, took action to discharge the frail and under stress woman that had already been subjected to other forms of stress. And even more abuse on this great lady was to come! Manor Care Doctors Dosing Glenda with Round-the-Clock Drugs That Decreased Pulmonary Function Immediately upon arrival at Manor Care, and under supervisory physician Dr. Martin Jimenez, Glenda was given round-the-clock Lorazepam (aka as Ativan). 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 later, morphine). Heavy Narco Dosing by Manor Care Physicians From Glenda's arrival at Manor Care, the total denial of pulmonary rehabilitation was combined with heavy dosing of drugs that worsened pulmonary breathing problems. One such drug was Norco (hydrocodone-Acetaminophen). The warnings associated with that drug include: Emergency type of side effects (all of which were reported in Manor Care records): Swelling in mouth, face, lips, or tongue. Airway constriction (bronchospasm) and wheezing.| Causing serious breathing problems. Anxious feelings. Dry mouth. Loss of appetite. Anxiety.| Shallow breathing, slow heartbeat At www.ehealthme.com, the following: "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) ... Morphine's Adverse Effect on COPD One of the internet articles warning against the consequences of giving morphine related drugs to patients with COPD breathing problems: 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. If the breathing is stopped completely without restarting, the patient dies. Because COPD patients have compromised breathing already, ... very More warnings about morphine usage: 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 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. Because COPD patients have compromised breathing already, ... very inefficient breathing, overly high doses of morphine can quickly cause these patients to stop breathing. Morphine Instead of Wound Treatment! The morphine was primarily for the pain arising from the open wound on Glenda's back that should have been under the attention of doctors specializing in wound care. Prior to Glenda's entry into Manor Care, in 2011, Glenda was under the care of a wound specialist in the Wound Center of Walnut Creek. That treatment kept the pain under control. Manor Care's Head Physician Withholding Information From Person Responsible for Arranging Glenda's Medical Treatment During all this time, Manor Care's physician in charge, Dr. Martin Jimenez treated the person responsible for Glenda's medical treatment with contempt, and connived to turn Glenda against the person primarily responsible for the prior four years of selecting the medical care that helped her beat the one-year cancer survival rate. In this way, the harm inflicted upon Glenda by Manor Care physicians continued throughout the period Glenda was a patient. In addition, the pulmonary rehabilitation was never given because Manor Care had no such unit. Glenda's Pulmonary Doctor Abandoning Critically Ill Patient Like being in a corruption-riddled industry, the medical care industry, Glenda and her caregiver were experiencing even worse misconduct than in the worse of America's endless number of industry corrupt practices. Glenda's pulmonary doctor, Ramin Khashayar, had abandoned Glenda during these difficult days, and Rodney send a complaint to the California medical board. A long-time movie producer friend of Rodney, D.J. Donnelly, heard about Rodney's problems with Khashayar and contacted the executive offices at John Muir hospital. Khashayar then called Rodney on the phone and accused him of blackmail. Blackmail for complaining about abandoning a dying patient? Rodney repeatedly tried to obtain information from Khashayar about her treatment and what he was doing for her condition. Anyone suffering great pain is in no position to be inquiring of her not-present physicians about these matters, and any physician has enough common-sense intelligence to realize an informed caregiver must be kept informed. The following were some of the faxes Rodney sent to Khashayar seeking information on Glenda's care, all of which were ignored. Fax sent to Khashayar January 6, 2012. Another fax the same day, January 6, 2012. Fax sent to Khashayar January 12, 2012. Finally, under pressure, a few days before Manor Care discharged Glenda, Glenda's pulmonary doctor, who had refused to remove the fluid from Glenda's lungs when she was admitted to John Muir hospital, arranged to have Glenda returned to John Muir hospital for removal of the fluid on her lungs. Blackmailing Phone Call From Glenda's Pulmonary Doctor Constant problems for Glenda's caregiver, affecting Glenda's life. On the evening of January 17, 2012, Rodney received an obviously hostile phone call from Glenda's Iranian doctor, Khashayar, accusing Rodney of blackmailing him. Khashayar stated that Glenda's primary care physician had asked him to check on his pulmonary patient, Glenda. 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 that he should have removed earlier, while she was in the hospital, and before Glenda's transfer to Manor Care.) That phone call was made by Dr. Khashayar following Rodney's complaints to the California medical board about Glenda’s pulmonary doctor abandonment of his patient, and apparently retaliation. The complaint concerned the refusal of Dr. Khashayar to provide any information about Glenda’s pulmonary problems and the doctor’s abandonment of a person near death due to breathing difficulties. Khashayar's conversation was so bizarre and indicative of the abandonment of Glenda in her near-death condition that Rodney 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!, who he had abandoned.] 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 and to check that no neglect is occurring.] 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 for a dying patient is a blackmailer if he objects to the abandonment of his loved one by an irresponsible physician.] 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 medical misconduct 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. Copy of January 20, 2012, letter pulmonary doctor Khashayar had hand given to Glenda and forcing her to sign receipt of it, while Glenda was suffering from lack of pulmonary care! That compounded the endless series of corrupt acts upon a gravely-ill and vulnerable woman! Bill of rights stated by American Hospital Association. Compounding Physician Neglect with Deliberate Infliction of Emotional Stress Khashayar had a letter hand-delivered to Glenda on January 20, 2012, at the Manor Care skilled nursing facility, where Glenda was laying in pain—possibly from Khashayar's failure to remove the fluid on Glenda's lungs while she was a patient at John Muir hospital, about three minutes from his office. Khashayar surely knew—and intentionally inflicted—additional stress upon this frail lady suffering from the combined effects of cancer and pulmonary problems. The letter severely criticized Rodney for protesting the doctor's abandonment of his seriously ill patient. Not satisfied with knowingly inflicting further stress upon Glenda, he insisted that she sign the bottom of the letter acknowledging that she received it. What motive could he have other than to harm his patient by forcing her to do that! That tactic inflicted more stress on Glenda, who was then already at the limit of what a cancer patient could endure. There were many different forms of treatments for Glenda's COPD, and required the attention of a responsible pulmonary physician. Glenda did not have that. Glenda eventually was overwhelmed by the magnitude and numer of doctors involved in the medical corruption. Rushing Glenda to the Nearest Hospital The next day, on January 21, 2012, she was rushed to nearby Kaiser Permanent 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 near-death condition, the nearest hospital was selected. Doctors at Kaiser Permanente hospital did not find any end-of-life condition affecting Glenda. They found the fluid on the lungs that had gone uncorrected for weeks; they found a possible pneumonia or fungus infection. The Kaiser Permanente doctors repeated what Manor Care was stating, that Glenda had anxiety and stress, for which they prescribed the dangerous mind and judgment-altering drug, Ativan, which also decreased pulmonary function. Doctors repeating a prior doctors findings or treatment is common. Glenda returned to Manor Care on January 23, 2012, for more of the Ativan and narcotics—decreasing her pulmonary function, and still with fluid on her lungs. Caregiver Pleading with Glenda's Primary Care Doctor for Help On January 26, 2012, Glenda's caregiver faxed an urgent message to Dr. Lorenzana, Glenda's primary care physician, who hadn't seen Glenda for some time. He briefly explained part of the problems and asked her for help. In that message Glenda's caregiver stated: Hello Dr. Lorenzana, 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. Dr. Lorenzana's office was about 400 feet from Manor Care, where Glenda was a patient. She surely knew that Glenda had two problems: The main one, shortness of breath for which the services of a pulmonary specialist and a standard pulmonary rehabilitation program should be made available. She surely knew that Manor Case did not have a pulmonary rehabilitation unit, and that Kindred SNF, 200 feet from her office, did have. The two open wounds, one on Glenda's back, and one on her ankle, were the primary source of her pain, and needed the care of a physician dealing with that condition--which Manor Care did not have. If she had checked the drugs being given to Glenda, she would have seen that in that list was one or more drugs that decreased pulmonary functions. She should have contacted Glenda's caregiver for more information. 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. 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 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 all needed health care services. As Glenda's primary care physician, Dr. Lorenzana had responsibility for overseeing Glenda's medical treatment by other doctors and medical facilities, and must investigate and correct any shortcomings. She knew, or should have known, that the two problems that had given Glenda so much grief, the shortness of breath and the pain from the open wound on her back and on her ankle, were not being seen by physicians competent and specializing in these problems. If Dr. Lorenzana had contacted Glenda's caregiver, he 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! Finally Returning Glenda to John Muir Hospital For Delayed Removal of Fluid on the Lungs Shortly before Glenda's discharge from Manor Care, she was transported to John Muir hospital where the fluid on her lungs was finally removed (January 24, 2012). Her pulmonary doctor, who previously stated to Glenda's caregiver (January 19, 2012 phone call) that he did not have a contract to perform at John Muir hospital, now was "suddenly" able to do so. He arranged for Glenda's transfer to John Muir hospital that should have been done weeks earlier. The earlier removal of that fluid would very probably have improved Glenda's well being, reduced the pain arising from the breathing difficulties, and paved the way for her transfer to Kindred where the facility had a major pulmonary unit. If that fluid had been removed earlier, Glenda's pain and depression would most probably have improved and changed Glenda's wish to just give up. Pulmonary doctor Khashayar may have been prompted to finally address Glenda's pulmonary problems by pressure arising from a TV producer friend of Rodney, D.J. Donnelly of DJ Donnelly Productions, and complaints to California medical regulators. Painful, Inadequately Treated, Bed (Pressure) Ulcer Glenda also developed a painful bed sore or pressure ulcer on her back while in the hospital, which was not given the medical attention that was needed at Manor Care. Medical records show constant reference to pain from a wound on her back. But not a single medical record mention any of the actions that must be taken to treat pressure ulcers. As described in a Mayo Clinic site (http://www.mayoclinic.com/health/bedsores/DS00570) , these actions include: 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. The pathetic primitive attention given to this medical problem resulted in Glenda suffering continual pain that eventually played a key role in giving up the will to live and return home. http://en.wikipedia.org/wiki/Bedsore. Systematic Withholding of All Information From Glenda's Caregiver Throughout this period Rodney 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. With all of the major violations of universally recognized medical care, it is obvious why Glenda's caregiver was kept totally uninformed by the physicians and management. Manor Care's physician-in-charge was Dr. Martin Jimenez, and a member of the John Muir hospital physician group. Every request was ignored, despite the fact that Rodney had sole responsibility for arranging for Glenda's treatment and 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. Knowing that Manor Care was determined to discharge her, Glenda became depressed and repeatedly said she wanted to go to a nursing home and die. 