The High Cost of Dying

By: Grainne Rhuad

This week I had a couple of troubling phone calls.

 

Firstly a call from a friend whose partner is dying.  She needs respite and has no outlet for it.  They aren’t married, both have been single, She divorced, he widowed for some time.  His wife died of cancer and while he took care of her until she died, it was a struggle.  He kept her at home and she died in her bed.  It was hard to make ends meet but it was do-able.

 

Now he is dying.  His kidneys are shutting down and he has refused dialysis.  A major reason is cost.  He can in no way afford the dialysis.  His long time partner who never wanted to get married because as she put it, she didn’t want a man to be a strain on her financially.  She had established herself in her own right after her very hard divorce.  Now she is accepting this strain anyway because there is nobody else.

 

Things have changed since his wife died.  Now there is no getting by.  He won’t even be able to afford to be buried by her.  Sadly he won’t be able to afford his religious death rituals and will have to be cremated despite his own beliefs because that is all anyone in his family can afford.

 

The other call was similar.  A friend of a friend is in need of surgery and cannot afford it.  She lives in a state that doesn’t allow for medical if you have any assets.  They own a very small house.  Medicaid won’t pay for the operation and they have spent the better part of the last several months searching for other programs to help with the cost.  Some were found but a lot of possessions had to be sold off in order to afford the surgery. Both so the value could not be counted against them and also so to raise money.

 

One of the sad truths of both of these situations is both of these couples were against the “Obama Care” package due to their unfounded fears of non-existent death panels and other prejudices to the Elderly.  I can’t help but think that even if there had been a boogey-man death panel, they would have at least died comfortably able to afford the pain saving morphine.  Kidney shut down is not a fun and comfortable way to die.

 

Now this week, James Verone of North Carolina makes headlines when he decides the only conceivable way to get the health care he needs is to go to jail.  He wasn’t greedy, he only asked the teller for $1.00.  I’m frankly surprised the teller took him seriously and didn’t let bank security deal with him.  But I guess there is protocol which Verone surely knew about.

 

He didn’t do this lightly, he states he had never been in trouble with the law.  He did his research stating “He was hoping for a three-year sentence so when released he would be old enough to collect social security. Planning ahead, he says he’s already spoken to a realtor about purchasing a condo in Myrtle Beach”

 

He  admitted to this calculation.  “If it’s called manipulation, then, out of necessity, because I need medical care, then I guess I am manipulating the courts to get medical care,” he told the station.

 

Unfortunately for the would-be bank robber, stealing $1 was only enough to get him charged with larceny from a person rather than a more serious bank robbery charge. With a conviction on that charge, Verone will likely spend less than three years in prison.

 

But what his sentence is is besides the point.  The very fact that he felt desperate enough to do this is a concern. Besides I kinda think a case could be made for fraud which would definitely get him the three years he needs.

 

James Verone is not alone.  There have been increasing numbers of men and women willing to commit crimes just to get into jail.  Their reasons are increasingly similar, the need for food, shelter and medical care, in particular end of life care.  The only reason his case is standing out is because his crime was so ridiculously minimal and he admitted his intention.  Most people commit larger crimes.  Mostly they don’t intend to get out.

 

Prison systems all over the country provide health care to their inmates.  It is a part of a 1974 Supreme Court ruling that stated that “the eighth amendment’s admonition about “cruel and unusual punishment” meant, among other things, that prisoners must get sufficient medical care.” Subsequent Supreme Court hearings have broadened the definition of what sorts of care should be provided.

 

There is a lot of argument over whether or not the prison system is doing a good job of this.  However it cannot be argued that they are providing  some care which is obviously better than no care.

 

The California Dept of Correction’s 2009 Death review states “there has been demonstrable improvement in the number and quality of the professional health care staff. Systemic improvements have been focused on introducing standardized guidelines for caring for chronic illness such as asthma, diabetes mellitus, hepatitis C, and chronic pain management. In 2009, two major initiatives took place: guidelines for specialty referral were introduced and a Primary Care team-based system of health care was installed in all of the thirty-three California prisons.”

