Study: Quarter of Oregon Assisted Suicide Victims Depressed, But Still Were Given Drugs

OHSU Study Finds Patients who Chose Physician-Assisted Suicide May be Clinically Depressed

Criminal Past is No Obstacle to Nursing in California

Web Site Encourages Doctors, Caregivers to Pledge No to Assisted Suicide

Washington Becomes 2nd U.S. State with Legal Assisted Suicide

Health Care Providers in Washington State Refuse to Perform Assisted Suicide

Undercover Reporters: Drug Used in Worldwide Euthanasia Faces Crackdown

Study Shows People With More Chronic Pain More Likely to Commit Suicide...

Study: Quarter of Oregon Assisted Suicide Victims Depressed, But Still Got Drugs
A new study shows about one-fourth of the people killed in assisted suicides in Oregon were depressed, yet they received lethal cocktails anyway.

Researchers at the Oregon Health and Science University conducted the study and skeptic say it shows the guidelines in the assisted suicide law don't work. Psychiatrist Linda Ganzini, the lead author of the study, says the results show doctors need to do a better job of screening for depression before allowing an assisted suicide to go forward.

But Wesley J. Smith, an author and attorney who is a leading euthanasia watchdog, says the guidelines in the law only a way for assisted suicide proponents to make citizens feel safeguards are in place. "As I have repeatedly pointed out, the guidelines are not actually there to protect the vulnerable, but merely to give the appearance of control," he said in response to the study.

"And if one doctor says no, the patient just goes doctor shopping until one is found who will prescribe--usually referred by [pro-euthanasia] Compassion and Choices," Smith says. "So, there is no protection of depressed patients in Oregon, and none is really intended." [8Oct08, Washington, DC, LifeNews.com)
http://www.oregonlive.com/news/index.ssf/2008/10/ohsu_study_finds_depression_in.html

OHSU Study Finds Patients who Chose Physician-Assisted Suicide May be Clinically Depressed

One in four Oregonians who seek to end their lives with a legally prescribed drug overdose may be clinically depressed, a new study reports.

The study, by researchers at Oregon Health & Science University, evaluated 58 terminally ill patients who considered ending their lives under Oregon's unique law. Eighteen received a prescription. Nine died by taking the drug, including three who met criteria for a diagnosis of depression.


Although the number is small, the study concluded that "the current practice of the Death With Dignity Act may fail to protect some patients whose choices are influenced by depression."
The findings appear in the British Medical Journal, which posted them online Tuesday.

Proponents and opponents of the Oregon law split predictably on the findings. Proponents said the usual measures of depression don't work accurately in very sick people at the end of their lives. Opponents said the results point to a fundamental flaw in the law.

Depression in the very sick "has stood as one of the difficult issues to address" in the passionate debate about what some call physician-assisted suicide and others call hastened death, said Dr. Linda Ganzini, a psychiatrist at OHSU, who led the study.

Depression, as defined in the study, is not merely a feeling of sadness. It means feeling "sad or blue and unable to experience pleasure almost all of the time for two weeks," Ganzini said. "That's different from someone getting unfortunate news and feeling intermittent sadness."

The line between sadness and depression -- difficult to draw in physically healthy people -- is doubly so in dying patients.

For example, the study asked patients whether they had been bothered by "thinking about death" during the previous two weeks.

"Give me a break," said Steve Hopcraft, a spokesman for Compassion & Choices, an advocacy group that works with most patients who end their lives under the Oregon law. "Is that kind of depression affecting their choice of aid in dying? Duh!"

Critics of the law warned that the study might have underestimated depression.

"At best, it's what they say -- three out of 58 patients, said Dr. Charles Bentz, an internist in Beaverton and president of Physicians for Compassionate Care, a doctors group opposing the Oregon law. "At worst, this is just the tip of the iceberg."

The finding is timely for two reasons. None of the 46 Oregonians who died last year by taking a lethal prescription was evaluated by a psychiatrist or a psychologist, according to state figures. And voters in Washington state are considering a November ballot measure modeled on Oregon's law.

Oregon is the only state where it is legal for a doctor to prescribe a drug overdose intended to end a terminally ill patient's life. The patient must make one written and two oral requests 15 days apart. Two doctors must affirm that the patient has unimpaired judgment, and the patient must undergo a psychological evaluation if either doctor suggests it.

A total of 341 Oregonians have ended their lives that way.