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 Desperately 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 an email to me, 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". At major cancer centers, or at any oncology group, the oncologist would be carefully following their client's progress and treatment, and being a part of the 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 large open wound on her back, Glenda still looked good and had a wish for recovery and going home. Outraged County SNF Ombudsman Suggested Filing an Appeal Rodney and his daughter Stephanie were frantically seeking to find a suitable facility upon Glenda's removal by Manor Care. They both called the county ombudsman (Nancy at 925-685-2070) over skilled nursing facilities, (coming shortly), and explained the problem. She stated that Rodney should file an appeal of the discharge order, which would provide several extra days to find a suitable facility. Rodney then planned to do that, but events were snowballing rapidly and the appeal was never filed. During all these events, Rodney told Glenda that nearby Kindred SNF, which had a pulmonary improvement unit and a pulmonary specialist that regularly visited, would take her, as they had previously stated they would. Upon being told of this transfer, Glenda's spirits then changed, and her appearance improved. But this bright spot would be undermined by another problem. Sample of media reports on Manor Care: http://www.cbsnews.com/2100-18563_162-600289.html. Seeking to Admit Glenda to Kindred SNF Providing Pulmonary Rehabilitation Rodney's daughter, Stephanie, contacted Kindred personnel, Jennifer, and sought to have Glenda admitted upon discharge from Manor Care. Glenda had an order by John Muir hospital for pulmonary rehabilitation treatment, which she had never received since Manor Care didn't have such a unit, and payment would be through Medicare and Healthnet PPO. Rodney sent a fax to Admissions Director Laura Stengel, Manor Care (January 27, 2012) asking her to forward Glenda's medical reports to nearby Kindred SNF. The Manor Care medical reports showed: An absence of the ordered pulmonary rehabilitation treatment ordered by John Muir hospital. An improvement in Glenda's breathing capabilities since the January 24, 2012, removal of fluid from on Glenda's lungs. The heavy dosing of Glenda with drugs known to worsen pulmonary function. The absence of specialized treatment for the pressure wound on Glenda's back. But now, possibly due to courtesy support for Manor Care's decision, Kindred refused to take Glenda. They were now being sabotaged by Kindred management personnel. That decision would be a death sentence for Glenda. On January 30, 2012, Rodney sent a fax to Kindred personnel explaining what they obviously already knew, reminding them that their refusal to admit Glenda was a virtual death sentence. Prior to Kindred's rejection, Glenda wanted to live and wanted to take part in the pulmonary rehabilitation. Kindred personnel never responded to that fax, making possible the fate that Glenda experienced within hours! Admission personnel at Kindred that were contacted included Admissions Director Stephanie Keshi and Jennifer (?). Depressed by It All, Glenda finally said, "I Just Want to die"! The obstacles faced by Glenda and her caregiver were overwhelming and Glenda was depressed. She finally succumbed to the pain, the abuses, the physician's abuses and deliberate infliction of stress, the conniving 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," Glenda said. 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. Glenda refused to listen to Rodney that there was treatment out there and he would get it for her. She stated to Manor Care physicians and management that she alone will make the decision, and that was to go to hospice. Intense pain from open pressure wound on back. 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 a 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. http://www.hospice.org/hospice-care/what-is-hospice/. Glenda never belonged in hospice. 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. Doped to the Hilt, in Pain, Fraud and Medical Outrages, Pressure to Elect Hospice, Glenda Didn't Understand That She Was Given a Multi-Panel Death Decree! When a person elects hospice, that ends in most cases any medical care for medical problems. Glenda's ugly and painful wound on her back would not get any medical treatment. Only morphine and similar pain medication. A person electing hospice, for instance, suffering intense pain from a toenail infection, would be drugged to death with morphine when universally recognized medical treatment would have corrected the problem. Glenda was giving up the treatable shortness of breath that was ordered for her by hospital physicians and denied to her by a coterie of doctors. In Glenda's case, it was easy to deliberately increase the morphine for the back pain, bringing about her death, and getting away with murder! 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. Glenda did not know that the pain she was suffering was from untreated medical problems, and that she was a victim of massive medical fraud by a group- of doctors belonging to the John Muir Physician Group. 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 will get worse, and in many cases require fatal dosage of morphine. False Certification of Terminal Illness Provided Death Decree For Glenda Two physicians provided sham Certification of Terminal Illness (CTI) to enable Glenda to be deprived of care for her treatable conditions. One doctor was Dr. Jan Pankey Spencer, a young female doctor for the Hospice of the East Bay. The other was Dr. Vona Lorenzana, Walnut Creek, Glenda's primary care doctor who rarely saw Glenda and hadn't seen Glenda throughout Glenda's ordeal with the breathing and back pain problems. Both signed the declaration [of death] on January 31, 2012. Those CTI had to state and imply: Glenda had less than six months to live. No such indication was made by hospital physicians. The medical condition responsible for death within six months. Esophageal cancer. [That condition had been in remission and was not the subject of Glenda's current medical problems.] Glenda's present medical condition was not treatable. [A standing order for pulmonary rehabillitation had never been carried out, and the severe pain from the wound on her back went virtually untreated and unaddressed.] That she and her family understood the ramifications of giving up treatment and settling for palliative or pain relief. [Glenda's judgment was affected by the massive drugging; she was unaware of the frauds affecting her; and her partner was denied access to the records.] That there was no medical fraud or misconduct associated with the treatment and decision. [Massive medical fraud was involved.] That certification was necessary for Glenda to go to hospice of the East Bay—where she would be overseen by Dr. Smita Chandra, the doctor at Manor Care that sought to have Glenda discharged and denied pulmonary rehabilitation within 24 hours, of Glenda's arrival. The following is a picture of Glenda on the day these two doctors signed a certification that halted efforts to correct the breathing problems (that John Muir hospital physicians had ordered but Glenda never received) and care to heal the open wound on her back. She was reading, using a calculator, and making phone calls. The U.S. Attorney’s office filed 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. Charge of homicide would be considered. Manor Care Prevailed: They Rid Themselves of A Patient They Fraudulently Diverted! A Manor Care memorandum dated 1/31/12 (and elsewhere 1/21/12) by Manor Care's physician in charge, Martin Jimenez, showed him arranging for Glenda's transfer to Bruns House hospice facility in Alamo, California. The memorandum stated: Glenda was transported to Bruns House, arriving about 2 pm on January 31, 2012. Visiting her an hour later, Rodney found Glenda in a good mood and not experiencing any significant pain or breathing difficulties. Her spirits were up. She thought that she would not get the pain-relieving treatment and she could live out her life comfortable. She was unaware of the negatives in hospice, or that she had just given up the opportunity to circumvent the treatment denial that she had gone through as Rodney would find another facility. She also didn't expect what would happen to her in a matter of hours. Glenda didn't belong in a hospice, and it was Rodney's intent to find a facility that would provide her the pulmonary treatment that she had been denied, especially by the physicians and management staff of John Muir Rossmoor Parkway, and then Kindred SNF. A person can opt out of hospice at any time, and it was Rodney's intent to do that once the intense pressure was off. But that was not to be! 