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she was on for about 6 mo at that time. She has M/S and has ben bedfast for 11 yrs. She was in extreme pain. She was given 300 mg every 4 hr and if she wasn't awake to take it they were giving it rectally. My opinion , they were trying to get her off hospice because after 6 mo they are loosing money on her. She is still bedfast, her pain is being controlled with vicodin now. Hospice called us in to make funeral arrangements and said she had hrs to live. I guess if we would have blindly followed their orders she would have died. but it would have been from overdose, not the M/S.
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My husband had metastic colon cancer for nine years, he had a surgery to remove the right side of his liver, then 5 months later he had a bile duct leak into the cavity of the right liver that was removed. A procedure was performed to insert the drain and an infected area was hit and he went septic, the trauma team brought him back. Long story short, he didn't recover and we went home with hospice care. Yes, he had the morphine and yes he died peacefully in his sleep. There is no quality of life at the end stages, it is better to let your loved one go, although it is so hard to do this. He was dying without the morphine, the septic shock undermined his health so that he could not undergo chemo treatment anymore. I am not bitter, just sad.
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Mamacat, I need to use tough love here, but you are not paying attention.... another writer and I have told you it would be impossible for your daughter to have receive a dosage of 300mg of morphine and live through it. I'll say it again, IMPOSSIBLE. The dosage was maybe 30mg, nothing more.

Hospice called you in to make funeral arrangements? Here in my area, Hospice is only responsible for having the telephone number for the funeral home for when, and if, the patient passes. Hospice needs to know whom to call.

I know during this time everything is highly emotionally charged. Family members are like deer in headlights, and not processing everything that the doctor and nurses are saying. It can be easy to get facts mixed up.
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I don't believe some of these are real posts. If you look at the profiles of these hospice-is-murder posts, most of them are brand new profiles, with only a couple of comments. Usually the ones in these threads.

I think "prolife" is making multiple personalities up, or else calling in other activist friends to invade the forum with their b.s. Maybe both.
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"Mamacat123",
I'll play along just so some new innocent poster doesn't really believe your crock of cr*p.

*She received 300 mg. of Morphine.
•Again, there is and never has been a doseage of Morphine that is 300mg. That would cause death instantly. Like I've said, the doses vary from 5-15 mg.

*They were trying to get her off hospice because after 6 months, they loose money on her.
•Wrong again. The Medicare program (federal government) funds hospice. Some patients  have been on hospice for years. If they improve (which occasionally is the case), they come off. If they need pain management, nausea/vomiting control or breathing assistance or anxiety control, we can put them back on hospice.

* Vicodan is controlling her pain where Morphine didn't?
• Wow, that's ridiculous. Morphine is much stronger than Vicodan. And Vicodan has Acetaminophen (Tylenol) in it, so the patient would receive too much of the Tylenol in trying to get rid of the pain.

I think this thread, like the other anti-hospice thread, should be put to sleep.
Let's give it 300 mg. of Morphine! 😝 💉
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FOR THE LAST TIME, PEOPLE GO TO HOSPICE TO DIE. WHY ARE PEOPLE AMAZED THAT THAT'S WHAT THEY DO ONCE THEY ARE THERE (MOST OF THE TIME)?
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Mamacat123,

What you witnessed was real and is happening widespread, in every state.

I recommend the Hospice Patients Alliance. It is a pro-life, patient advocate organization. It was founded by a hospice nurse, turned whistleblower. He saw these things happening and couldn't take it anymore.

Their website is filled with information and first hand accounts that could answer many of your questions.

You can email them, tell them your story and ask questions.

They also have a phone number you can call to get help and advice.

It is one of the best resources for these issues.
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I'm not sure it's wise to tell people they can't have seen what actually they might have seen. Mama cat's loved one was being given morphine either orally or p.r., and as a bedbound MS sufferer could have been a long-term opioid user.

So I looked it up and found this in the BNF:

Pain in palliative care (following initial titration)
By mouth using immediate-release medicines

For Adult
Usual dose 30 mg every 4 hours; up to 200 mg every 4 hours, higher dose may be required for some patients (occasionally more is needed); for management of breakthrough pain and other general advice, see Pain management with opioids under "Prescribing in palliative care".

By mouth using modified-release medicines

For Adult
Usual dose 100 mg every 12 hours; up to 600 mg every 12 hours, higher dose may be required for some patients (occasionally more is needed); for management of breakthrough pain and other general advice, see Pain management with opioids under "Prescribing in palliative care".