Ganzini said she hopes her study will lead doctors to improve screening for depression in such patients.

All the patients in the study had either requested a lethal prescription from a doctor or sought help in ending their lives from Compassion & Choices of Oregon between 2004 and 2006.

A psychologist interviewed each patient at home. While 15 out of the 18 patients who received a lethal prescription did not show signs of depression, researchers concluded that doctors should be more rigorous in screening for it.

Three terminally ill patients with depression is "very low," especially given the study's methodology, said Barbara Coombs Lee, a nurse who helped draft the law and who is president of Compassion & Choices. Lee criticized the study's use of standardized tests designed to measure depression in otherwise healthy people.

She called on psychiatrists to develop "a better tool, designed for people dying of cancer."

Whether a person has a "sunny outlook," she said, is the wrong question to ask of a patient facing a terminal illness. "They're sad, and they have a right to be sad."

The key question, she said, is whether they have the judgment to make an informed decision.

"All these patients did," she said.

Among the limitations of their study, researchers noted, their test for depression "carries the risk of inflating the prevalence of depressive disorder." That's because it attributes physical symptoms such as weight loss, fatigue and insomnia to possible depression, rather than to terminal cancer.

"If you count weight loss as a symptom of depression in a patient with terminal cancer, you're going to end up with a skewed study," Lee said.

Bentz, of Physicians for Compassionate Care, says the Oregon law makes it too easy for despondent patients to seek a life-ending pill -- and too easy for a doctor to prescribe one. He calls that "medical killing."

Depression is a treatable illness, Bentz said. The proper role of a doctor is not to tell a depressed patient, "Oh, you're suicidal? Here's your pill," he said. It is to say, "Oh, you're suicidal. Let's find out why."
[Don Colburn;
by Don Colburn, The Oregonian, 7October 2008]



Criminal Past is No Obstacle to Nursing in California
Times investigation finds the state nurse licensing board allowed sex offenders, drug users and convicts to retain and renew their permits.
By Tracy Weber and Charles Ornstein, Special to The Times
October 5, 2008
Dozens of registered nurses convicted of crimes, including sex offenses and attempted murder, have remained fully licensed to practice in California for years before the state nursing board acted against them, a Times investigation found.

The newspaper, in a joint effort with the nonprofit investigative news organization ProPublica, found more than 115 recent cases in which the state didn't seek to pull or restrict licenses until nurses racked up three or more criminal convictions. Twenty-four nurses had at least five.

In some cases, nurses with felony records continue to have spotless licenses -- even while serving time behind bars.

Nurse Haydee Parungao sits in a federal prison in Danbury, Conn., serving a nearly five-year sentence after admitting in 2006 that she bilked Medicare out of more than $3 million.

In her guilty plea, Parungao confessed to billing for hundreds of visits to Southern California patients that she never made, charging for visits while she was out of the country and while she was gambling at Southern California casinos.

Yet according to the state of California, she is a nurse in good standing, free to work in any hospital or medical clinic.

Reporters reviewed stacks of nursing board files and court pleadings, consulted online databases and newspaper clippings and conducted interviews with nurses and experts in several states. The investigation included an analysis of all accusations filed and disciplinary actions taken by the board since 2002 -- more than 2,000 in all. The offenses included misdemeanors and felonies ranging from petty theft and disorderly conduct to assault, embezzlement and bail jumping.

Among the cases in which the board acted belatedly or not at all:

* An Orange County man continued to renew his nursing license for years even after he was imprisoned for attempted murder.

* A Redding nurse was convicted 14 separate times from 1996 -- a year after she was licensed -- through 2006 on charges including several instances of driving under the influence, driving with a suspended license and drug possession.

* A San Pedro man amassed convictions for receiving stolen property, as well as possession of cocaine and burglary tools, before the board placed him on probation. He subsequently was arrested two more times, for possessing cocaine and a pipe to smoke it.

In response, the board extended his probation.

* A Calimesa nurse has a clean record despite a felony conviction for lewd and lascivious acts with a child.

"I'm completely blown away," said Julianne D'Angelo Fellmeth, administrative director of the Center for Public Interest Law at the University of San Diego and an expert on professional licensing boards in California. "Nurses are rendering care to sick people, to vulnerable people. . . . This is a fundamental failure on the part of this board."

Escaping scrutiny

California has the largest number of registered nurses in the nation. Hospitals and clinics rely on the website of the California Board of Registered Nursing, in part, when checking out job applicants because all accusations and disciplinary actions are posted there for public review.