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. Rodney and Glenda, Late afternoon, January 31, 2012: Rodney and Glenda, Late afternoon, January 31, 2012: Hostile India-Trained Manor Care Doctor Taking Over Glenda's Morphine and Other Drug Dosage As Rodney sat by Glenda's bed, he was shocked to see entering the room Dr. Smita Chandra, the doctor from Manor Care who played a key role in Glenda's denial of pulmonary rehabilitation. Rodney wondered what role this doctor would have affecting Glenda's life. That doctor would now be in charge of the pain-relieving drugs given to Glenda and her care. This was the same doctor that Glenda's caregiver encountered within hours of Glenda's arrival at Manor Care SNF. Chandra sought to evict Glenda as soon as Glenda arrived at Manor Care. This was disturbing to Rodney! A dramatic and seemingly unnatural change occurred soon after Rodney and Stephanie left Glenda that night. What was given to Glenda to bring about that dramatic change is unknown at this time, and probably will never be known. But it had to be something deliberate to be so quick and so dramatic! The Premature and Suspicious End Of a Beautiful Life: February 1, 2012 Upon arriving at Bruns House early the following morning, Rodney found Glenda comatose, totally different from when he left the night before. Apparently Glenda had received a heavy opiate dosage that put her into a drug-induced comma—along with respiratory distress. Glenda hadn't been in significant pain when last seen. In fact, she was in a good mood when Rodney and Stephanie left her about 12 hours earlier. Glenda went quickly from looking good, and writing notes, to a comatose condition. She also had respiratory distress. Something wasn't right. Heavy dose of opiates will bring about respiratory distress, and coma. All day long people from Oklahoma and other places called Glenda and the phone was held to Glenda's ear, as the callers expressed their love for her. Even though Glenda was comatose, the callers felt that even in her unconscious state Glenda could understand. It was sad witnessing the endless number of calls made to Glenda in this manner while watching her heavy and difficult breathing. Death Induced by Heavy Opiates? Deliberately? A coma can be induced by heavy opiates, such as morphine. Even death. It was strange that Glenda was looking and feeling good the evening that Rodney and Stephanie left, and then seeing her comatose twelve hours later when they arrived early the following morning. Twelve hours earlier, when Glenda’s last visitors were leaving, the evening before, she was breathing normally, she was alert, and smiling. That dramatic change was not normal. Glenda's pain level did not require administration of any heavy opiate dosage. Signs of opiate overdose that Rodney observed shortly before she died included respiratory depression, shallow, breathing, and body twitching, precise signs of opiate over dosage! Medical reports have documented the deliberate killing of patients by physicians as an increasing practice. Rodney sat by Glenda's bed, occasionally holding her hand, thinking of the many great moments they shared together. 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, he left for home so as to get enough sleep for the next day's vigil. But no sooner had he arrived home, a call from Bruns House said she was near death. Rushing back, the 15 minutes it took to arrive was not soon enough. A beautiful life was over for Glenda. 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 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." Morphine Overdose Probable Cause Of Glenda's Death It is well known in the medical community that morphine and morphine-containing drugs decrease a person's breathing capabilities. One internet article warning against the consequences of giving morphine related drugs to patients with COPD breathing problems is at 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. If the breathing is stopped completely without restarting, the patient dies. Because COPD patients have compromised breathing already, ... More warnings about morphine usage: 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." Sampling of Internet Articles on Deliberate Physician-Ordered Overdose (i.e., murder!) Mother killed by hospice overdose. http://www.hospicepatients.org/euth-acct-three.html. Glenda's treatment and death were treated like a disposable commodity by these physicians that comprise the major group of physicians in that area, the John Muir Physician Network. Glenda's partner sent an April 1, 2012, fax to that group. Compound Greek Tragedy: Another and Related Death in the Family! Upon Glenda's death at 9 p.m. Wednesday, February 1, 2012, Rodney immediately e-mailed to Glenda's sons news of Glenda's death: Bruce, Martin and Mike. Martin and Mike knew that Bruce was very close to Glenda, and emotional. 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. Accidental or overdose? A double tragedy; a Greek tragedy! Bruce during an earlier flying trip to the Grand Canyon With Glenda and Rodney The question arises as to the role of certain people in this literal Greek tragedy that resulted in Glenda's unnecessary suffering her premature death, and the death of Glenda's son, Bruce. Funeral Services For a Great Lady Funeral services for Glenda were held in Walnut Creek on February 8, 2012, and burial at the Alamo-Lafayette cemetery in Lafayette, California. In attendance was Glenda's 18-year companion and caregiver, Rodney Stich, the "clan" of which Rodney's daughter, Stephanie, was matriarch, and Glenda's many friends from the Rossmoor retirement community, and especially from the sewing and quilters' group. From Glenda's family, Mike and Martin appeared. Bruce was dead and Glenda's daughter did not attend. Thumbnail List of Major Medical Industry Offenses Against a Vulnerable Glenda Glenda's abandonment by pulmonary doctor at a critical time, including the doctor's charge of blackmail against Glenda's caregiver when the caregiver complained of abandoning Glenda. Inadequate treatment in initial John Muir hospital, discharging Glenda while having fluid on the lungs that affected her breathing. John Muir hospital personnel discharging Glenda to Manor Care SNF for pulmonary improvement when the hospital knew, or should have known, that facility did not have a COPD rehabilitation operation and did not have a pulmonary specialist. John Muir personnel not informing the person arranging Glenda's medical treatment of her medical situation, treatment, or dismissal plans. Manor Care physicians and management accepting Glenda for COPD rehabilitation that they knew she needed, and they did not have—knowing she could die from lack of needed pulmonary treatment—as part of a business decision to avoid having John Muir hospital, their primary source of patients, divert Glenda to nearby Kindred SNF, a competing medical business. Manor Care physicians, and especially Dr. Martin Jimenez and India-born Dr. Smita Chandra, moving immediately upon Glenda's arrival to discharge Glenda, knowing this would affect her life. Manor Care physicians ordering drugs for Glenda that decreased pulmonary functions, in a patient already suffering from breathing problems, including drugs that bring about a suicidal desire—a desire to die. Manor Care physicians and management repeatedly withholding from Glenda's caregiver information about the drugs and treatment they were providing, and not providing. Manor Care physician in charge, Dr. Jimenez, manipulating the drugged Glenda into denying her caregiver any role in her medical treatment. Kindred SNF management refusing to accept Glenda for COPD care, based on Manor Care's claim that her pulmonary conditions could not be improved, knowing that Manor Care had no pulmonary facilities or pulmonary physician to make such determination. Kindred personnel knew that their refusal would lead to Glenda's premature death in the hospice facilities selected by Manor Care—and staffed with the same Manor Care physician, India-born Dr. Smita Chandra, who had sought to discharge Glenda within 24 hours of Glenda's arrival. January 30, 2012 letter to Kindred SNF management making reference to their role in Glenda's wanting to die—two days before Glenda's suspicious premature death. February 22, 2012 letter to Kindred requesting copies of records seeking evidence of wrongful acts leading to Glenda's highly suspicious death. The suspicious sudden death of Glenda within hours of arrival at Bruns House. The sudden transformation of a smiling and writing Glenda at Bruns House hospice into a coma, with death hours later, under Dr. Chandra's care! Dates January 14, 2012: Glenda transferred from John Muir hospital to non-qualified Manor Care skilled nursing facility (SNF). No facilities for pulmonary rehabilitation treatment. January 15 2012: Initial efforts by Manor Care physicians (Drs. Smita Chandra and Martin Jimenez) and management to remove Glenda from Manor Care facility. January 17, 2012: Glenda's pulmonary doctor, Ramin Khashayar called Glenda's caregiver and accused him of blackmail for sending letter to California medical board relating to charge of the doctors' neglect of a seriously ill patient; Glenda. January 20, 2012: Dr. Khashayar has letter condemning Glenda's caregiver taken to Glenda at Manor Care and forcing her to sign for the letter, inflicting additional stress and anxiety upon her. Glenda had already been repeatedly diagnosed with anxiety and given the mind-altering drug, Ativan. The only possible result of that stunt was inflicting additional stress upon her, and losing any hope of help from the pulmonary doctor who had already abandoned the seriously ill Glenda. January 21, 2012: Due to stress and dangerously low oxygen level, Glenda was rushed to the nearest hospital: Kaiser Permanente in Walnut Creek, California. Returned to Manor Care on January 23, 2012. January 27, 2012: Long overdue thoracentesis to remove fluid on the lungs performed on Glenda. January 31, 2012: Manor Care prepares to discharge Glenda. Kindred SNF that had formerly agreed to accept Glenda, and had a pulmonary rehabilitation unit and doctor, now refuses to take Glenda. Depressed, and on mind-altering Ativan, Glenda gives up and goes to hospice to die. Glenda arrives at Bruns House hospice facility at 2 p.m., January 31, 2012. Glenda looks good, is alert, reading, and writing notes. Rodney, her caregiver, and Stephanie, his daughter, leaves a smiling Glenda at 6 p.m. The Hectic Necessities Upon Death of a Loved One Even though death was long expected and plans made, carrying them out can be tiresome, both immediately after the death and the funeral services, and then the trustee duties. An obituary was sent to the Contra Costa Times for a three-day placement, and an obituary to the Rossmoor News, a paper for the 8,000 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 the Grace Presbyterian Church conducting the services. Several members of this writer's family spoke of their love for Glenda. A loving and caring Pastor Cherie Reid conducted the services From Glenda's family, there appeared at the funeral services two of the sons, Martin from Tulsa, Oklahoma, and Mike from New Jersey. Bruce, who was found dead after being informed of his mother's death, obviously was not there. Glenda's daughter, living closer than any of the other family, did not appear. Plight of Glenda's Cancer Stricken Partner: Other Ugly Aspects to Dying in America The horrors that Glenda experienced during her four-year battle with cancer and COPD, were shared to some extent by Rodney. In May of 2011, Rodney discovered he had 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 arrogance and corrupt conduct he encountered from rogue physicians at his HMO Kaiser Permanente medical group has further shown the sordid depths to which certain members of the medical fraternity had sunk in the United States. While fighting the death panel and arrogance of certain physicians at Kaiser, he had to deal with the many problems confronting Glenda. Details at Deadly denial of health care by Kaiser Permanente senior Medicare plan.. Rodney had fought off for several decades attacks to halt his exposure of high-level corruption in the federal government which continue to cause or enable to occur great American tragedies. The attacks upon him, seeking to silence him, caused him to suffer enormous personal and financial harm. Now, toward the end of his own life, corruption again affected him personally. Sampling of informative sites: www.defraudingamerica.com,where over a thousand files provides evidence that is never made available to the trivia-obsessed masses. www.defraudingamerica.com/list_of_books.html for a list of the heavily documented books on multiple areas of high-level corruption discovered by Rodney and his coalition of other former government agents and insiders. There is a reason for the reported 30,000 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! Rampant Physician Misconduct That Met Definition of Criminal Conduct The need for, and the laws permitting, criminal prosecutions of HMO denial of care decisions are addressed in an article written by Ohio State University professor, John A. Humbach with dozens of legal citations showing criminal offense from HMO withholding of life-affecting treatment. 