From the New York Times:

A retirement community affiliated with Dartmouth Medical School in New Hampshire has become a laboratory for the ’slow medicine’ movement, allowing patients to put on the brakes when considering care that may have high risks and limited rewards for elderly people.

… it educates patients and families how to push back against emergency room trips and hospitalizations designed for those with treatable illnesses, not the inevitable erosion of advanced age.

Slow medicine, which shares with hospice care the goal of comfort rather than cure, is increasingly available in nursing homes, but for those living at home or in assisted living, a medical scare usually prompts a call to 911, with little opportunity to choose otherwise.

The movement is not without controversy.

Many in their 80s and 90s — and their boomer children — want to pull out all the stops to stay alive, and doctors get paid for doing a procedure, not discussing whether it should be done. The costliest patients — the elderly with chronic illnesses — are the only group with universal health coverage under Medicare, leading to huge federal expenditures that experts agree are unsustainable as boomers age.

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An analysis by the Dallas Morning News of state personnel records finds that 72 employees from Texas’ 10 state mental hospitals have been fired in the last three years over allegations of physical abuse, including brutal beatings and sexual abuse. Hundreds more were terminated for other violations, from sleeping on the job to over-medicating mentally ill patients.

State officials say there will always be some reports of abuse and neglect in an institutional setting. And they say they take any allegations of mistreatment seriously. But the records show that as in other state-run facilities, abuse and neglect are systemic.

The state’s juvenile prisons, group homes for the disabled, and state schools for people with mental disabilities all came under fire last year for reports of widespread physical and sexual abuse. The state psychiatric hospitals, like other systems for vulnerable Texans, are chronically starved for cash, advocates of more state funding say, and services at the local level can’t keep up.

“You get what you pay for,” said Rep. Garnet Coleman, D-Houston, who has bipolar disorder. “When you financially dumb something down, you make services cheap, something’s got to give. Unfortunately, it usually ends up being a mentally ill or disabled Texan.”

See earlier posts here and here.

Waiting for help that’s not coming

‘Judge a society by how it treats its weakest?’

From the Annapolis Capital, an extended feature on people with disabilities in Maryland who qualify for services that would allow them to live more independently, but cannot receive them because the services have not been funded.

Four years ago, there were 9,697 people waiting for help. There are 17,250 today. Ninety-four percent of those on the list need help immediately, said Michelle Hart, co-director of public policy initiatives for the Maryland Developmental Disabilities Council. She estimates it would take hundreds of millions of dollars to solve the problem.

“It is at a crisis stage,” said Robert T. Ireland, executive director of a group that serves about 450 people with developmental disabilities. “I turn people away every day. It’s the saddest part of my day.”

See related posts here and here and here.

Book by Darby Penney and Dr. Peter Stastny; Review by Abigail Zuger, M.D., in the New York Times:

A new book attempts to catalog and explain what was found in suitcases left by patients at Willard State Hospital, a gigantic institution that housed people with incurable mental illness from 1869 to 1995. The book, which follows an exhibition, includes a collection of “transfixing” photographs of the residents and their possessions. Dr. Zuger finds the authors’ reasoning “problematic.”

Stories about the experience of illness are in vogue these days. Some seek to humanize medical science, while others (like those in the movie “Sicko” from Michael Moore) aim to change health policy with the brute force of anecdote.

The authors, Darby Penney and Dr. Peter Stastny, are in the second camp. Both are prominent patients’-rights advocates: Dr. Stastny is described on one advocacy Web site as a “dissident psychiatrist” and Ms. Penney as a “long-time activist.” Their platform is clearly stated in the book’s first pages: much mental illness is “understandable reaction to stress,” orthodox psychiatry often “stands in the way of healing” and even the most “distressed” patients will fare better outside institutions.

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From the BBC:

The human rights of people with learning disabilities are frequently breached, according to a report from the British Parliament.

The Joint Committee on Human Rights says vulnerable adults are particularly likely to be abused and neglected. The report highlights cases where people in care homes or hospitals were inappropriately restrained with straps or sedated with drugs.

The committee was shocked that even in cases of horrific abuse, staff did not know they were doing wrong.

Improvements are being made, the report says, but a culture based on outdated negative stereotypes needs changing.

“The evidence has shown us that the consequences of a lack of awareness of people’s rights can be devastating,” said Andrew Dismore, chairman of the committee.

Writing in the Ottawa Citizen, Renate Lindeman says that the website for Toronto’s Hospital for Sick Children carries misleading and negative information about Down syndrome. Such misinformation deprives women of the opportunity to make informed choices about their pregnancies, she says.

With only negative or misinformation available it is a sad but true statistic that over 90 per cent of parents in Canada choose abortion when faced with a prenatal diagnosis of Down syndrome. As president of the Nova Scotia Down Syndrome Society I have seen the number of registrations of new babies drop an astonishing 85 per cent.

Is this the aimed objective? Today, in Canada, only those lucky enough to know someone with Down syndrome, stubborn enough to initiate their own research about Down syndrome, or those who are pro-life no matter what, will experience that a life with Down syndrome is a life worth living.

If we don’t speak up, life will indeed not go on for an entire population.

From Reuters, Fox News:

A mentally ill paraplegic man has filed a lawsuit against a hospital that dumped him in a gutter on Los Angeles’ “Skid Row.”

Gabino Olvera, 42, sued the Hollywood Presbyterian Medical Center for negligence after it discharged him in February 2007, took him across town in a van and left him in a soiled hospital gown without a wheelchair in the heart of the city’s homeless area.

Witnesses who came to Olvera’s aid said they saw him dragging himself on the ground with hospital papers and documents clenched in his teeth while the driver sat in her van and applied makeup before driving off.

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