It sounds as though there was maybe some kind of reaction to the morphine itself? - if her pain was uncontrollable in spite of the increased dose, but then able to be controlled with Vicodin instead.

But then isn't that the point anyway? That hospice are not death squads who, once you invite them over the threshold, will kill your loved one come what may. Mamacat decided on a second opinion on her sister's behalf. I'm very glad, good catch, good outcome. That's what's *supposed* to happen.
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#mylovedonetoo
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CM,
I tried to access the BMF website but I couldn't find a way to look up anything. (?)

This is from drugs.com;
"CDC (Center for Disease Control) states that primary care clinicians should carefully reassess individual benefits and risks before prescribing morphine sulfate dosages ≥50 mg daily for chronic pain and should avoid dosages ≥90 mg daily or carefully justify decision to prescribe such dosages. Other experts recommend consulting a pain management specialist before exceeding a dosage of 80–120 mg daily."

I understand patients developing a tolerance to opioids but I have NEVER seen 300 mg. of Morphine being given AT ONCE. I would bet you a weeks pay that there never was an order that said to give 300mg. at once.

You wrote 30 mg. every 4 hrs., up to 200 mg. every 4 hours (or 50 mg./hr.)
Then;
100 mg. every 12 hours, up to 600 mg. every 12 hours. (or 50 mg. hr)
for a maximum dose of 1200 mg. in a 24 hour period.

I think you'd be hard pressed to find that amount being given in most hospices or written by most doctors.

At the hospice where I work, our orders;
Give Morphine 15 mg. every four hours.
For "breakthrough" pain, give Morphine 5-10 mg. every hour as needed.

Let's suppose the patient needed breakthrough pain medicine (Morphine 10 mg.) EVERY hour.

Morphine 15 mg. given 6 times in a 24 hour period plus Morphine 10 mg. given 18 times in a 24 hour period.
90+180=270 mg. for a 24 hour period.

I'm not saying huge doses can't and don't happen, but I think it's a lot less common than the lower doses.

I'm only one person working with one hospice. I have worked more than 2 decades in acute care hospitals.
If this is happening, it flew past me. 🕊

P.S. Vicodin is prescribed for moderate pain. It contains 300 mg. Acetaminophen (Tylenol) and therefore can't be given after the acetaminophen doseage has gone over 2 Gm./day or liver toxicity could result. The dose instructions are to take one tablet every 6 hours, not to exceed 6 tablets in 24 hours.
Is that going to be sufficient to relieve pain in a dying person? I doubt it.
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This is a statement on the Brad Harris "Hospice Boss" case.

"Nurses gave high doses of drugs such as morphine, regardless of whether patients needed it, to justify the higher payments, prosecutors said. In some instances, these excessive dosages resulted in serious bodily injury or death."

dallasnews.com /news/frisco/2017/02/28/frisco-man-15-others-indicted-medicare-hospice-scheme-used-human-life-vulnerable-stage

Just the tip of the iceberg. I hope they all get caught.
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How much it would take to cause death, would depend on how much is being given and the persons condition.

Sue what you copied and pasted, warns against exceeding 90mg to 120mg DAILY.
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Prolife, here's what I think you should do. Instead of posting on these threads about folks who are already dead and sowing doubts about the hospice care they/we got for our parents, why aren't you posting on threads of folks who have parents who are actively dying, in pain and agitation, the way my mom was back in August.

You should be using your talents to tell folks who are watching their loved ones die that they should prolong the suffering, don't you think? Really, you might extend a few days of agony for everyone, which I think is what you want.

Let the doctors try that experimental treatment that might give mom another week. Force them to do another round of chemo, another round of injections, another lung tap.

That's the natural way to die, right?
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Prolife,
Here it is again;
"""Other experts recommend consulting a pain management specialist ""BEFORE"" exceeding a dosage of 80–120 mg daily."""""

This means you CAN exceed this doseage but should be done under a pain specialist's (MD) watchful eye.

I can only speak for the hospice I work for. We do NOT give huge doses to our patients with severe pain. The dose is "titrated" to keep the patient comfortable-not comatose!
If it takes giving them meds every hour, then that's what we do. But not in ridiculous doses.

