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Weitzel case raises a host of medical, ethical questions

Experts hope verdict doesn’t put damper on end-of-life care

SHARE Weitzel case raises a host of medical, ethical questions

With psychiatrist Robert Allen Weitzel behind bars, health-care providers in Utah are wondering:

Could treatments they give their patients also land them in hot water?

Will one doctor's conviction lead others to withhold needed medication for terminally ill patients?

Or could this case open a Pandora's box of investigations and litigation?

A jury last week found Weitzel guilty of two counts of second-degree felony manslaughter and three counts of class A misdemeanor negligent homicide in connection with the deaths of five patients under his care in December 1995 and January 1996. In rendering their verdict, jurors agreed that Weitzel recklessly or negligently caused the patients' deaths because he was inattentive in his care while ordering excessive doses of medication.

In the days afterward, the medical community and state medical licensing officials responded, saying they hope the Weitzel case doesn't have a chilling effect on physicians and their patients.

At a meeting called by the Partnership to Improve End of Life Care in Utah, Utah Physicians Licensing Board chairman Mark Foote said the public should rest assured that the "vast, vast majority" of physicians provide quality end-of-life care.

"If anything, there's probably too little comfort care provided," Foote said.

Indeed, experts recognize the importance of medications — often the same medications jurors decided caused the five patients' deaths — in providing comfort care.

"Studies throughout the country have shown that pain medications tend to be underutilized for people at the end of life," partnership spokeswoman Maureen Henry said. "Our concern is to prevent people from fearing they will be killed by a doctor who uses pain (medications) and to educate them that there is a role for pain medication at the end of life that will not necessarily cause death."

Weitzel's case was "a tragedy, not representative of good palliative care," said Arthur Lipman, an expert in such care who is also a professor at the University of Utah College of Pharmacy.

"I am a strong advocate for the appropriate use of opioids (such as morphine) in palliative care," Lipman said. "Good symptom control is a core value of good end-of-life care."

Helping, not killing

Kit Jackson, founder of Hospice for Utah, said she had mixed feelings about the Weitzel case. She said in her years as a hospice provider, she has seen patients exhibit the kinds of health crises and plateaus about which Weitzel testified.

But, she said, "it is not the hospice philosophy to snow people with morphine, render them unconscious and kill them. The hospice philosophy is not to help people die. It's to help people live until they die."

Former Hospice for Utah client Marshall Isaacson agreed. During his five months of hospice care in his Ogden home, the 74-year-old Isaacson said pain medication played a minor role in his treatment.

"Pain medication was the very least of the things I got from hospice," he said in a telephone interview. "If that's all people perceive hospice as being, it's a totally erroneous picture. What I got out of it was the total support of the medical staff and the chaplain. They were so encouraging, not only to me, but to my wife. They made every effort to communicate with me, to find out what I was thinking and what I was feeling.

"From what I've heard, it sounds to me like Dr. Weitzel had not even the faintest understanding what hospice is."

Isaacson, who in February had been diagnosed with terminal pancreatic cancer, unexpectedly went into full remission. A committed Christian, he said his recovery was a miracle and views every day as a gift from God.

More inquiries?

It is likely the Weitzel case will prompt more complaints and more inquiries into physicians' conduct, Utah Division of Occupational and Professional Licensing director Gary Bowen conceded. But, Bowen stressed, only the most egregious cases will be formally investigated.

DOPL spokesman Kim Morris said doctors who provide quality care have nothing to fear.

"There is no witch hunt. Good medical care is good medical care," Morris said. "What we contended here (in Weitzel's case) was that his care was outside the bounds of standard medical practice."

DOPL last August suspended Weitzel's psychiatrist's license after he ignored an order from the Physicians Licensing Board to register for an evaluation at a clinic in Kansas that specializes in helping physicians with their personal problems.

Bowen also said the Weitzel case should not prompt the public to demand more restrictive laws that will hamper a physician's ability to appropriately care for patients. He advocated keeping investigations as "low key" as possible unless the alleged infractions amount to a gross deviation from the recognized standard of care.

Following the announcement of the verdict, several family members of Weitzel's victims proclaimed the need for better monitoring of physicians, clarification of what constitutes "appropriate" patient care and more awareness on the part of patients and their loved ones — all to prevent what happened to them from happening to others.

Though Weitzel's conviction may be disconcerting to physicians providing legitimate end-of-life care, Utah Medical Association spokesman Mark Fotheringham said in an interview the worst thing they could do is withhold appropriate treatment from their patients because they fear a possible investigation.

"I guess there is a danger that physicians who are prescribing appropriately might think twice about their dosages and that kind of thing," Fotheringham said. "But the last thing we want to have happen is that people who are suffering the end stages of terminal cancer or others with terminal illnesses will not receive appropriate care. We want to make sure that those who need these medications to improve their quality of life at the end of their lives get the appropriate medications.

"This was a pretty isolated case. Dr. (Jack) Kevorkian is the one setting all the precedents," he said, referring to the physician who has led the national argument for euthanasia and has been convicted of murder for assisting terminally ill patients to end their lives — earning himself the soubriquet "Dr. Death."

"I don't think we've covered any new ground," Fotheringham said.

E-mail: jnii@desnews.com