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.’’ Prosecutors said they will not comment on the case until LaBrie is sentenced. 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: http://articles.boston.com/2011-04-13/news/29414342_1_hospice-care-medication-young-son/2. Compassion and Coordination with Caregivers Alien to These Medical Industry Physicians What Glenda and Rodney both experienced together in their cancer journeys were in key areas the exact opposite of what is expected as a practical manner and what is claimed at major medical centers. The consequences were felt by Glenda in her cancer ordeal under the fee-for-service Medicare and Healthnet PPO, and what her caregiver and life companion experienced at his HMO type medical group at Kaiser Permanente. It is the belief by this writer that the quality of care, the compassion, the cooperation with caregivers, is far superior at the major medical centers. Rodney and Glenda encountered a constant pattern of indifference, being treated like a commodity, being denied details of the treatment and medical condition, even when repeatedly requested and demanded. This denial made it impossible for Glenda's caregiver to know what treatment was being given, and whether it met the standards that can often be found through an intelligent Google search. In Glenda's case, Rodney was unable to discover the plans for the removal of the fluid from the lungs, who was going to do it, and when. At Manor Care, he was unable to find out what the pulmonary rehabilitation consisted of (They didn't have a professional pulmonary unit!), and couldn't get any details about what if anything was being done. Since they had a moral and legal responsibility to do these things, and contributed to Glenda's premature death from breathing problems, this writer would call these outrageous criminal acts that led to Glenda's needless suffering and premature death! Glenda's life companion and caregiver, Rodney, gave notification to Glenda's cancer doctor of Glenda's death. February 3, 2012. No response. The only one of Glenda's physicians that responded after Glenda's death was Glenda's primary care physician, Vona Lorenzana. A later discovery would reveal a bizarre side to that caring gesture. Honest Medical Care and Compassion: Missing in Medical Industry The universally recognized requirement of care requires physicians to keep caregivers and family members fully informed of a patient's condition and treatment. But there were physicians affecting Glenda's life doing the very opposite, while drugging Glenda with the mind-altering Ativan drug. They kept the medically sophisticated caregiver and partner totally in the dark while they used Glenda in the business-related scheme. Then they encouraged Glenda, in pain from denial of treatment, and under the effect of the mind-altering drug, Ativan, to deny to Rodney any say in her treatment. For four years, he maneuvered under difficult circumstances to arrange for treatment that greatly assisted her living four years instead of the normal one year after a Stage IV esophagus cancer diagnosis. Unnatural Change in Glenda's Appearance Within Few Hours of Her Arrival At Bruns House Hospice Within 12 hours, at 6 p.m. on January 31, 2012, Glenda went from this: Twelve hours later, the following morning: The most probable cause: A lethal overdose of opiates! Murder by physician? For Rodney, losing Glenda after 18 years was traumatic. Losing her under these conditions greatly compounded the grief. Exerts from one article http://www.hospicepatients.org/no-prn-morphine-copd.html 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. 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. Glenda's Caregiver Embarking on Exposing The Ugly Elements in America's Healthcare Industry At this stage, Glenda's life companion, Rodney Stich, the granddaddy of high-level corruption whistleblower, is gathering evidence and will attempt to get attention to this corrupt culture among key physicians that prey upon vulnerable sick people. As he started getting his grieving under control, his attention focused on the arrogance and corruption in the medical industry, and particularly that which caused so much stress upon Glenda, her desire to just give up, and the apparent deliberate death by opiate overdose. He started requesting all medical records relating to Glenda from the medical sources that had a role in Glenda's care—and death. Manor Care even used a law firm to block the record release. Glenda would have died eventually, but misconduct played key roles in her premature death. This can be considered criminal homicide. Physicians expected her death from cancer within a year of her early 2008 diagnosis with Stage IV esophagus cancer. In early 2011, physicians expected her death from cancer to be in several weeks. She outlived all of those estimates. She finally died from morphine overdose. The latter being a common hospice practice! How many more deaths like this are part of or in addition to the 30,000 deaths in hospitals due to medical errors! Glenda died from morphine overdose; not from the esophagus cancer. John Muir Hospital failed to remove the fluid on Glenda's lungs during the Jan 3, 2012 to Jan 14, 2012 hospitalization. Glenda's pulmonary physician refused to take timely action when Glenda was suffering, blackmailing Rodney with the statement that he would not treat his patient, Glenda, until Rodney stating in writing that prior statements made in a complaint to the California medical board, and elsewhere, were incorrect. He was blackmailing Rodney with tragic consequences for Glenda. Manor Care and its physicians fraudulently accepted Glenda for pulmonary improvement knowing that it lacked the facilities and personnel to do so. Manor Care management and physicians, including Dr. Smita Chandra, immediately upon Glenda's arrival from John Muir hospital, acted to discharge Glenda, knowing that such discharge would deny to Glenda the urgently needed pulmonary treatment. It is believed that Manor Care and certain physicians of the John Muir Hospital Medical Group, including possibly Dr. Chandra, sent misleading reports to Kindred skilled nursing facility, that caused Kindred SNF to block Glenda's transfer to that facility. Kindred SNF and it's personnel knew that Manor Care did not have a pulmonary nursing facility or physicians, had never had any pulmonary improvement efforts, and therefore were not qualified to make any statement about Glenda's ability to improve her pulmonary function. And, that their refusal to accept Glenda would have fatal consequences. The role by the John Muir medical group physician, Dr. Chandra, in acting to discharge Glenda upon Glenda's arrival, making false or incorrect statements; and what role Dr. Chandra played in Glenda's sudden comatose situation and death upon arrival at Bruns House. Another of America's Never Ending Scandals: The Medical Industry Highlights in the abuses inflicted upon this great lady by an endless list of physicians reflects the corruption spreading through America's healthcare system. Is this another tentacle of another of an endless series of American scandals that required enablers to continue, and withhold from the masses? Repeated refusal of attending physicians to inform Glenda's caregiver, with former sophisticated medical background, and who was responsible for arranging Glenda's medical care, of the medication and treatment being provided. This prevented Rodney from knowing if care was adequate, and prevented him from seeking additional or alternate care. This secrecy violated universally recognized requirement to keep the caregiver and family of the care being provided, or not provided. Discharge of Glenda by John Muir hospital on January 14, 2012, without removal of the fluid on her lungs, which most probably was the reason for her continuing breathing-related pain. John Muir hospitals transfer of Glenda to the Manor Care skilled nursing facility (SNF) for pulmonary rehabilitation, when that SNF had no such program and no pulmonary physician. Acceptance of Glenda's transfer by Manor Care physicians and management, when they knew they did not have pulmonary rehabilitation facilities. This acceptance was probably motivated to not disturb their primary sourced of business, the referrals by John Muir hospital. To have refused to accept Glenda, with John Muir hospital then sending Glenda to nearby Kindred SNF, where pulmonary rehabilitation and physicians were available, risked losing future referrals from Manor Care's primary source of business. The statement to Glenda by Manor Care personnel, starting with Dr. Smita Chandra, within 24 hours of her arrival, that she would be discharged, when her hopes were on the pulmonary rehabilitation that she was promised, inflicted great stress upon Glenda and changed her will to live. Manor Care, after fraudulently accepting Glenda for pulmonary rehabilitation, then had to promptly discharge her to avoid conflict from Medicare since Manor Care had accepted a Medicare patient for pulmonary rehabilitation when they had no pulmonary rehabilitation program. Glenda became the victim of that fraudulent conduct. The actions of Manor Care physicians and management, starting with Dr. Chandra, constituted a fraud, and deliberate infliction of abuse. Kindred personnel then expanded on the abuse by refusing to accept Glenda when Manor Care was forcing Glenda's immediate discharge. In doing so, they knew they were doing great harm to Glenda. Prior to that point, they had been willing to accept Glenda and even had a room for her. Kindred personnel knew that Manor Care did not have a pulmonary unit and that her discharge from Manor Care was the result of the absence of that form of treatment. Also, Manor Care's physicians and management did not have the medical expertise in that area to make any comment on Glenda's present medical condition or candidate for pulmonary improvement. Kindred had such a program and also pulmonary physicians at the unit. Kindred personnel knew that about the prior deception, and knew that their rejection of Glenda could have fatal consequences. Glenda's brief less than 12 hours of apparently normal life raises suspicion of deliberate over dosage with opiates. The same physician was in attendance, Dr. Smita Chandra, at Bruns House as was involved at Manor House with the fraud occurring there. An unnatural major change in Glenda's appearance over a span of less than 14 hours (and probably much less). John Muir Hospital report of January 13, 2012 showing Glenda's breathing difficulties to be less than major and capable of improvement with pulmonary rehabilitation. Glenda's medical condition, breathing problems, did not meet the criteria for a person in need of hospice. John Muir hospital reports did not meet Medicare's criteria for entering the hospice program, as the reports did not in any way state she had less than six months to live. Welcomed Calls Rodney made known on the Internet the Glenda story, and this caused comments from as far away as Australia. A whistleblower that Rodney had known for many years sent an email (February 27, 2012): Hi Rodney. I took a quick look at some of your writings here and the way that Glenda was abused. I am very sorry to see how she was, in effect, left to die on what appeared to be an overdose of pain medicine that she did not even require. Rodney, you have had enough pain in your life. I am sorry once again