I had a patient who was 55 years old, (younger than me 😢) dying from cancer. Her partner had witnessed her parents die in pain and told me to keep her out of pain. When I had given her everything I could and she was STILL writhing, I called the doctor. I got new orders for medications. The Sig Other wanted me to keep giving her more but I explained medication takes a few minutes to be absorbed. If after 15 minutes, she's still restless, I'd give her more.
OUR GOAL IS TO RELIEVE PAIN AND ANXIETY.
She calmed down and was able to rest with slow, easy breathing. Her SIg. Other sat with her for a couple of hours and was relieved that she was finally comfortable. The patient died many hours later that day. The spouse was immensely grateful that she didn't thrash around suffering in her last hours.

I did not kill her-cancer killed her. I made her as comfortable as I could with the little time she had left.

I'm not saying every hospice is perfect-far from. But to clump ALL hospices in the "killer" catagory is wrong. We provide a needed service to the dying and their families.
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The hospice we have here sedates them into a coma with it.
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What is wrong with sedating a dying patient into a coma? A coma is not death. Doctors induce comas all the time to aid healing.

I did not want my mother, who was in terrible pain, and agitated, to die in that state. I wanted her to die peacefully. Because she WAS dying. She had dementia, chronic heart failure, had fallen, broken her wrist, smashed up her face and developed pneumonia, which was treated with antibiotics. She wouldn't get out of bed and lay there with her face screwed up in pain and horror. Doubling her regular pain meds did not help. Morphine eased her breathing and restored her calm.

If she was meant to heal and live, taking away her pain would have helped. She died, but not because of morphine.
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"Nurses gave high doses of drugs such as morphine, regardless of whether patients needed it, to justify the higher payments, prosecutors said. In some instances, these excessive dosages resulted in serious bodily injury or death."

This is the indictment; what he was charged with. It does not prove him guilty. This is not the verdict. Your arguments would carry more weight if they were based in fact.
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"Nurses gave high doses of drugs such as morphine, regardless of whether patients needed it, to justify the higher payments, prosecutors said. In some instances, these excessive dosages resulted in serious bodily injury or death."

Let's tear this apart.
"Nurses gave high doses of drugs such as Morphine".,.. Yes, hospice nurses (and hospital nurses) give high doses (10-15-20 mg.) to relieve pain. If you or I took that amount, we'd sleep for hours. That's a GOOD thing when you have intractable pain when dying, right?

...."regardless of whether patients needed it or not"...Now WHO assessed whether they needed it? Nurses with a state license? Or the Prosecutors? Were they medically trained to spot signs of pain? Do they make up the rules as they go along? "Oh, this one is screaming, so give her some Morphine but this one is only moaning and frowning, so he doesn't get any Morphine."
This is ludicrous.

....."To justify the higher payments, prosecutors said"......
Prosecutors obviously don't understand that Medicare is billed for each day hospice has a patient on service and pays a set rate. It is NOT billed by how much medicine the nurse gives.
As with the rest, this sentence doesn't make sense.

Any registered pharmacy (NOT HOSPICE) dispenses a standard amount of Morphine for the patient. The hospice doesn't get a kick back or get paid for the medications.

..."In some instances, these excessive doseage a have resulted in 'serious bodily injury' or 'death'."
These are people dying in pain or anxiety. What 'serious bodily injury' will present itself by getting a large dose of Morphine? It's not rat poison. It doesn't make your skin fall off. Death is to be expected if a person is on hospice. A doctor had to recommend them and state that they believe they have less than 6 months to live.

If hospice is trying to get rich, wouldn't you think they'd be trying everything they could to keep their patients ALIVE?
You can't bill Medicare for a dead patient.

Where does this cr*p come from?
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Prolife, it would be better if you contact your State Senators/Congresspersons and your U.S. Senators/Congresspersons and let them know how you feel regarding Hospice.

And also contact the National Institute of Health and let them know that their information is incorrect according to your findings.

Otherwise, nothing is going to be solved by posting your material on the forums.
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Sue is giving information--not advice. She is not accessing a patient. She is not talking about a particular patient.
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Prolife is a troll who has infested many threads on this forum in order to manipulate people's emotions for the purpose of (in his/her mind) furthering his/her personal political agenda.

If Prolife were truly interested in doing something about this issue, he/she would be busy lobbying legislators and other decision-makers, and wouldn't have the time to post repetitively in a single forum. Prolife is clearly only interested in provoking reactions and disrupting conversations, and is probably enjoying him/herself very much.

In my real life, I've known a couple of "pro-life" (in this case, anti-abortion) people who've gotten kicked out of their local activist group for being problematic and disruptive, so they've taken their energy online to troll people where there are fewer consequences for their actions.