If the nursing board's website says that a convicted nurse has a clean record, D'Angelo Fellmeth said, "It's like fraud. It's consumer fraud."

A top nursing board official says her agency is taking the newspaper's findings seriously but was unable to say why individual cases were missed.

"We're just really putting our arms around the issue," said Heidi Goodman, the board's assistant executive director. "It's important. It's vital. It is what we do. That's our mandate: Public protection."

The newspaper's investigation found the board's screening process to be flawed in two significant ways.

First, it allows a large portion of the 343,000 active registered nurses in California to escape scrutiny. The state began requiring applicants to submit their fingerprints in 1990, so that the board would be flagged by law enforcement agencies whenever a licensed nurse was arrested. But the rule does not apply to nurses licensed before then -- a group that now numbers about 146,000.

California misses a second chance at catching errant nurses when they apply to renew their licenses every two years. Unlike many states, California does not ask nurses to disclose criminal convictions that occurred since the last time they applied.

Even California's vocational nursing board, which oversees nurses with a lesser degree of training, requires renewing nurses to report convictions. California's registered nurses are asked only to pay a fee and verify that they have completed continuing education courses.

As a result, Goodman said the board must rely on complaints and anonymous tips to discover convictions among roughly 40% of its nurses.

She conceded that the system has gaps. Prompted in part by questions from The Times, the board plans to ask the Legislature for permission to add a question about convictions to its renewal application. Goodman said the board does not believe it has the authority to change the application on its own.

The state Department of Consumer Affairs, which provides support for all state licensing boards, also is considering asking the Legislature for permission to seek fingerprints from nurses and other health licensees who have not provided them.

Goodman said the board is doing what it can with its limited budget and staff. It can't pursue cases it doesn't know about, she said.

"I don't know what I don't know," she said. She added: "I don't view it as a problem. I'm just viewing it as taking a look at opportunities."

Delayed reaction

At times, the board's slow pace has put patients at risk.

Some nurses with convictions for drug or alcohol- related crimes later were accused of taking drugs intended for patients.

Before one nurse lost her license, she was twice convicted of drunk driving, failed to complete a rehabilitation program and later appeared drunk at three separate nursing jobs, according to the board's complaint against her.

A nurse convicted in 1994 of smuggling rock cocaine to her jailed husband was not disciplined until nearly 10 years later.

"The exceedingly serious criminal conduct that is the subject of this matter most certainly would have resulted in a revocation of her license" if the charges had been brought sooner, an administrative law judge wrote when the case ended. "No explanation is apparent for the significant delay."

As a result, the judge gave the nurse probation.

In another case, an Orange County jury convicted Stephen Menchaca in 1994 of the attempted murder of his wife. A judge later wrote that Menchaca "hit her on the head with a hard object, pushed her to the ground, put towels in her mouth and over her head and struck her head against the floor."

Menchaca was sentenced to life plus three years in prison.

The nursing board didn't act until eight years later -- after Menchaca had renewed his license repeatedly while in prison. His license finally was revoked in February 2003.

Goodman recalled the case well. "That was a real strange one," she said, adding that the board acted after an anonymous complaint. Asked how he was able to renew his license, she said, "The address of record we had wasn't in prison, so somebody was able to do something on his behalf unbeknownst to us."

Menchaca did not respond to a request for comment sent to him in state prison in Lancaster.

Databases

Goodman said many hospitals conduct their own criminal background checks. And, she said, one minor crime such as a drunk driving conviction may not indicate that a nurse shouldn't be allowed to practice, a view shared by outside experts. Even so, multiple convictions generally warrant some sort of discipline, Goodman said. "There's obviously a problem. There's obviously a pattern."

The board could have found out about some nurses' criminal histories or accusations against them just as The Times and ProPublica did -- by reviewing government databases.

By comparing the state's Megan's Law database, which lists registered sex offenders, with the state's list of registered nurses, for instance, reporters immediately found three cases in which the names and addresses of sex offenders matched those of registered nurses with clean records.

One of those in the Megan's Law database was Thomas Walker Carson, 52, who was convicted in 1989 of lewd and lascivious conduct with a child under 14 and in 1997 for failure to register as a sex offender.

In an interview outside his home in Calimesa, Carson said he continues to work as a nurse and has never been contacted by the nursing board. "The people I work with know all about me and my office knows all about me," he said. "It's never been a problem."