that you had to go through all of this. May God comfort you during this time. He is there and knows what you have gone through. He can give you the peace that you desire during this time. Trust him. In my own trials, when I was heartbroken, God came to me more than once and comforted me. He will surely do this for you because he cares for you so very much. You have always been in the forefront of the battles, caring for even those who were dying from the neglect from the FAA. God sees your heart and he is surely near you today. Just rest in his love. There is no greater place that we may find. Take care. Your friend, ..... Records Support Widespread and Possibly Criminal Misconduct Leading to Glenda's Suffering and Premature Death Glenda's caregiver, Rodney, with years of investigative experience behind him that enabled him to recognize serious misconduct, was determined to expose what was done to Glenda. He forced the involved people and groups to produce the medical records that they had refused to make available while Glenda was alive. The primary groups that played a decisive role in Glenda's death were the physicians and management of Manor Care and Kindred skilled nursing facilities, and East Bay Hospice of which Bruns House was a part. These records were combined with the records obtained from John Muir and the Kaiser Permanente hospitals in Walnut Creek, California. There was a striking difference in the medication used to treat Glenda between the hospitals and Manor Care. Also in Manor Care, a major difference between what the Manor Care nurses were reporting and what Manor Care physicians and management were reporting. A hour-by-hour and day-by-day analysis of, the Manor Care records show that there were two primary drugs used on Glenda. Either one of these drugs decreased pulmonary functions, when the need existed to improve pulmonary function. When combined, the decrease in pulmonary function was worsened. Hundreds of records were obtained from John Muir and Kaiser Permanente hospitals, from Manor Care skilled nursing facilities, and from the hospice organization, Hospice of the East Bay. [http://hospiceeastbay.org] These records not only supported the tragedy causing pain and subsequent death of a fine lady, but revealed misconduct that Glenda's caregiver had not known during the hectic final moments of Glenda's tragic death. Glenda's Hospital Records Indicated Favorable Pulmonary and Cancer 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. Favorable Cancer Remission Status A combination PET-CT scan (10/28/11) shortly before entering John Muir hospital (1/5/12) showed a favorable medical and cancer status. Key parts of the Muir Oncology Imaging and Treatment Center report stated. 1. Since the prior study the areas of abnormality in the right lung and right perihilar region have resolved and likely these were representative of inflammation or infection. 2. No new or suspicious findings are seen to suggest local, regional, or metastatic disease. John Muir Hospital Records No End-of-Life Problems Found John Muir hospital promptly provided the records that Rodney 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, though suffering pain from the substituted cancer drug when the primary drug, Taxol, was unavailable. 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. ] Pain and anxiety. While in the hospital, she has been taking and Norco-10 five times a day 1 tablet in addition to Ativan 1 mg at bedtime and p.r.n. [when necessary]. The patient will be discharged to a skilled nursing facility with the same medications. Kaiser Hospital Reports No End-of-Life Problems Found During Glenda's stay at Manor Care SNF the absence of pulmonary rehabilitation facilities caused Glenda to experience a critically low oxygen level on January 21, and the nursing staff had Glenda rushed to the nearby Kaiser Permanente hospital. 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 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. Manor Care Records The next set of Manor Care records, exceeding a hundred pages, were finally received by Rodney from Manor Care Rossmoor Parkway in Walnut Creek on February 28, 2012. These reports showing the treatment being given—or not given—had been repeatedly requested by Glenda's caregiver while Glenda was at Manor Care. Every request went unanswered. Rodney had no knowledge of Glenda's medical condition, or the treatment being given—or not given. It was at Manor Care where Glenda's deterioration occurred, and where there were dozens of reports showing her deterioration, her suffering, her delusions, her anxiety, and other problems. Each of the problems and the treatment that was given or not given were repeatedly withheld from Glenda's caregiver, common law husband for 18 years, with actual responsibility for arranging her medical treatment. The physician in charge was Dr. Martin Jimenez, and he played a major role in getting Glenda sent to hospice, where she was dead within hours of her arrival. It was Jimenez that played a major role in withholding information about Glenda's treatment, preventing Rodney from taking corrective action. During the entire time at Manor Care, Glenda was denied the pulmonary rehabilitation treatment that Manor Care implied to John Muir hospital personnel—and to Glenda—they would provide. One of the drugs that was given to Glenda several times a day throughout Glenda's presence at Manor Care not only depressed pulmonary function—the very opposite of what Glenda needed—but also was well known to alter a patient's thinking, and make the patient suicidal. The side effects are so serious that Glenda was required to sign a document authorizing its use—and acknowledging that she knew the dangers. Expecting a patient in a medical facility, suddenly asked to sign a document to that effect, presented by a doctor supposedly helping the patient, without the patient having access to the warning material and the time to read the material, is a fantasy. Especially a patient under pain from untreated medical conditions. By untreated, the fluid was still on her lungs; her pulmonary problems were not treated, and the reason for her back pain was not determined. Nor was a doctor made available that specialized in pain treatments. And that is a physician specialty. While Glenda was under the influence of the mind altering drug, Dr. Jimenez had Glenda state that the person responsible for arranging her very difficult cancer care for the prior four years would now be barred from making any decision about her medical care. Those decisions would now be made by the Manor Care physicians (Dr. Jimenez) and management, that had engaged in fraud by accepting Glenda for pulmonary rehabilitation—which they did not have; who repeatedly withheld from Glenda's caregiver information about the treatment and lack of treatment; that knowingly gave Glenda round-the-clock drugs that decreased her pulmonary function and distorted her mind, with suicidal thoughts. Glenda wanted to die, but what she needed was treatment, not death! Glenda, her mind then altered by the round-the-clock stupor medicine, known to bring about suicidal tendencies, was completely under the control of Manor Care and Dr. Jimenez. Glenda, unaware of what was being done to her, and what the outcome would shortly be for her, then agreed to Jimenez's suggestion that her caregiver be barred from any involvement in her medical decisions. These duplicitous tactics contributed to Glenda's suffering and premature suspicious death. Glenda, who needed treatment, was instead sent to hospice to die. Helping this scheme were personnel at the Bruns House, part of the East Bay Hospice Group. Within a few hours after arrival, Glenda went from smiling and talkative, writing and mentally active, to comatose and death. January 25,2012 Manor Care report showing breathing improvement after delayed thoracentesis. Revealing Bruns House Hospice Records It was at Bruns House hospice facility that Glenda went from a smiling talkative person to comatose within a period of hours, and dead in a little over 24 hours. It was these records that Rodney sought from Hospice of the East Bay, of which Bruns House was a part. On March 5, 2012, Glenda's caregiver met with Virginia Bruski at the Pleasant Hill offices of Hospice of the East Bay, obtaining over a hundred pages of documents relating to Glenda. These documents included some they had obtained from Manor Care and the remaining bulk were generated by the hospice group, which included Bruns House. The main evidence Rodney sought were: The names of the two physicians that supported the withholding of care and determination that Glenda had less than six months to live. The medication provided to Glenda upon arrival at Bruns House that converted her, within hours, from a smiling and active person to comatose and death. The name of one of the two physicians making possible the abandonment of medical care for Glenda that would have addressed Glenda's two problems, correcting the cause of Glenda's pain from the two large open wounds on her back and her ankle, and correcting the shortness of breath, proved to be a shocker. One physician, Dr. Spencer, relied upon the record of treatment by the Manor Care physicians, especially Dr. Martin Jimenez. Since the culture of many physicians in treating patients is often cursory, indifferent, it is not too difficult to understand that Dr. Spencer would assume that the Manor Care medical reports presented the full story. But for the other doctor, there was no such excuse. The other doctor was Glenda's primary care physician, Dr. Vona Lorenzana! Glenda's caregiver had sent faxes to her on several occasions, including the faxes on January 16, 2012, and January 20, 2012, and January 26, 2012, that very clearly showed that: As it related to Glenda's shortness of breath, Manor Care personnel did not have a pulmonary care facility or pulmonary care specialist; that Glenda could not have received the pulmonary rehabilitation for which John Muir hospital physicians had ordered; that Manor Care physicians did not have the medical qualifications for making any judgment on whether Glenda was capable of pulmonary improvement; As it related to Glenda's pain, the primary source of pain was the large open wounds on her back and ankle. That chronic and treatable painful condition, by wound specialists that Manor Care did not have, would affect Glenda's entire well being. In addition to not providing acceptable treatment, some of the drugs ordered by Manor Care physicians actually decreased Glenda's pulmonary capacity, including Ativan. In addition, Dr. Lorenzana knew that the fluid on Glenda's lungs was one reason for the shortness of breath, and this problem was finally removed on January 24, 2012. That thoracentesis, that should have been done almost three weeks earlier, brought about an immediate improvement in Glenda's condition. Yet, Dr. Lorenzana signed papers that enabled Manor Care to rid themselves of a liability, Glenda, and led to Glenda's highly suspicious death two days later! Hospice article. Looking Back and Understanding In looking back at the daily crises occurring within a 30-day period, and examining hundreds of documents, the following appears to be what happened: On January 4, 2012, Glenda developed one of her breathing difficulty problems and was admitted to John Muir hospital for treatment. The hospital physicians diagnosed the breathing problem to be caused by a possible fungus infection (which she first developed a year earlier, and was difficult to cure). Hospital physicians also discovered fluid on her lungs, for which thoracentesis was indicated. (Draining of the fluid.) On January 14, 2012, without draining the