As discussed in another hospice thread.....I'm sorry some of the threads are making people's hearts heavy, but it's quite clear things were going fine until Prolife came along to disrupt supportive conversations and drag all of these hospice threads under. If the moderators would ban Prolife's IP address (this site IS supposed to be non-political), these threads would probably return to some kind of normalcy.

Personally, I'm not one bit sorry for mocking Prolife, because he/she is a big faker who goes around making up new accounts (sockpuppets) on AgingCare.com just to troll us all with more obviously fake "testimonies."

Emotional manipulators are among the worst kind of people, and he/she ought to know some of us see right through him/her.
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Sue,

As a nurse, you are not licensed to give medical advice.

Only a doctor is licensed to give medical advice.

Diagnosing, prescribing treatments and giving recommendations for specific conditions all constitutes giving medical advice.
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Describing situations one has encountered and protocols which have had to be followed in one's many years' professional experience, however, is absolutely fine. Carry on, Sue, please.
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She has stated over and over what dosages of morphine are appropriate and the limit she claims will not cause harm.

Now, what if someone follows that advice, and harm is caused? She is liable for that harm. That is why there are laws against it.

A nurse can not prescribe medication or the medication dosages.

I have seen her and others make many other statements that would fall under making a diagnosis, prescribing treatment, as well as making "professional" recommendations, for specific conditions, based on the fact that they are a nurse.
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And Sue, you are being a bit deceptive here...

Say you are giving your patient 100 mg of morphine... you mentioned you can give every hour if needed..

If the medication lasts say 4 hours and you are giving 100mg per hour... that's 400mg in the patient's body at one time!!
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********************

Prolife is a TROLL who has infested many threads on this forum in order to manipulate people's emotions for the purpose of (in his/her mind) furthering his/her personal political agenda.

If Prolife were truly interested in doing something about this issue, he/she would be busy lobbying legislators and other decision-makers, and wouldn't have the time to post repetitively in a single forum.

Prolife is a big faker who goes around making up new accounts (sockpuppets) on AgingCare.com just to troll us all with more obviously fake "testimonies."

Prolife is clearly only interested in provoking reactions and disrupting conversations, and is probably enjoying him/herself very much.

Prolife is obviously a very sad and lonely person with nothing better to do than troll caregivers online. 

I urge everyone to remember this when you decide whether or not to engage.

********************

Please feel free to copy and paste this message wherever/whenever you see Prolife posting, so as to warn others who may get sucked in by his/her trolling.
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Prolife,
You are obviously confused.
I have never diagnosed anyone. That's a doctor's job. As others have done, I have speculated on physical problems but I have never given a diagnosis.

I have never prescribed medication for anyone. Again, that takes a doctor order to do that. Along with others, I have given an opinion on certain medications and how they have worked for me, my mother or my patients. That is NOT prescribing, nor is it giving advise. It is my opinion only. I do not charge for any opinion, therefore I am not practicing medicine without a license.

I HAVE medically treated hundreds of patients over 39 years, WITH a doctor's order. By law, I am allowed to do that. That's why we have licenses, so we can implement the doctor's orders.

IF you had bothered to read my posts, I have described my experiences and actions.
No one IN THEIR RIGHT MIND would suggest that I did otherwise.

I'm actually sorry for you. You are not happy unless you're stirring up p**p.

Make all the accusations you want. Your credibility is non-existent.
Go troll someplace else. I'm tired of your ridiculous rants here.
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You don't think medical malpractice attorneys look at site like these? I can tell you they are.
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Sue,

You didn't respond to my other comment.

Please, tell me how long it takes morphine to metabolize in the body?
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I'm going to try and keep my story short.... My mother, Diva, has had Alzheimer's for close to 10 years now. She is in the last stages and has "beat the odds" more than once. She has been with hospice for over a year and can no longer speak, walk, use the bathroom on her own, she is so stiff she can not put her legs down, and her arms hurt as well as her neck will hyper-extend for hours at a time. She will speak to the spirit world (those from her family that have passed already). She has to be bathed, fed, given her drinks, turned, changed, pretty much everything but assist in her breathing. Here's my issue.. Hospice has started her on 0.25 morphine, every three hours or as needed. When she receives the morphine, she is more relaxed, but OH MY GOODNESS, she looks like she is truly dying. Now, 0.25 is not very much! I feel like I am hurting her... I don't know what to do. She also has Haldol, and Ativan ordered. The hospice nurse has told me to give them to her together, but I have not as of yet. This is the hardest thing I have ever had to do. I thought caring for my dad and watching him die was hard, not as hard as this. Yes, she lives with my husband and I.
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