Carson, a former medic in the Air Force, said his conviction occurred nearly 20 years ago and involved a friend's 13-year-old sister.

Asked why he didn't tell the nursing board about his conviction, Carson said, "I'm not going to volunteer for more grief. . . . They don't ask me anything on my renewals. I just pay for a class and pay a fee."

He now works as a home health nurse with an older patient, he said, not children. But he said he still must provide for his two children and believes he is a good nurse.

"I personally am not dangerous," he said. "I wasn't dangerous then."

The nursing board's Goodman said she was unaware that any sex offenders were licensed in good standing.

"I'm sure with Megan's Law being what it is, I'm sure there's a database out there and it would be very interesting -- wouldn't it? -- to run names against a database," she said. "I don't know. I'm thinking out loud."

Reporters also matched the state's list of registered nurses against the federal government's database of health providers banned from Medicare. It found four examples of banned nurses that the board has never disciplined, one of whom was found guilty of patient abuse or neglect.

Parungao, who now is in federal prison, is not listed in the database as being barred from Medicare. But her case is listed on the Internal Revenue Service website as one of its significant healthcare fraud prosecutions of 2007.

Her lawyer, Donald Etra, said there's a distinction between "financial impropriety and medical competence."

"There is no question that Ms. Parungao was a terrific nurse and there was never any question that she was competent and gave great care to the patients entrusted to her," Etra said. "That's what the board should focus on."

Sometimes the board doesn't act upon convictions in California until another state does.

In May 1989, Michael Jay Lutzow was convicted of committing a lewd act on a child in San Diego. Six years later, the California board issued him a nursing license.

In September 2006, Arizona's nursing board rejected Lutzow's application for a license based on his California conviction and other factors.

Nearly a year later, California filed an accusation against Lutzow, citing the Arizona denial.

He did not return calls seeking comment.

In April, the board put him on three years' probation. One of the standard conditions: He must practice as a nurse in California.

; charles.ornstein@ propublica.org; Researcher Maloy Moore also contributed to this report.

http://www.latimes.com/news/local/la-me-nurses5-2008oct05,0,6417887.story
TIMES INVESTIGATION

Comment: Not very reassuring when it comes to "safeguards" against euthanasia.
Nancy V.

WEB SITE ENCOURAGES DOCTORS, CAREGIVERS TO PLEDGE NO TO ASSISTED SUICIDE. With Washington becoming the second state to legalize assisted suicide, euthanasia opponents have put together a new web site to urge doctors, medical caregivers and citizens to say no to assisted suicide. The site comes after doctors and medical centers have said they won't urge patients to kill themselves.

The Take the Pledge web site urges the three different categories of people to sign an online pledge affirming they will help patients, not urge their death. "I will treat the sick according to my best ability and judgment, always striving to do no harm. Whenever I care for a terminally-ill patient, I will provide optimal comfort care until natural death," the pledge for doctors says.

Wesley J. Smith, a noted author and attorney, has endorsed the new web site and urges people to take the pledge to affirm pro-life principles over assisted suicide. "Just because assisted suicide is legal in Oregon and Washington-State, that does make it right. The time has come for a very public and vibrant declaration of non cooperation with the culture of death," he says. 

Take The Pledge - http://www.take-the-pledge.com [http://www.lifenews.com/bio2632.html; Olympia, WA www.LifeNews.com]

WASHINGTON BECOMES 2ND U.S. STATE WITH LEGAL ASSISTED SUICIDE. The state of Washington voted to allow legal assisted suicide according to the Oregon model in yesterday’s ballot. Initiative 1000, the Washington “Death with Dignity Act,” which allows physicians to prescribe a fatal dose of medication to patients whom a doctor feels is likely to die within six months, passed in the state 59% to 41%.  The measure was formulated in imitation of Oregon Measure 16, which was passed in 1994. Euthanasia movement supporters donated enormous sums of money to press Washington’s Initiative 1000 forward, believing that, should it pass, the “domino effect” would soon help to legalise assisted suicide in other states. [http://www.lifesitenews.com/ldn/2008/nov/08110503.html Life Site News]

HEALTH CARE PROVIDERS IN WASHINGTON STATE REFUSE TO PERFORM ASSISTED SUICIDE. Eastern Washington’s largest hospital system, Providence Health Care, has said assisted suicide will not be permitted in its hospitals: “This position is grounded in our basic values of respect for the sacredness of life, compassionate care of dying and vulnerable persons, and respect for the integrity of medical, nursing, and allied health professions. We do not believe health care providers should ever be put in a position of aiding a patient in taking his or her own life.”