 

The following illustrates that among inmates end of life services went beyond what those on medical/medicaid have available to them.  In many cases even those with insurance are not covered by their insurance companies for the full amount or are kicked off due to their pre-existing conditions clauses (In CA this has changed this year due to implementation of the Federal Patient Protection and Affordable Care Act-Other States too are in the process of making changes)

 

Table 1. Causes of Death Among All California Inmates, 2009

NUMBER OF CASES

CAUSE OF DEATH

Cancer-133

Lung (36), Liver hepatoma (30), Colorectal (13), Pancreas (12), Lymphoma (6), Prostate (6), Unknown Primary (3), Bladder (2), Esophagus (2), Leukemia (2), Renal Cell (2), Stomach (2), Acute Lymphocytic Leukemia (1), Angiosarcoma (1), B Cell Lymphoma (1), Brain (1), Breast (1), Cholangiocarcinoma (1), Chronic lymphocytic leukemia(1), Epiglottis (1), Gastrointestinal Stromal Tumor (1), Head/Neck (1), Lymphoma Hodgkin’s (1), Malignant Melanoma (1), Oropharyngeal (1), Prostate/Bladder (1), Squamous Cell (1), Testis (1), Thyroid (1)

End Stage Liver Disease-60

Sudden Cardiac Arrest /Acute Myocardial Infarction-47

Suicide-25

Drug Overdose-14

Pneumonia-12

Congestive Heart Failure, Homicide-10 each

Chronic Obstructive Pulmonary Disease, Coccidioidomycosis, End Stage Renal Disease, Pulmonary Fibrosis, Subarachnoid Hemorrhage, Upper Gastrointestinal Hemorrhage-5 each

Aortic Aneurysm, Dementia, Pulmonary Embolism, Stroke-4 each

HIV/AIDS-3

Amyotrophic Lateral Sclerosis, Diabetic Ketoacidosis, End Stage Kidney Disease, Endocarditis, H1N1 Influenza, Pancreatitis, Traumatic Brain Injury-2each

Acute Hepatitis, Acute Respiratory Distress Syndrome, Acute Water Intoxication, Coronary Artery Disease, Gastric Ulcer, Hepatic Hemangioma, Peritonitis, Polycythemia, Progressive Multifocal Leukoencephalopathy, Pseudomembranous Colitis, Scleroderma, Seizure, Sepsis, Small Bowel Obstruction, Small Bowel Perforation, Suprapituitary Tumor, Systemic Lupus Erythematosis, Unknown, Vasculitis-1each

CASES REVIEWED-393

Reviews Pending-2

TOTAL DEATHS-395

It seems clear from this data that inmates are dying not from ‘the wages of sin’ but in the most part from normal everyday disease that happens to all of us.  And according to the California Corrections Website Report (see link at bottom) everything that can be done to treat them and make them comfortable is being done.

When we are at this point, where our well laid out plans of individuality and self-sufficiency fail us and our instinct to vote against our own self interest hurts us and we are so out of ideas that we are willing to live out our days in a cell shouldn’t we be thinking in terms of a change?

Many people are unsure whether the federal and state governments should be involved in the business of health care.  However it seems to have escaped the naysayers heads to think of any alternative.

It could be a concedable point that the government should stay out of the care of citizen’s everyday lives.  After all health care and welfare didn’t come available until after the first world war, with the exception of poorhouses and orphanages which very often were maintained by church groups anyway.    Until that time families and individuals cared for themselves and one another.  Communities very often would take up the slack for a terminally ill or otherwise incapable individual.

So why are we continuing an extremely unhealthy and detrimental cultural tradition of not caring for our own?  Of putting from sight the elderly and infirm?  Of playing this game with ourselves of pretend in which tomorrow never comes and we can take out loans to stretch our faces back to (supposedly) look younger?

The loans are another interesting thing.  It’s easy for a young to middle aged person who is a worker bee to get a loan for absolutely any kind of crazy body alteration from tummy tucks to split tongues, however loans aren’t available for the ill.  Banks know they have a higher chance of defaulting.  Until the housing crash this was taken care of handily with the shill of Reverse Mortgages.  A tidy game in which a house which is payed for is put into another loan that the owners don’t have to pay back, the bank just gets it when they die.

I am just a little nervous however at the idea of loans for medical procedures having recently watched Repo Men .

A better solution would be to begin building our houses and communities with extended families in mind.  Quarters for Grandma, neighborhoods set up for walking in instead of sprawl.  And by the way this would help not just with our geriatrics but with the rest of our struggling families.  Let us not forget family groups however you define them are for support, not for status.

We also need to take a look at the way we are viewing the ending of life.  It is not something to look away from.  It is in fact as important as the blessed occasion of birth.  If we changed how we viewed it I bet a lot more of us would be setting up grass roots home grown traditions that would be more in line with our own beliefs and more satisfactory to both those leaving this mortal coil and those left behind.

 

http://www.library.ca.gov/crb/98/09/98009.pdf

http://www.cphcs.ca.gov/docs/resources/OTRES_DeathReviewAnalysisYear2009_20100907.pdf

http://www.cphcs.ca.gov/

http://www.healthcare.ca.gov/

http://www.dhcs.ca.gov/Documents/1115%20Waiver%20Fact%20Sheet%2011.2.10.pdf