fluid from her lungs, hospital personnel transferred Glenda to Manor Care SNF (Rossmoor Parkway) for COPD rehabilitation treatment, considering her problem treatable. Manor Care management accepted Glenda's referral from the hospital. But Manor Care did not have a COPD pulmonary rehabilitation facility, and thereby was in violation of its relationship with Medicare. The decision to admit Glenda for medical treatment that it did not have was medical fraud, and set in motion a string of events that inflicted great harm, emotional distress, and eventually days later, Glenda's death. Manor Care's management obtained a majority of their business from John Muir hospital and probably did not want to have that relationship affected, or start having the hospital start sending business to its competitor, nearby Kindred SNF, which did have such pulmonary rehabilitation. From that point on, Glenda's untreated pulmonary problems worsened. Rather than arrange for transfer to a competitor SNF that had such care, Kindred SNF, Manor Care compounded Glenda's pulmonary condition by giving her drugs that worsened her initial problem. Manor Care physicians claimed, without having given her the pulmonary rehabilitation treatment, and worsening her condition with drugs, that she could not be improved. Conveying this information to Kindred, that SNF then refused to accept Glenda. That decision, and the effects of the drugs upon Glenda, caused her to give up and want to die. She was then transferred to the Bruns House hospice facility of the Hospice of the East Bay. Within hours Glenda was comatose—and shortly thereafter, death. When a report is read that about 30,000 people who die each year due to medical "mistakes" in the United States, think of what was deliberately done to Glenda, and decide whether her suffering and death could be euphemistically called "mistakes"! Physician Fraud and Euthanasia (Homicide!) In Some Hospice Groups The American public, especially seriously ill patients, or their caregivers, know very little about hospice programs and businesses. For some, and at some hospices, hospice groups provide a valuable service. But there are negatives that must be understood to avoid inflicting even worse harm to already suffering people. Addressing one of several serious problems with some hospice groups was the following comments: “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.” But there are far more serious problems. This link provides information that must be understood to avoid even worse harm and suffering to vulnerable people. 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. A few excerpts from that site follows: 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. ... 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. 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/terri-schindler-schiavo-docs-links-page.html. Report of overdosing: http://www.hospicepatients.org/hospice-nurse-observes-euthanasia.html. Research indicating euthanasia is more widespread than commonly thought and that some euthanasias are clearly done without patient knowledge or permission: JAMA at http://jama.ama-assn.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. Archives of Internal Medicine - AMA at http://archinte.ama-assn.org/cgi/content/full/160/1/63?maxtoshow=&hits=10&RESULTFORMAT=1&author1=Willems&title=Attitudes+and+Practices+Concerning+the+End+of+Life&andorexacttitle=and&andorexacttitleabs=and&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&volume=160&fdate=1/1/2000&tdate=4/30/2001&resourcetype=HWCIT 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). See Survey of Physician Ethics Medical Economics Archive: Oct. 11, 2002. 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  866-9127. 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-morphine-pump-overdosage.html. Glenda Didn't Meet the Less-Then-Six-Months- To-Live Hospice Requirement Glenda did not qualify for hospice under Medicare and her Healthnet PPO insurance. In order for Medicare and health insurance to pay for hospice, two physicians must give a diagnosis that the patient has less than six months to live. Two weeks earlier, John Muir hospital physicians wrote reports that Glenda was doing well. A January 13, 2012 report by John Muir hospital physicians made no such statement and indicated the very opposite. Briefly, the report stated: 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. Further, John Muir hospital physicians determined that Glenda was suitable for pulmonary improvement and having met that criteria, referred Glenda to a skilled nursing home. These actions certainly did not indicate Glenda had less than six months to live. The only physicians with contact to Glenda were those at Manor Care. And they had a motive to report the worse so as to justify their conduct. If, and who, made such declarations has yet to be determined. Any such report would be directly opposite to a report two weeks earlier by physicians at John Muir hospital in Walnut Creek, California. None of the physicians at any stage, including those certifying her as having a terminal illness, that her two problems were treatable: the pulmonary problem and the source of her pain: the inadequately treated wound/ulcer on her back. They decreed a premature death to Glenda! Certification of Terminal Illness Made Possible Glenda's Fraud-Related Death Two California physicians signed the Certification of terminal illness that made possible Glenda's fraud related death. Dr. Vona Lorenzana, and the other was by Dr. Jan Spencer of the Hospice of the East Bay, Pleasant Hill. Dr. Lorenzana's Certification of Terminal Illness (CTI) dated January 31, 2012, had major, arguably fraudulent, and deadly errors. These are described in a fax sent to Dr. Lorenzana on March 22, 2012, by Glenda's former partner, Rodney Stich. Dr. Jay Spencer's Certification of Terminal Illness, dated February 2, 2012, the day after Glenda's highly suspicious death in the Bruns House unit of the Hospice of the East Bay, resembled an off-the-shelf basic form that was more suitable for some minor inter-office matter. Rodney sent a March 22, 2012 fax sent to Dr. Spencer. Both of the Certification of Terminal Illness: Falsely stated the medical condition being treated. Falsely covered up for the treatable pulmonary condition that was the sole reason for Glenda being in the hospital. Falsely covered up that hospital physicians had ordered pulmonary rehabilitation treatment and that the treatment had been fraudulently denied to her. Falsely covered up the fact that if she had been given the medical treatment ordered, she could return to her previous active life. No tests were made to support cancer spreading. Findings made by unqualified and incompetent physicians. Making Dr. Spencer's certification even worse, Bruns House hospice had a requirement for admission that the patient has an estimated seven to ten days of life remaining. The picture of Glenda's arrival at Bruns House, and at Manor Care, and Glenda's medical records, show no such prognosis. The heavy morphine dosing of Glenda took care of that "problem"! Exact Opposite Findings by Professional Oncologists Shortly Before the Sham Physicians' Certification of Terminal Illness A combination PET-CT scan (10/28/11) shortly before entering John Muir hospital (1/5/12) showed a favorable medical and cancer status. Key parts of the Muir Oncology Imaging and Treatment Center report stated: The patient continues on chemotherapy (last dose 1 wee, ago). Patient clinically relatively stable. No complaints of fatigue....No suspicious axillary mass or adenopathy is noted. IMPRESSION: 1. Since the prior study the areas of abnormality in the right lung and right perihilar region have resolved and likely these were representative of inflammation or infection. 2. No new or suspicious findings are seen to suggest local, regional, or metastatic disease. 4. No acute findings are seen in the chest, abdomen, or pelvis. 5. There is trace pericardial fluid and pleural fluid. There are pleural and parenchymal changes which appear chronic. FINDINGS: No suspicious axillary mss or adenopathy is noted. The breast tissue is symmetric and without hypermetabolic abnormality. ... No new or suspicious areas of lytic or blastic disease are seen. IMPRESSION: 1. Since the prior study the areas of abnormality in the right lung and right perihilar region have resolved and likely these were representative of inflammation or infection. 2. No new or suspicious findings are seen to suggests local, regional, or metastatic disease. 4. No acute findings are seen in the chest, abdomen, or pelvis. 5. There is trace pericardial fluid and pleural fluid. There are pleural and parenchymal changes which appear chronic. Physician Justifying Putting to Death Anyone Exceeding Average Life Expectancy As in the past, prior requests for responses were ignored. With the possible forced death of one person, with multiple parties contributing, none wanted to become identified. The callous attitude of Dr. Spencer was revealed in a March 15, 2012 fax from Hospice of the East Bay, that appeared to justify putting to death anyone exceeding the average life expectancy: "Dr. Spencer stated that Glenda had ... far outlived her life expectancy." Under that distorted and deadly medical thinking, Glenda's caregiver, ten years older, living long past his life expectancy, can be euthanatized—put to death—if he enters a medical facility for a treatable medical condition!! Incredibly, he already encountered that medical thinking as a member of Kaiser Permanente medical group! Death has become a commodity for many physicians! Fraudulent Diversion into Hospice Hospice services are appropriate for terminally ill people who wish to abandon brutal treatment and simply receive palliative care, which is usually for pain, and if they are fully informed and understand the availability of treatment and the negatives of selecting hospice. It is outright fraud, if not a form of criminal homicide, for physicians to divert a woman—needing treatable medical conditions, into life-ending hospice. To then bring about the person's death within hours through drug overdose, arguably, compounds the criminal homicide into a conspiracy to commit the act! At one internet site by a hospice group appeared the following information: Hospice that enrolls Non-Terminal Patients Commits Fraud The United States Office of Inspector General has issued its warning to the public about questionable hospice agency practices and stated that some hospices have been found to engage in, "practices which ... have inappropriately maximized their Medicare reimbursements at beneficiary expense. These practices include: Making incorrect determinations of a person’s life expectancy for purposes of meeting hospice eligibility criteria." A hospice that bills Medicare, Medicaid or a private insurer for a non-terminal patient is violating the contracts which allow hospices to provide services for the terminally ill. Hospices are not licensed to care for the chronically ill. In order for a patient to be admitted to hospice, the physician must "certify" that the patient is likely to die within six months due to a terminal illness. Terri Schiavo has no terminal illness; the only cause of death in her case would be her intentional murder by those intent on ending her life. As two recent hospital records showed, Glenda had shortness of breath associated with fluid on the lungs and a possible lung fungus infection—which had been earlier diagnosed. The pain was from open wounds. Both were treatable. Anyone Can Easily Become a Candidate for a Death Decree! Anyone can be put into an appearance of near death by drugs, and then have a physician sign