News Briefs

The American Medical Association (AMA) Institute for Ethics recently announced details of its EPEC (Education for Physicians in End-of-Life Care) train-the-trainer project, funded with a grant from the Robert Wood Johnson Foundation. EPEC is aimed at "equipping the physicians of America with the knowledge and skills necessary to ensure that dying patients are comfortable and that their remaining life has value and dignity,"explained AMA Board Chairman Thomas Reardon, MD, at a Chicago press conference.

"By educating physicians on the appropriate use of hospice care, the importance of adequate pain management, and the critical nature of advance care planning to clarify patients' wishes for end-of-life care, we can secure that patients experience a dignified death with comfort, quality, and value," adds Linda Emanuel, MD, PhD, director of the Institute for Ethics.

The AMA will offer four two-day regional EPEC conferences in Chicago, Boston, Phoenix, and Atlanta this fall and next spring. These conferences will train a select group of 250 physician educators, chosen through a special application process, giving them the skills needed to train others in EPEC's standardized curriculum. That curriculum addresses how to deliver the news of a life-threatening diagnosis, conduct an assessment in end-of-life care, manage imminent dying and bereavement, and respond to requests for physician-assisted suicide.

EPEC is also compiling a speaker's list on end-of-life care, a resource guide for continuing medical education programs, and a "compendium of hospice experiences," listing educational opportunities for physicians within hospices and palliative care units. Two EPEC videos will also be produced. For information, contact the AMA's Institute for Ethics, 515 N. State St., Chicago, IL 60610. Telephone: (312) 464-4979.

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News Briefs

VistaCare, the multi-state hospice company profiled in last month's Hospice Management Advisor for the buzz it has created in the industry, recently announced a definitive agreement to purchase 21 hospices owned by Vencor, a Louisville, KY-based health facilities company. Effective June 1, Vista was set to begin managing the Vencor hospices in Arizona, Idaho, Utah, Colorado, Missouri, Indiana, Ohio, Pennsylvania, Massachusetts, South Carolina, and Georgia. The purchase is expected to close within the next few months, subject to regulatory approval.

Terms of the transaction were not announced, although it would raise Vista's cumulative patient census for hospice programs in 13 states to 900.

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News Briefs

According to recent wire services reports, Geoffrey Fieger, the outspoken attorney for Michigan death doctor Jack Kevorkian, is running for Governor of Michigan. In announcing his plans at an April press conference, Fieger revealed that he doesn't support assisted suicide or abortion. Meanwhile, prominent end-of-life medical ethicist and Project on Death in America faculty scholar Steven Miles, MD, of the department of geriatrics at the University of Minnesota, announced his candidacy for the U.S. Senate. Miles, who would bring an usually rich understanding of end-of-life issues to that position, is considered a long shot, at best, in his campaign against conservative republican Rod Grams.

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News Briefs

The final report of the National Hospice Organization (NHO) Nursing Home Task Force, approved by the organization's board of directors but not yet released, asserts that the integration of hospice care into nursing homes can fundamentally change the culture of care dying patients receive there. But the challenges of this setting, in terms of meshing two very different organizational cultures, demand that hospice care be fully integrated into the culture of the nursing home.

The report has a dual purpose: internally, to point the way for hospices to do self-audits and elevate the standards of their nursing home care, and externally, to work with the nursing home industry and the Health Care Financing Administration to address structural problems in this setting. The report emphasizes researching the quality of care given to dying hospice patients in the nursing home and analyzing and reconciling the various payment systems and benefits for nursing home patients. It recommends identifying specific pathway outcomes for hospice patients in the nursing facility and developing a hospice residential benefit.

"The report is really good," task force Chairman J. Donald Schumacher, PsyD, president and CEO of the Center for Hospice and Palliative Care in Cheektowaga, NY, modestly asserts. "This is one of our most important, but vulnerable, settings for hospice care, largely because of the complexity of the dual provider relationship," he says.

"I hear a huge, huge lack of understanding of this benefit. Hospice people haven't paid attention, and haven't kept pace with its development. My feeling is that every hospice has to update itself, review its contractual relationships, and see how close its program fits the guidelines in our report," Schumacher adds. "Otherwise, we'll get in trouble again. The government is always looking for ways to save money," and could threaten to end the hospice nursing home benefit, as it has in the past.

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News Briefs

Volusia County, FL, Medical Examiner Ronald Reeves has been investigating Hospice of Volusia/Flagler, in Daytona Beach, and several other local medical practitioners, alleging that high doses of morphine and other painkillers are speeding up the deaths of terminally ill patients. According to the Daytona Beach News Journal, Reeves' investigation has angered the medical community, county officials, and the families of terminally ill patients.

On May 18 Reeves called for a coroner's inquest into the deaths of three cancer patients whom he believes died of morphine overdoses, although State Attorney John Tanner responded that he would not ask for an inquest based on the insufficient information provided by Reeves. Tanner has voiced frustration with Reeves' methods of practice in the past, according to the News Journal report. The hospice, which strongly criticized Reeves' scrutiny as unfounded and unwarranted, has also retained an attorney to conduct its own investigation.

"This guy is a loose cannon. He's hurtful," Greg Smith, MD, a local pain management specialist, told the newspaper. "He's only harming patients. The big fear of cancer patients isn't diagnosis but that their pain won't be treated," Smith said. "Dr. Reeves'efforts run the risk of setting back the proper treatment of terminal cancer patients by decades." n