IF HE IS HAPPY WE WILL LEAVE IT ALONE. YOU WONDER ABOUT THE PAIN.
>> DR. BILL MITCHELL AN ONCOLOGIST IN SAN DIEGO AND HE IS ALSO PALLIATIVE CARE DOCTOR,
PALLIATIVE MEDICINE SAMES TO TREAT ALL SYMPTOMS THAT ACCOMPANY A SERIOUS ILLNESS.
PAIN, ANXIETY AND FEAR. MANY OF THE PATIENTS MITCHELL SEES ARE DYING
AND SOMETIMES HE HAS TO ASK THEM TO MAKE A DIFFICULT CHOICE, CONTINUE CHEMOTHERAPY WHICH
WILL NOT CURE THE DISEASE BUT COULD MAKE THEM FEEL BETTER OR HOSPICE WHICH PROVIDES HOME
CARE, VISITS FROM A NURSE, HOME HEALTH AIDS AND MEDICINE TO HELP WITH PAIN
>> PATIENTS REALLY NEED HOSPICE AND CHEMOTHERAPY THAT WOULD GENUINELY BENEFIT FROM BOTH AND
FEEL BETTER AND LIVE LONGER WITH BOTH. BUT THE REALITY IS HOSPICES CAN'T AFFORD TO
DO THAT. >> REPORTER: MEDICARE PAYS FOR HOSPICE CARE
AT A DAILY RATE, FOR PEOPLE WHO HAVE SIX MONTHS OR LESS TO LIVE.
HOSPICE LEGALLY HAVE THE OPTION TO GIVE PATIENTS CHEMOTHERAPY, RADIATION AND BLOOD TRANSFUSIONS
IF THEY HAVE PALLIATIVE SYMPTOMS AND MAKE THEM FEEL BETTER.
>> HOSPICE HAS TO PAY FOR THAT AND THEY ARE NOT REIMBURSED ENOUGH MONEY TO COVER THAT.
THEY WILL GO OUT OF BUSINESS. >> REPORTER: SO HOSPICES MUST ALSO CHOOSE,
GIVE A DYING PATIENT CHEMO OR RADIATION OR LIVE LONGER AND LOSE MONEY.
THEY GAVE PATIENT CURATIVE TREATMENTS, CHEMO, RADIATION AND BLOOD TRANSFUSIONS AND POSSIBLY
'TIS CARE AND IT'S NOT CLEAR HOW THEY WERE ABLE TO PAY FOR THE TREATMENTS OR WHETHER
PROVIDING THEM CONTRIBUTED TO THE FINANCIAL DEMISE.
THE HOSPICE IS CURRENTLY IN BANKRUPTCY COURT. >> AND ARE YOU TAKING LAXIX STILL.
>> REPORTER: BOTH ROLAND AND MITCHELL DID THEIR TRAINING AT SAN DIEGO HOSPICE.
>> MANY PATIENTS I TOOK CARE OF WITH EXPENSIVE TREATMENTS AND BLOOD TRANSFUSIONS AND CHEMOTHERAPY
AND RADIATION AND A HOST OF OTHER THINGS WHO ARE ANEMIC BUT REALLY WANT TO GET TO THE GRADUATION
OR REALLY WANTED TO GO TO THE WEDDING. AND SO THEY GOT THEIR BLOOD TRANSFUSION ONCE
A WEEK. THE MONTRA WAS DO THE RIGHT THING FOR THE
PATIENT, IF IT ENDS UP COSTING MORE MONEY IT'S THE RIGHT THING FOR THE PATIENT.
>>. >>> AS PRACTICING ONCOLOGIST THEY REFERRED
PATIENTS TO SAN DIEGO HOSPICE. >> I HAD A PATIENT WHO WAS VERY, VERY ILL
WITH AN METASTATIC LUNG CANCER AND SHE WAS SO ILL THAT SHE COULD BARELY SPEAK, COMPLETELY
BED BOUND, SHE WAS TOO SICK FOR CHEMOTHERAPY BUT WE HAVE A VERY EXPENSIVE ORAL DRUG AND
WE ARE LEFT WITH THIS DECISION. WHAT TO DO.
SAN DIEGO HOSPICE PAID FOR THE DRUG. >> REPORTER: HOW MUCH.
>> $4,000 A MONTH, $4,000 A MONTH. FOR EIGHT MONTHS SO THEY WENT FROM BED BOUND
AND UNABLE TO SPEAK TO SITTING UP AT THE TABLE AND PEELING VEGETABLES AND HELPING HER FAMILY
PREPARE DINNER. A PROGNOSIS I ESTIMATED ON THE ORDER OF A
FEW WEEKS BECAME 8 MONTHS BEFORE SHE DIED AND THEY WERE 8 GOOD MONTHS.
SHE NEEDED BOTH. DESPERATELY.
>> REPORTER: THE HEALTHCARE LAW WAS SUPPOSED TO EXPERIMENT WITH ALLOWING DYING PATIENTS
TO CHOOSE HOSPICE AND CURATIVE TREATMENTS AND THE LEGAL FRAMEWORK IS IN PLACE TO ALLOW
15 HOSPICES ACROSS THE COUNTRY TO DO SO BUT THE MONEY HAS YET TO BE APPROVED.
>> THIS HOSPICE BENEFIT IS OPERATING UNDER THE ASSUMPTION THEY ARE BLACK OR WHITE, A
OR B, AND IN ALL REALITY IF IT WERE YOU OR ME, THE CHOICE IS C, ALL OF THE ABOVE.
YOU WANT ALL OF THE ABOVE. THAT IS THE RIGHT THING TO DO FOR PEOPLE.
THE RISK IS THAT IF WE LEARN THAT ANTICANCER TREATMENT AND HOSPICE CARE MAKE A DIFFERENCE
WE MAY HAVE TO PAY FOR BOTH. >> REPORTER: A QUARTER OF ALL MEDICARE DOLLARS
ARE SPENT IN THE LAST YEAR OF LIFE, FROM THE KPBS AND I‑NEWS SOURCE INVESTIGATION DESK,
I'M JOANNE FARYON. >> REPORTER: I‑NEWS BRAD CONTRIBUTED TO
THE STORY AND YOU CAN SEE MORE AT KPBS.ORG/END OF LIFE.