The statement follows the deeply controversial passage of the ballot measure, I-1000, which on November 4th legalized assisted suicide in Washington State. Author and bioethicist Wesley Smith commented on Providence’s resolve: “This is important. Medical professionals must resist turning killing … into a medical treatment.”

“None can be forced (yet) to participate,” he says, adding, “Of course, eventually the ideologues will try and force people to participate or be complicit in the killing.”

He says, however, that Providence’s example is vital because it “may save lives of people” who, because of the decisions “of non participating medical professionals, will never ask for assisted suicide.”

I-1000, which allows physicians to prescribe lethal doses of barbiturates to patients they think have less than six months to live, was also resisted by numerous physicians. The Washington State Medical Association (WSMA) was emphatically against the statute.

In a press release in July, the WSMA’s president Brian Wicks said, "We believe physician-assisted suicide is fundamentally incompatible with the role of physicians as healers…Patients put their trust in physicians and that bond of trust would be irrevocably harmed by the provisions of this dangerous initiative."

"Initiative-1000 gives doctors power which we do not want and which we believe is contrary to good medical practice," he continued. "The initiative is a dangerous distraction from symptom-directed end-of-life care that provides comfort for dying patients and their families. Our focus should remain on caring for terminally ill patients and should never shift toward helping them kill themselves."
[7Nov08, By Jonquil Frankham, Washington State, LifeSiteNews.com]

WASHINGTON DOCTORS, HOSPITALS REFUSE TO TAKE PART IN NEW ASSISTED SUICIDE LAW. Voters in Washington may have made their state the second in the nation to legalize assisted suicide but that doesn't mean patients who want their physician's help in killing themselves will be able to get it. Doctors and hospitals are already speaking up saying they will refuse assisted suicide requests. Though voters approved I-1000 on Tuesday, the Washington State Medical Association says doctors have no obligation to participate in killing patients. Meanwhile, Providence Health and Services, the largest medical system in eastern Washington, states it will prohibit doctors from killing patients at its medical centers, nursing homes and other facilities. [8Nov08, www.LifeNews.com, #4466, Olympia]

UNDERCOVER REPORTERS: DRUG USED IN WORLDWIDE EUTHANASIA FACES CRACKDOWN. An undercover news team from a television station in San Diego has found that officials in Mexico are cracking down on a drug promoted for suicides. Euthanasia advocates worldwide have been promoting Mexico as a destination to obtain drugs that elderly people or terminally ill patients can use to kill themselves. As LifeNews.com has reported, at least 200 people from English-speaking countries have traveled to since 2001 to end their lives by obtaining a drug normally used to euthanize animals -- Nembutal. Exit International, a pro-euthanasia group from Australia, is one of the groups promoting the purchase of the drug because it was easy to obtain for a small amount of money.

But undercover reporters from News 10 in San Diego find that's not the case anymore.

The drug, a strong barbiturate, was formerly used as a sleeping pill and it has been blamed for the deaths of luminaries such as Marilyn Monroe, Judy Garland and Jimi Hendrix. To see if the drug is still as readily available, undercover reporters from News 10 went to Tijuana and followed the instructions found in a book Australian euthanasia advocate Philip Nitschke has written with specific instructions on obtaining Nembutal. [15nOV08, http://www.lifenews.com/bio2632.html; Tijuana, Mexico (LifeNews.com]

STUDY SHOWS PEOPLE WITH MORE CHRONIC PAIN MORE LIKELY TO COMMIT SUICIDE. A new study from University of Michigan researchers finds that people with more chronic pain are more likely to commit suicide. The study is important now that Washington has become the second state to legalize assisted suicide after Oregon.

The study included 5,700 adults and it found those who have chronic pain other than arthritis were four times more likely to have attempted suicide than adults without pain. Patients with head pain or pain linked to multiple areas of the body were most likely to consider suicide -- indicating pain relief continues to be a great method of reducing the desire for assisted suicide. According to a Reuters report, among those with three or more painful conditions, 14 percent said they had at some point thought about suicide, while nearly 6 percent reported an actual suicide attempt. [13Nov08, www.lifenews.com, #4470; Washington, DC, www.LifeNews.com]