a document that the person has less than six months to live. Glenda needed the prescribed and universally recognized pulmonary rehabilitation when John Muir physicians sent her to Manor Care. That medical treatment was not available and not given to her. Instead, she received drugs, plenty of them, that included drugs that worsened her breathing. (In addition to the excruciating pain from the large open wound open her back.) Determined to nail down the doctors that played a role in Glenda's premature death, Rodney sent faxes (March 9, 2012) to Dr. Jan Spencer at Hospice of the East Bay, and Dr. Vona Lorenzana. These faxes had specific questions about how the doctors came to the conclusion, and certified, that Glenda had less than six months to live. Without their certification on January 31, 2012, Glenda would not be dead the next day—and the apparent suicide or death by grief of Bruce Guilinger, her son in Big Lake, Minnesota. Dr. Spencer, from Hospice of the East Bay, certifying a patient for their Bruns House hospice, had never seen Glenda before and was going by the records. The records of the past 15 days included the doctors at John Muir hospital and Kaiser Permanente hospital who did not find any signs of dying within six months. Further, there were no records at Manor Care or the two hospitals relating to treatment for the cancer. Cancer was not the issue in any of the three medical facilities involved with Glenda. (The cancer that she had survived for the past four years was in apparent remission.) Without any records at their disposal relating to cancer, these two doctors signed the "death decree" that Glenda had less than six months to live, thereby barring her from the COPD rehabilitation that had been previously ordered and denied, and correction of the painful wound on her back. With the help of unknown forces—at this time—smiling and active Glenda was dead within hours—under the care of the Hospice of the East Bay. Fax sent to Dr. Jan Pankey Spencer (March 9, 2012) at the Hospice of the East Bay organization—under whose care Glenda's suddenly and suspiciously died within hours. Dr. Spencer ignored a prior request (February 27, 2012) for information. Rodney was trustee of Glenda's estate; her common law husband; and power of attorney over her medical care. Two people died under suspicious circumstances within hours of the action by Dr. Spencer. It would be safe to assume that Dr. Spencer—and Hospice of the East Bay personnel—had something serious to hide. Fax sent to Dr. Vona Lorenzana (March 9, 2012). Here there was also a very serious problem. Glenda's partner and caregiver, Rodney, had notified her by faxes of serious misconduct that were affecting Glenda's medical treatment that could be expected to have life-affecting consequences. A January 16, 2012 fax to Dr. Lorenzana notified her of conditions affecting Glenda's life, including: Glenda's pulmonary doctor, Dr. Ramin Khashayar, had abandoned Glenda at a critical time, when her life was in danger. The absence of pulmonary rehabilitation program at Manor Care (Rossmoor Parkway) to which Glenda was sent by John Muir hospital physicians for the sole purpose of receiving that medical treatment. Nearby Kindred skilled nursing facility, 200 feet from Dr. Lorenzana's office, did have, and arrangements should have been made for immediate transfer. The statement by Dr. Smita Chandra to Glenda—within 24 hours of Glenda's arrival at Manor Care—that Glenda was going to be discharged. This knowledge should have motivated Dr. Lorenzana to arrange for Glenda's transfer. A January 26, 2012, fax to Dr. Lorenzana notified her of: Manor Care's imminent discharge of Glenda, stating that Manor Care physicians were going "to discharge her [Glenda] from the skilled nursing facility because they think she can't improve [her pulmonary function] any further. It was obvious to Dr. Lorenzana that: Since Manor Care did not have the pulmonary rehabilitation treatment for which she was sent to that skilled nursing facility, no improvement could be expected. Nor would the doctors without pulmonary expertise be qualified to make that determination. The heavy amount of drugs Manor Care gave Glenda had some drugs with known side effects reducing pulmonary function. Totally Irrelevant Response Dr Lorenzana replied the next day, writing on the bottom of the January 26th fax: Dear Rodney. I am so sorry to hear about Glenda's plight. It is unfortunately an insurance problem. They are the ones that make la determination of how long that a patient can be in a skilled nursing facility. Sincerely, Vona Lorenzana, MD. That response was ludicrous. Neither Medicare or Glenda's Healthnet PPO insurance were denying coverage for pulmonary rehabilitation in a skilled nursing facility. It was not an insurance issue. The issue was that Manor Care accepted Glenda for pulmonary rehabilitation when they knew they had no such medical treatment. Now, they had to get rid of Glenda before this fact became known to Medicare and the insurance company. The greed by Manor Care management accepting Glenda from John Muir hospital, the source of many of their patients, required engaging in deception as they falsely claimed that Glenda was not showing any improvement. Dr. Lorenzana, as Glenda's primary care physician, had an extra responsibility to insure that Glenda was receiving recognized medical care. Within the last few weeks of Glenda's life, Glenda's partner and caregiver had repeatedly stated facts to Dr. Lorenzana showing that Glenda was being denied treatment that hospital doctors had authorized. Yet, she did nothing. She then compounded that literal criminal neglect with certifying that Glenda had less then six months to live—from a medical condition that was not even the subject of Glenda's immediate medical problems. Compounding that death panel decision, Dr. Lorenzana placed Glenda's probable cause of death as esophagus cancer, when the subject of her cancer had never come up, and was in apparent remission. Glenda had exceeded the estimated one-year survival time by three years and still scheduled for remission treatment! Prior to that time, Glenda's caregiver had considered Dr. Lorenzana as considerate and extremely interested in Glenda's welfare, based upon the doctor's mannerisms and long time spent with the patient. Glenda's surviving partner had an entirely different perspective after he discovered Dr. Lorenzana's certification that resulted in Glenda's suspicious death the next day, and after Rodney had a chance to go over past notes. Evidence Shows Glenda Did Not Die from Shortness of Breath or Cancer: She was Put to Death! A person that enters a medical facility with a treatable shortness-of-breath problem, looking good, active, doesn't die from that treatable condition within a few hours. Evidence indicates Glenda was probably put to death! As the evidence adds up, it reveals how a group of rogue physicians all played a role in bringing about the death of a love one, a 18-year loving partner. Stripped of niceties, it is almost like seeing a loved one murdered by members of the medical community. Rodney embarked on a crusade determined to obtain as much evidence as possible and circumvent the usual blocks. He started accumulating hundreds of pages of medical reports from John Muir and Kaiser Permanente hospitals, Manor Care Rossmoor Parkway, and Hospice of the East Bay. He also send letters and faxes to individuals physicians and others whose conduct either directly inflicted, or allowed others to inflict, great harm upon Glenda. A sampling of these communications follows: Dr. Martin Jimenez, Physician in charge, Manor Care Rossmoor Parkway. March 14, 2012. Dr. Jay Spencer, Hospice of the East Bay. March 9, 2012. Dr. Smita Chandra, Hospice of the East Bay. March 14, 2012. Dr. Vona Lorenzana, Glenda's primary care physician. March 9, 2012. Laura Stengel, Admissions Director, Manor Care. March 14, 2012. Multiple Physicians Complicit in Homicide? 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. Those legal duties may arise in various ways. For example, a legal duty to provide care is imposed on the parents or legal guardian of a child. Such a legal duty may also be created by contract, for example when a person agrees to provide care for another. 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). Legal article on hospice fraud. Repeat of Summary Highlights Of Medical Homicide Seeking medical help for a treatable shortness of breath condition to physicians-induced death within a short time reveals the unrecognized callousness by rogue physicians and enablers in America's medical business. A quick summary follows: Failure by John Muir hospital physicians to treat a pressure ulcer on Glenda’s back that developed while she was a patient from January 5, 2012 to January 14, 2012. What happened thereafter were medical frauds after hospital physicians ordered pulmonary rehabilitation treatment for Glenda as Manor Care skilled nursing facility (SNF) in Walnut Creek, California. Up to that point, the problems inflicted upon Glenda consisted of physicians' errors. Fraudulent admission of Glenda as a patient for pulmonary rehabilitation treatment by Manor Care managements and physicians. Manor Care had no such medical unit, and apparently admitted Glenda to avoid the transfer of patients by the hospital that constituted the bulk of the SNF's business. Manor Care managements and physician then had to engage in additional fraudulent actions to remove Glenda before Medicare and California regulators discovered Glenda in a facility for which payment was made for pulmonary rehabilitation when the facility had no such medical unit. Fraudulent actions taken by Manor Care management and physicians to remove Glenda before Medicare and California regulators discovered what had occurred. The following actions against Glenda were then taken: First falsely telling Glenda, suffering great pain from the untreated pressure ulcer, that she was not capable of improving her shortness-of-breath problem , that the false prognosis was made by non-qualified non-pulmonary personnel, that her planned discharge was to protect itself from sanctions; and made to cover up for the fraudulent admission on false pretenses. Withholding treatment for the pressure ulcer on her back, which would have extended Glenda’s stay at Manor Care, increasing the risk of sanctions by Medicare and California regulators. Covering up for the untreated and painful pressure ulcer by round-the-clock dosing with morphine and related drugs that were not to be used on patients with pulmonary problems. Encouraging Glenda to disregard my objections to the denial of treatment and mistreatment, relying upon the suicidal side effects of the Ativan drug given to Glenda; her great pain from the untreated pressure ulcer; Glenda’s slack of knowledge of the fraud being perpetrated against her. These medically corrupt acts were being aided and abetted by: Glenda’s primary care physician, Vona Lorenzana, who knew of these problems and covered up for them, signed a Certification of Terminal Illness form stating that Glenda had less than six months to live and would die from esophageal cancer. Tests showed the cancer that was diagnosed four years earlier was in remission; none of the treatment during that hospitalization was for cancer. Physician Dr. Jay Spencer of the Hospice of the East Bay, signed a Certification of Terminal Illness, supporting her fellow colleague in the clubby culture of the John Muir Physicians Group. She had no prior contact with Glenda Facilitating Glenda’s discharge from Manor Care into Bruns House hospice, a unit of Hospice of the East Bay, Spencer held that Glenda had only seven to ten days to live. (Bruns House hospital had an admission requirement that hospice patients have an estimated life remaining of seven to ten days.) Glenda was not eligible for hospice. She had one treatable medical condition when she went to John Muir hospital, where an order was made for Glenda to have pulmonary rehabilitation treatment—that was fraudulently denied to her by Manor Care management and physicians. The second treatable medical condition was the pressure ulcer on Glenda’s back that developed in the hospital and at Manor Care skilled nursing facility. The final coup de grâce occurred to Glenda within hours of her arrival at Bruns House hospice with a massive overdose of morphine: Glenda’s smiling and active appearance the afternoon of her arrival was quickly changed to comatose, gasping for breath—signs of morphine overdose. “She was dead hours later. The physician in charge of ordering Glenda’s morphine at Bruns House hospice was India-trained Dr. Smita Chandra, another doctor on the staff of Hospice of the East bay. It was this same doctor that within 24 hours of Glenda’s arrival at Manor Care commenced the scheme to discharge Glenda without receiving the pulmonary rehabilitation training. With Glenda’s death, the fraudulent conduct by Manor Care management and physicians was seemingly covered up. Aiding and abetting the above medical corruption were a list of people and groups that revealed a level of corruption in America’s medical industry that would equal corruption in almost any other of America’s endless areas of corruption. The sequence of medical corruption was pictured as the events took place. Links to Hospice Misconduct Reports It is easy to falsify records for hospice. http://hospice-uncovered.blogspot.com/. Other related sites: http://www.avvo.com/legal-guides/ugc/hospice-fraud-in-south-carolina--the-us-for-consumers-whistleblowers--sc-attorneys--lawyers. Article Source: http://EzineArticles.com/4358159. http://ezinearticles.com/?Hospice-Fraud---A-Review-For-Employees,-Whistleblowers,-Attorneys,-Lawyers-and-Law-Firms&id=4358159. 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-officials-accuse-hospice-provider-medicare-fraud-14342. 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, Texas-based 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-medicare-hospice-fraud-boom/ Not described here is the grief inflicted by these corrupt actions upon loved ones left behind, the bereavement that often seems endless. 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. Various forms of fraud is associated with hospice. In this matter, the fraud involves patient who was not terminally ill, and who had treatable medical conditions. Physicians certified Glenda as having less than six months to live, and expecting to die of esophageal cancer. But the Stage IV esophageal cancer that was diagnosed four years earlier was in remission and being treated. The illness for which Glenda was in the hospital and skilled nursing facility was treatable shortness of breath, compounded by hospital-SNF-developed wound/bed sore/ulcer on the back. Certification raised possible multiple criminal acts. Fraud against Medicare, and criminal homicide. Article Source: http://EzineArticles.com/4358159. Honest Criminal Investigation Needed Hospice fraud identified by the Office of Inspector General in the U.S. Department of Health and Human Services: http://oig.hhs.gov/newsroom/news-releases/2011/hospice.asp. Glenda's caregiver will try to have her suffering and needless premature death exposed and try to warn others about the arrogance and corruption spreading throughout the medical industry. But with billions of dollars at stake in the medical industry, the American public will probably remain uninformed about this additional area of corruption in America. It is considered murder to do some act, or fail to do some required act, that results in a person's death. The need for, and the laws permitting, criminal prosecutions of HMO denial of care decisions [or any other medical provider] are thoroughly addressed in an article written by Ohio State University professor, John A. Humbach with dozens of legal citations showing criminal offense from HMO withholding of life-affecting treatment. Circumventing the Physicians' Refusal to Respond The refusal of physicians to provide information on Glenda's medical care required a chance in tactics. Fax sent to physician-in-charge at Manor Care Rossmoor Parkway skilled nursing facility, Dr. Martin Jimenez, MD. (March 21, 2012, with copy to Medical Board of California.) Fax sent to Manor Care's admissions director, Laura Stengel. (March 21, 2012) Fax sent to Dr. Smita Chandra (March 22, 2012) stating the evidence of her involvement in Glenda's treatment and final moments in Bruns House hospice, a unit of Hospice of the East Bay. Fax sent to Dr. Vona Lorenzana (March 22, 2012) stating facts indicating her role in Glenda's abusive treatment, fraudulent Certification of Terminal Illness. Fax sent to Dr. Jay Spencer (March 23, 2012) stating facts associated with her role in preparing a sham Certification of Terminal Illness. All of the doctors complicit in the actions against Glenda were members of the John Muir Physician Network. For whatever reason, the head of that group, Dr. Michael P. Kern, sent a letter to Rodney (March 30, 2012) addressing the error by Manor Care admitting Glenda for treatment that the SNF did not have, but sought to hold the complicit physicians blameless. Rodney responded to that letter with an April 1, 2012, fax. Expanding Corruption Exposing Activism Glenda's other half, Rodney, continued gathering evidence to support the extraordinary number of questionable or outright medical frauds. He was determined to expose the physicians and, others in California's medical industry that openly engaged in the fraudulent medical conduct that brought about Glenda's unnecessary suffering and premature death! As he had found during 40 years of prior exposure efforts starting as a federal airline safety investigator, he was a lonely fighter. See www.defraudingamerica.com. People Notified: Protectors─or Enablers Since the 1960s, as a federal airline safety inspector, Rodney had uncovered multiple areas of major misconduct that caused or enabled to occur some of America's worst tragedies. Life in the United States would be totally different if these areas of corruption did not exist. But they did exist, and the American public did suffer, and continues to do so more than ever, because of the enablers that covered up. And that includes well-paid government regulators who were too lazy, too indifferent, and more interested in their own self, to perform the duties they were paid and entrusted to do. Examples of the many documented areas of corruption and consequences can be found at www.defraudingamerica.com. California Medical Board Complaints to the California Medial Board resulted in the standard do-nothing that is the culture in state and federal regulators. The following are two of many examples: Fax sent to Medical Board of California, January 24, 2012, with complaint against Iranian born doctor, Ramin Khashayar, alleging abandonment of Glenda at critical time. No response. Fax sent to Medical Board of California, February 20, 2012, enlarging on Khashayar's conduct and Glenda's death, that possibly could have been prevented if they had acted instead of covered up. They now have a primary reason to cover up and protect Khashayar. Continued cover-up. Fax sent to Attorney General Kamala D. Harris, California Department of Justice, April 4, 2012. No response. Fax sent to sheriff of Contra Costa County, David O. Livingston, April 4, 2012. Acknowledged and showed concern, but not in his area of responsibility. Fax sent to California Attorney General, Kamala D. Harris, April 4, 2012. No response. And so it is, in the medical field, and the needless sufferings and deaths that occur, that this writer experienced the do-nothing complicity of California and federal healthcare regulators. And publicizing these problems, considering this writer's age and cancer, will be the final efforts in 50 years of doing these foolish things. This is one example of the street-thug type of abuses inflicted upon America's vulnerable sick by a culture spreading throughout the medical field. Glenda had earlier wanted to die only because of the inadequately treated pain and COPD problems. Neither she nor her caregiver wanted her murdered by the conditions inflicted upon her. Thousands of people reportedly die every year in the United States from medical errors. But those who die from physician misconduct, as described at this and other sites, die because of the indifference, self-interest, cowardice, of state and federal regulators, who are complicit and enablers. Questions Needing Answers A reported 30,000 people die each year from errors in hospitals. How many of those "errors" are due to outright medical corruption? How many are the unreported deaths outside of hospitals due to medical personnel misconduct? Will Glenda's premature death, and many others, ever be reported as medical errors or medical corruption? Was Glenda's sudden death a result of excessive opiate administration? See one article on the internet relating to the deliberate administration of excessive opiate and resulting death: http://www.hospicepatients.org/euth-acct-four.html. Government medical oversight personnel will not act on these corrupt acts, just as government oversight personnel have allowed to continue the corruption that enabled to occur many of America's worst tragedies. See: www.defraudingamerica.com. www.defraudingamerica.com/medical_care_minefield.html. Deadly denial of health care by Kaiser Permanente senior Medicare plan.. Miscellaneous Related Medical Sites Hospice patients alliance. http://www.hospicepatients.org/euth-center.html. Lawsuits against California Manor Care facilities. "A major lawsuit against every Manor Care home in California accuses the company of fraud—putting "profits over proper medical care." http://www.cbsnews.com/2100-18563_162-600289.html. Hospice is abortion for seniors. http://nhregister.com/articles/2008/11/28/opinion/doc492fd4ae9a647919075495.txt?viewmode=fullstory. EBook on hospice. http://www.hospicepatients.org/this-thing-called-hospice.html. http://www.propublica.org/article/gone-without-a-case-suspicious-elder-deaths-rarely-investigated?key=0. http://www.webmd.com/cancer/news/20120403/half-cancer-survivors-die-other-conditions?ecd=wnl_hrt_041012. "Hospice: Eugenics Carrying out Euthanasia with a Smile." http://lonestarwatchdog.blogspot.com/2012/02/hospice-eugenics-with-smile-and.html. "Now we see Hospice is Federally funded though Medicare. I have even noticed a pattern with people who were under hospice care. I notice some of the patients needed some assistance who were independent who had cancer or some other terminal illness. They where pretty alert and independent. All of sudden the same thing I hear happening over and over. The nurse gives morphine for the pain at night. The patient goes into a coma and dies. Hospice has been reported to starve patients to death with no food or water. It is just I am seeing a pattern now accelerate where everyone who comes under the care of this organization are all of sudden dead." http://www.dailymail.co.uk/news/article-1219853/My-husband-beaten-cancer-doctors-wrongly-told-returned-let-die.html. An almost free eBook is available on Glenda, called Medical Industry's Death Panels: Greek Tragedy of a Lady Named Glenda. Amazon Kindle: http://www.amazon.com/dp/B007RUTEDU. Amazon download to computer. www.google.com: Elsewhere. Print book is available from: www.amazon.com. Numerous other inline book sources. Index of book.